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

Abstract

Background: Globally China has the largest urban-rural disparity in socioeconomic development, and the urban-rural difference in upper gastrointestinal cancer (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 Helicobacter pylori 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 gallbladder cancers and leukemia in both sexes and breast, ovary, thyroid, and kidney cancer 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: 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.

Keywords: Helicobacter pylori infection; disadvantaged population; social determinants of health; socioeconomic development; urban-rural disparity in cancer; urbanization.

Figure 1

Comparison of age-standardized incidence rates of major cancer types between rural Shexian County and urban Shijiazhuang city in 2012. (Presented at the top of the bars is the statistical significance level calculated by the approximate method described in the International Agency for Research on Cancer Scientific Publication 128.¹²)

Figure 2

Cancers with significantly (P ≤ .05) or marginally significant (P < .10) increasing and decreasing trends in biennial age-standardized incidence rates in rural Shexian County between 2000-2015 by Join Point Analysis 4.2.0.2. ASR, age-standardized rate.

Figure 2

Cancers with significantly (P ≤ .05) or marginally significant (P < .10) increasing and decreasing trends in biennial age-standardized incidence rates in rural Shexian County between 2000-2015 by Join Point Analysis 4.2.0.2. ASR, age-standardized rate.

Figure 2

Cancers with significantly (P ≤ .05) or marginally significant (P < .10) increasing and decreasing trends in biennial age-standardized incidence rates in rural Shexian County between 2000-2015 by Join Point Analysis 4.2.0.2. ASR, age-standardized rate.

Figure 2

Cancers with significantly (P ≤ .05) or marginally significant (P < .10) increasing and decreasing trends in biennial age-standardized incidence rates in rural Shexian County between 2000-2015 by Join Point Analysis 4.2.0.2. ASR, age-standardized rate.

Figure 2

Cancers with significantly (P ≤ .05) or marginally significant (P < .10) increasing and decreasing trends in biennial age-standardized incidence rates in rural Shexian County between 2000-2015 by Join Point Analysis 4.2.0.2. ASR, age-standardized rate.

Figure 2

Cancers with significantly (P ≤ .05) or marginally significant (P < .10) increasing and decreasing trends in biennial age-standardized incidence rates in rural Shexian County between 2000-2015 by Join Point Analysis 4.2.0.2. ASR, age-standardized rate.

Figure 3

Comprehensive decrease in biennial age-specific incidence rates of esophageal and stomach cancer in Shexian from 2000-2015 in parallel with socioeconomic development and urbanization.

Figure 4

Comparison of age-standardized incidence rates of major cancer types between agricultural and nonagricultural populations within Shexian County between 2008-2012. (Presented at the top of the bars is the statistical significance level calculated by the approximate method described in the International Agency for Research on Cancer Scientific Publication 128.¹²)