Effects of screening and universal healthcare on long-term colorectal cancer mortality

Yi-Chia Lee; Chen-Yang Hsu; Sam Li-Sheng Chen; Amy Ming-Fang Yen; Sherry Yueh-Hsia Chiu; Jean Ching-Yuan Fann; Shu-Lin Chuang; Wen-Feng Hsu; Tsung-Hsien Chiang; Han-Mo Chiu; Ming-Shiang Wu; Hsiu-Hsi Chen

doi:10.1093/ije/dyy182

Effects of screening and universal healthcare on long-term colorectal cancer mortality

Int J Epidemiol. 2019 Apr 1;48(2):538-548. doi: 10.1093/ije/dyy182.

Authors

Yi-Chia Lee^{1

2

3}, Chen-Yang Hsu², Sam Li-Sheng Chen⁴, Amy Ming-Fang Yen⁴, Sherry Yueh-Hsia Chiu^{5

6}, Jean Ching-Yuan Fann⁷, Shu-Lin Chuang², Wen-Feng Hsu^{1

2}, Tsung-Hsien Chiang^{1

8

9}, Han-Mo Chiu^{1

2}, Ming-Shiang Wu¹, Hsiu-Hsi Chen^{2

3}

Affiliations

¹ Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
³ Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁴ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
⁶ Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁷ Department of Health Industry Management, Kainan University, Tao-Yuan, Taiwan.
⁸ Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
⁹ Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.

Abstract

Background: To evaluate the time trends of colorectal cancer (CRC) affected by a Nationwide Colorectal Cancer Screening (NCCS) programme with biennial faecal immunochemical testing (FIT) and Nationwide Healthcare Insurance (NHI).

Methods: Data from the national registries on cancer and death in Taiwan were separated into years 1984-1993, 1994-2003 and 2004-2013 based on the implementations of NHI (starting 1995) and NCCS (starting 2004). The adult population was divided into three age groups (young, 30-49; middle-aged, 50-69; and old, 70-84 years); only the middle-aged were eligible for NCCS. Crude and adjusted effects of NCCS and NHI were quantified by percentage change and 95% confidence interval (CI) with respect to CRC mortality, according to the attributions from incidence and survival.

Results: Within 335 million person-years of follow-up, 204 362 incident CRCs and 80 771 CRC-related deaths were identified. Increasing mortality trends were noted for 1994-2003 (post-NHI) vs 1984-1993 due to remarkable increasing incidence trends that could not be offset by improved survival as a result of NHI. During 2004-13 (post-NCCS), mortality continued to increase by 15% (95% CI: 10-21%) in young adults (30-49 years) and 8% (95% CI: 6-11%) in older adults (70-84 years), whereas middle-aged adults (50-69 years) had a reduction of 7% (95% CI: 5-9%) due to a remarkable stage shift and subsequent improvement in survival. In the middle-aged adults, increased incidence was less but survival improvement was more compared with other age groups.

Conclusions: Whereas universal healthcare insurance led to improvement in CRC survival, FIT-based screening has made an even greater contribution to reducing CRC mortality.

Keywords: cancer prevention; colonoscopy; colorectal cancer; screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Distribution
Aged
Aged, 80 and over
Colonoscopy
Colorectal Neoplasms / diagnosis*
Colorectal Neoplasms / mortality*
Early Detection of Cancer / methods*
Female
Forecasting
Humans
Incidence
Male
Mass Screening / methods*
Middle Aged
Multivariate Analysis
Occult Blood
Registries
Regression Analysis
Sex Distribution
Taiwan / epidemiology
Universal Health Care*