Inter-prefectural and urban-rural regional disparities in lung cancer surgery: a Japanese nationwide population-based cohort study from 2017 to 2019

Masamitsu Kido; Satoru Okada; Naoyuki Takashima; Luying Yan; Atsuki Uchibori; Koji Sensaki; Tetsuo Kido; Masayoshi Inoue

doi:10.1007/s00595-024-02864-4

Inter-prefectural and urban-rural regional disparities in lung cancer surgery: a Japanese nationwide population-based cohort study from 2017 to 2019

Surg Today. 2024 May 13. doi: 10.1007/s00595-024-02864-4. Online ahead of print.

Authors

Masamitsu Kido^#¹, Satoru Okada^#², Naoyuki Takashima³, Luying Yan⁴, Atsuki Uchibori⁵, Koji Sensaki⁶, Tetsuo Kido⁷, Masayoshi Inoue⁵

Affiliations

¹ Department of Orthopedic Surgery, Inage Hospital, 6-21-3 Konakadai, Inage-Ku, Chiba, 2630043, Japan.
² Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 6028566, Japan. s-okada@koto.kpu-m.ac.jp.
³ Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 6028566, Japan.
⁴ Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
⁵ Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 6028566, Japan.
⁶ Division of Thoracic Surgery, Japan Self-Defense Forces Central Hospital, Tokyo, 1548532, Japan.
⁷ Department of Thoracic Surgery, TOHO Yao Hospital, Osaka, 5810802, Japan.

^# Contributed equally.

PMID: 38739174
DOI: 10.1007/s00595-024-02864-4

Abstract

Purpose: To investigate regional disparities in lung cancer surgery in Japan.

Methods: The annual incidence of lung cancer, lung cancer surgery, and the number of board-certified thoracic surgeons in Japan during 2014-2019 were investigated using a national open database. Lung cancer surgeries were categorized by procedure (wedge resection, segmentectomy, lobectomy, pneumonectomy) and approach (open, thoracoscopic). Disparities in 47 prefectures and urban-rural disparities during 2017-2019 were evaluated using the Gini coefficient and an unpaired t-test. Correlation was assessed using Pearson's correlation method.

Results: The national annual average incidences of lung cancer and lung cancer surgery were 121,106 and 50,959, respectively, in 2014-2019. The use of the thoracoscopic approach increased over time in all procedures, except pneumonectomies. The Gini coefficients of lung cancer, thoracoscopic surgery, and board-certified thoracic surgeons indicated low inequality across prefectures; however, those of open surgery indicated high inequality. Open surgery was more common in urban areas than in rural areas. The number of thoracoscopic surgeries and board-certified thoracic surgeons by prefecture were moderately correlated.

Conclusion: The thoracoscopic approach is becoming more common in lung cancer surgery, with little inter-prefectural regional disparity in the incidence of lung cancer, thoracoscopic surgeries, or the number of board-certified thoracic surgeons.

Keywords: Board-certified thoracic surgeon; Epidemiology; National database; Regional disparity; Thoracoscopic lung cancer surgery.