摘要:
We read with interest Xin Ni and colleagues'1 study on cancer incidence, and the association between incidence and inaccessibility of health services among children and adolescents in China. The authors found that an estimated 121 145 cancer cases were diagnosed among children and adolescents in China between 2018 and 2020, and found a positive association between cancer incidence and regional socioeconomic status (p<0·0001).
We would appreciate more information from Ni and colleagues1 about the time interval selected for estimating incidence of cancer among children and adolescents. First, we believe, with the influence of the COVID-19 pandemic, the cancer incidence in 2020 might be underestimated.2 Therefore, it is rational to estimate the cancer incidence stratified by year. Second, Ni and colleagues1 concluded that cancer incidence in children and adolescents in China was much higher in 2018–20 than 2000–15—a conclusion we believe to have weak supporting evidence. The Healthy China 2030 Initiative and the Healthy Children Action Plan were implemented in China in 2016 and 2018, respectively, and great progress has been made in the improvement of health services and health promotion among children and adolescents since their implementation. Hence, we believe that comparing cancer incidence from 2016 to 2020 with that from 2000 to 2015 would be more accurate. Moreover, we believe the seemingly higher cancer incidence can be partly explained by advanced medical technology, which was not discussed by Ni and colleagues.1
Another important factor is the assessment of socioeconomic inequalities, which we believe to be incomplete. Although Ni and colleagues' study is highly valuable because it provides quantifiable evidence of inequality in access to health services among children and adolescents, health economics should be considered if we are to achieve the 2030 Sustainable Development Goals.3 Current national evidence about the financial burden, especially catastrophic health expenditure, of childhood and adolescent cancer is insufficient. Analysis of hospitalisation expenses, using data from National Center for Pediatric Cancer Surveillance and the nationwide Hospital Quality Monitoring System, can provide more evidence about the socioeconomic inequalities, and can also summarise effective advice to inform policies about social service protection and medical insurance for this population.
Our final concern relates to the limitations of using Gini coefficients to measure inequality of health services. Gini coefficients can only capture the overall concentration of inequality, which might miss crucial information contained in income distribution among different groups.4 In view of the large income differences in China, we suggest the authors use the Lorentz curve of a multiparameter model (such as the two-parameter Ortega model) to better analyse the socioeconomic inequalities of health services...
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