Estimating cancer incidence based on claims data from medical insurance systems in two areas lacking cancer registries in China

Abstract

Background: We aimed to establish a Medical-Insurance-System-based Cancer Surveillance System (MIS-CASS) in China and evaluate the completeness and timeliness of this system through reporting cancer incidence rates using claims data in two regions in northern and southern China.

Methods: We extracted claims data from medical insurance systems in Hua County of Henan Province, and Shantou City in Guangdong Province in China from Jan 1, 2012 to Jun 30, 2019. These two regions have been considered to be high risk regions for oesophageal cancer. We developed a rigorous procedure to establish the MIS-CASS, which includes data extraction, cleaning, processing, case ascertainment, privacy protection, etc. Text-based diagnosis in conjunction with ICD-10 codes were used to determine cancer diagnosis.

Findings: In 2018, the overall age-standardised (Segi population) incidence rates (ASR World) of cancer in Hua County and Shantou City were 167·39/100,000 and 159·78/100,000 respectively. In both of these areas, lung cancer and breast cancer were the most common cancers in males and females respectively. Hua County is a high-risk region for oesophageal cancer (ASR World: 25·95/100,000), whereas Shantou City is not a high-risk region for oesophageal cancer (ASR World: 11·43/100,000). However, Nanao island had the highest incidence of oesophageal cancer among all districts and counties in Shantou (ASR World: 36·39/100,000). The age-standardised male-to-female ratio for oesophageal cancer was lower in Hua County than in Shantou (1·69 vs. 4·02). A six-month lag time was needed to report these cancer incidences for the MIS-CASS.

Interpretation: MIS-CASS efficiently reflects cancer burden in real-time, and has the potential to provide insight for improvement of cancer surveillance in China.

Funding: The National Key R&D Program of China (2016YFC0901404), the Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (XXZ0204), the Sanming Project of Shenzhen (SZSM201612061), and the Shantou Science and Technology Bureau (190829105556145, 180918114960704).

Keywords: Cancer incidence; Cancer surveillance; China; Claims data; Medical insurance system.

Fig. 1

The procedure for capturing new cancer cases from medical insurance systems in Hua County, Henan Province and Shantou City, Guangdong Province. ^aRecords were identified as cancer-related and exported if they met any of the following criteria: a. ICD-10 codes ranged from C00 to C97; b. text-based diagnoses contained cancer-related key words such as “cancer”, “carcinoma”, “sarcoma”, “malignant tumour”, “leukaemia”, “lymphoma”, “Franklin disease”, “Alpha heavy chain disease”, etc.

Fig. 2

Population pyramid of the insured population in Hua County, Henan Province and Shantou City, Guangdong Province, China, 2014 and 2018.

Fig. 3

Geographical pattern of oesophageal cancer age-standardised incidence rates (World standard, per 100,000) in Shantou City, Guangdong Province, China, 2018. ASR=age-standardised incidence rate.

Fig. 4

Age-specific incidence rates of oesophageal cancer by gender in Hua County, Henan Province and Shantou City, Guangdong Province, China, 2014–2018. ASR=age-standardised incidence rate.