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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Colorectal Neoplasms
Delivery of Health Care
Insurance
Mortality
Early Detection of Cancer
Survival
Confidence Intervals
Incidence
Age Groups
Taiwan
Registries
Young Adult
Population

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Effects of screening and universal healthcare on long-term colorectal cancer mortality. / Lee, Yi-Chia; Hsu, Chen-Yang; Chen, Sam Li-Sheng; Yen, Amy Ming-Fang; Chiu, Sherry Yueh-Hsia; Fann, Jean Ching-Yuan; Chuang, Shu-Lin; Hsu, Wen-Feng; Chiang, Tsung-Hsien; Chiu, Han-Mo; Wu, Ming-Shiang; Chen, Hsiu-Hsi.

In: International Journal of Epidemiology, 03.09.2018.

Research output: Contribution to journalArticle

Lee, Y-C, Hsu, C-Y, Chen, SL-S, Yen, AM-F, Chiu, SY-H, Fann, JC-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
Lee, Yi-Chia ; Hsu, Chen-Yang ; Chen, Sam Li-Sheng ; Yen, Amy Ming-Fang ; Chiu, Sherry Yueh-Hsia ; Fann, Jean Ching-Yuan ; Chuang, Shu-Lin ; Hsu, Wen-Feng ; Chiang, Tsung-Hsien ; Chiu, Han-Mo ; Wu, Ming-Shiang ; Chen, Hsiu-Hsi. / Effects of screening and universal healthcare on long-term colorectal cancer mortality. In: International Journal of Epidemiology. 2018.
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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.",
author = "Yi-Chia Lee and Chen-Yang Hsu and Chen, {Sam Li-Sheng} and Yen, {Amy Ming-Fang} and Chiu, {Sherry Yueh-Hsia} and Fann, {Jean Ching-Yuan} and Shu-Lin Chuang and Wen-Feng Hsu and Tsung-Hsien Chiang and Han-Mo Chiu and Ming-Shiang Wu and Hsiu-Hsi Chen",
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TY - JOUR

T1 - Effects of screening and universal healthcare on long-term colorectal cancer mortality

AU - Lee, Yi-Chia

AU - Hsu, Chen-Yang

AU - Chen, Sam Li-Sheng

AU - Yen, Amy Ming-Fang

AU - Chiu, Sherry Yueh-Hsia

AU - Fann, Jean Ching-Yuan

AU - Chuang, Shu-Lin

AU - Hsu, Wen-Feng

AU - Chiang, Tsung-Hsien

AU - Chiu, Han-Mo

AU - Wu, Ming-Shiang

AU - Chen, Hsiu-Hsi

PY - 2018/9/3

Y1 - 2018/9/3

N2 - 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.

AB - 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.

U2 - 10.1093/ije/dyy182

DO - 10.1093/ije/dyy182

M3 - Article

C2 - 30184208

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

SN - 0300-5771

ER -