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

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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.

Original languageEnglish
JournalInternational Journal of Epidemiology
DOIs
Publication statusE-pub ahead of print - Sep 3 2018

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    Lee, Y-C., Hsu, C-Y., Chen, S. L-S., Yen, A. M-F., Chiu, S. Y-H., Fann, J. C-Y., Chuang, S-L., Hsu, W-F., Chiang, T-H., Chiu, H-M., Wu, M-S., & Chen, H-H. (2018). Effects of screening and universal healthcare on long-term colorectal cancer mortality. International Journal of Epidemiology. https://doi.org/10.1093/ije/dyy182