Development and status quo of digestive endoscopy in China: An analysis based on the national census in 2013 and 2020

Abstract

Background and objectives: Technique and practice of digestive endoscopy are undergoing speedy development all over the world. This study aimed to evaluate its status quo and development in China.

Methods: All hospitals performing digestive endoscopy in mainland China participated in the national census in 2013 and 2020. Retrospective data of hospitals, endoscopists, volumes, and qualities were collected via an online structured questionnaire, and its accuracy and rationality were verified by logical tests and manual reviews. Data from other countries were used to compare with that of China.

Results: From 2012 to 2019, the number of hospitals performing digestive endoscopy increased from 6,128 to 7,470 (1.22-fold), in which primary healthcare played a minor role. The median hospitals per 100,000 inhabitants per provincial region increased from 0.49 (IQR, 0.39-0.57) to 0.55 (IQR, 0.49-0.63). The endoscopists increased from 26,203 to 39,638 (1.51-fold), but their average workload even expanded. Overall volume increased from 28.8 million to 44.5 million (1.55-fold), and most types of endoscopic procedures recorded a high growth rate. Contrastingly, the specific utilization rates were low and paled in comparison with some developed countries. Nationwide, regional utilization rates showed a significant correlation with GDP per capita (P <0.001). Overall qualities of digestive endoscopy were excellent, but certain results of quality indicators posed a huge challenge, such as the detection rates of adenoma and early cancers.

Conclusions: Impressive progress has been made in digestive endoscopy with rapidly expanding economy in China. However, primary healthcare, utilization rates, and income-related inequality of regional services were needed to be improved to promote public health better.

Keywords: China; digestive endoscopy; national census; quality improvement.

Figure 1

Flow chart of organization of Chinese Digestive Endoscopy Census in 2013 and 2020. *CMDA, Chinese Medical Doctor Association. ^#The repetitions and the hospitals that had the ability to perform digestive endoscopy but without any volume in 2012 were excluded.

Figure 2

Formation of hospitals and volume for the period 2012 and 2019. (a), comparison of hospitals performing digestive endoscopy to all hospitals with different grades; (b), composition of hospitals performing digestive endoscopy with different grades; (c), composition of annual volume of hospitals with different grades.

Figure 3

Regional distribution of annual volume, utilization rate, and their correlations with GDP per capita in mainland China. (a), annual volumes of 31 provincial regions in 2019; (b), utilization rates of 31 provincial regions in 2019; (c), scatter plot diagram showing the correlation between volume and GDP per capita in 2012 and 2019; (d), scatter plot diagram showing the correlation between utilization rate and GDP per capita in 2012 and 2019.

Figure 4

Utilization rates of different types of procedures in mainland China and other developed countries. (USA, the United States of America; UK, the United Kingdom. Some of Japanese volumes were from NDB open data. The response rate of UK endoscopy census was 68.4%. The EUS rates of China and developed countries had been published previously.)

Figure 5

Distribution of ten results of quality indicators in 31 regions across mainland China in 2019.