Urban-Rural Disparity in Helicobacter Pylori Infection-Related Upper Gastrointestinal Cancer in China and the Decreasing Trend in Parallel with Socioeconomic Development and Urbanization in an Endemic Area

• Main Authors: Xiaoduo Wen (Author), Denggui Wen (Author), Yi Yang (Author), Yuetong Chen (Author), Guiying Wang (Author), Baoen Shan (Author)
• Format: Book
• Published: Ubiquity Press, 2017-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2214-9996; 10.1016/j.aogh.2017.09.004
• Keywords: socioeconomic development; urbanization; urban-rural disparity in cancer; social determinants of health; Helicobacter pylori infection; disadvantaged population; Infectious and parasitic diseases; RC109-216; Public aspects of medicine; RA1-1270
• Source: Annals of Global Health, Vol 83, Iss 3-4, Pp 444-462 (2017)

Background: Globally China has the largest urban-rural disparity in socioeconomic development, and the urban-rural difference in <a title="Learn more about Upper Gastrointestinal Cancer" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/upper-gastrointestinal-cancer">upper gastrointestinal cancer</a> (UGIC) is similar to the difference between developed and developing countries. Objectives: To describe urban-rural disparity in UGIC and to emphasize prevention by socioeconomic development and urbanization in China. Methods: Age-standardized incidence rates (ASRs) of cancers in 2012 were compared between urban Shijiazhuang city and rural Shexian County, and trends from 2000-2015 in Shexian County were analyzed. Findings: Compared with urban Shijiazhuang city, the ASR of gastroesophageal cancers in rural Shexian County was 5.3 times higher in men (234.1 vs 44.2/100,000, 'P' '<' '.'01) and 9.1 times higher in women (107.7 vs 11.8/100,000, 'P' '<' '.'01). This rural-urban disparity in UGIC is associated with differences in socioeconomic development in annual gross domestic product (GDP) per capita of US$2700 vs US$6965, in urbanization rate of 48% vs 100%, and in adult '<a title="Learn more about Helicobacter pylori" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/helicobacter-pylori">Helicobacter pylori</a>' infection prevalence of 75% vs 50%. From 2000-2015, the GDP per capita in Shexian County increased from US$860 to US$3000, urbanization rate increased from 22.4% to 54.8%, and prevalence of 'H pylori' infection among 3- to 10-year-old children decreased from 60% to 46.1% ('P' '<' '.'01). Meanwhile, the biennial ASR of esophagogastric cancer decreased 42% in men, from 313.5 to 182.1 per 100,000 ('P' '<' '.'01), and 57% in women, from 188.6 to 80.4 per 100,000 ('P' '=' '.'00). However, lung, colorectal, and <a title="Learn more about Gallbladder Cancer" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/gallbladder-cancer">gallbladder cancers</a> and <a title="Learn more about Leukemia" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/leukemia">leukemia</a> in both sexes and breast, ovary, <a title="Learn more about Thyroid Cancer" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/thyroid-cancer">thyroid, and kidney cancer</a> in women increased significantly. Despite this offset, ASR of all cancers combined decreased 25% in men (from 378.2 to 283.0/100,000, 'P' '=' '.'00) and 19% in women (from 238.5 to 193.6/100,000, 'P' '=' '.'00). Conclusions</h3>Urban-rural disparity in UGIC is related to inequity in socioeconomic development. Economic growth and urbanization is effective for prevention in endemic regions in China and should be a policy priority.