Improving childhood cancer care in China – Authors' reply

We thank Yaping Wang and Jue Liu for their Correspondence in response to our Article1Ni X Li Z Li X et al.Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study.Lancet. 2022; 400: 1020-1032Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar about socioeconomic inequalities in cancer incidence and access to health services faced by Chinese children and adolescents. Wang and Liu raise concerns about the time interval selected for estimating the incidence of cancer among children and adolescents. As stated in our Article,1Ni X Li Z Li X et al.Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study.Lancet. 2022; 400: 1020-1032Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar the National Center for Pediatric Cancer Surveillance (NCPCS) collected hospital admission records from Jan 1, 2017, and used a washout period of at least 12 months to identify new incidence cases.2Li Z Zheng R Xu X et al.Pediatric cancer surveillance in China: a hospital-based introduction.Pediatr Investig. 2021; 5: 81-85Crossref PubMed Scopus (6) Google Scholar To account for potential confounding factors, we estimated the number of new cases from five dimensions, including the hospital admission or diagnosis year, but reported a 3-year average incidence rate drawing on an international report,3Steliarova-Foucher E Colombet M Ries LAG et al.International incidence of childhood cancer, 2001–10: a population-based registry study.Lancet Oncol. 2017; 18: 719-731Summary Full Text Full Text PDF PubMed Scopus (821) Google Scholar in view of the fact that the calculated annual incidence was stable. Assessing the effects of policy implementation and showing the trends were not the aims of our study. Considering that the Chinese Government has been issuing a package of more targeted policies and programmes on childhood and adolescent cancer in recent years, we will evaluate the policy effectiveness in the future. In response to the comment that our Article1Ni X Li Z Li X et al.Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional study.Lancet. 2022; 400: 1020-1032Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar did not discuss the role of advanced medical technology in higher cancer incidence rates, in our Article we did state the positive effect of higher-quality health services (including medical technology surely) and other possible factors on cancer incidence rates among children and adolescents. We state that exploring each possible cause needs to be supported by evidence, which was not the aim of our study, but will be studied in the future. As a vulnerable population, children and adolescents with cancer might face multiple aspects of socioeconomic inequalities, which are difficult to comprehensively assess and discuss in a text limited by word count. In addition to cancer incidence, health services, and financial burden, socioeconomic inequalities faced by this population could also exist in areas such as education, infrastructure in transportation and communications, climate change, and nutritional status.4Qiao J Wang Y Li X et al.A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China.Lancet. 2021; 397: 2497-2536Summary Full Text Full Text PDF PubMed Scopus (128) Google Scholar Our study is just the beginning of an analysis using NCPCS data, and more comprehensive evidence will be available in the future to help this population. Wang and Liu's final criticism was the limitation of using Gini coefficient to measure inequalities in health services, but we respectfully disagree with this assessment. As the most popular measure of inequality across the social sciences, Gini coefficient has been widely used due to its ease of access and interpretation.5The World BankGini index.https://data.worldbank.org/indicator/SI.POV.GINIDate accessed: November 15, 2022Google Scholar In our study, the division of socioeconomic regions was based on the official provincial Human Development Index data, rather than income, and when discussing differences in access to health services across regions, the Gini coefficient could increase the comparability of our conclusions.6WHOMeasuring health workforce inequalities: methods and application to China and India.https://www.who.int/publications/i/item/9789241500227Date: 2010Date accessed: November 15, 2022Google Scholar The drawbacks of Gini coefficient, such as its inability to adequately distinguish distribution differences, would not affect the findings of this study because we did not involve comparisons of the regional health services distribution between different groups with the same Gini coefficient. We declare no competing interests. Socioeconomic inequalities in cancer incidence and access to health services among children and adolescents in China: a cross-sectional studyOur study showed that the burden of cancer in children and adolescents in China is much higher than previously nationally reported from 2000 to 2015. The distribution of the accessibility of health services, as a social determinant of health, might have a notable role in the socioeconomic inequalities in cancer incidence among Chinese children and adolescents. With regards to achieving the Sustainable Development Goals, policy approaches should prioritise increasing the accessibility of health services for early diagnosis to improve outcomes and subsequently reduce disease burdens, as well as narrowing the socioeconomic inequalities of childhood and adolescent cancer. Full-Text PDF Improving childhood cancer care in ChinaWe read with interest Xin Ni and colleagues'1 study on cancer incidence, and the association between incidence and inaccessibility of health services among children and adolescents in China. The authors found that an estimated 121 145 cancer cases were diagnosed among children and adolescents in China between 2018 and 2020, and found a positive association between cancer incidence and regional socioeconomic status (p<0·0001). Full-Text PDF