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. 2024 Jun 3:30:1611754.
doi: 10.3389/pore.2024.1611754. eCollection 2024.

Decreasing incidence and mortality of lung cancer in Hungary between 2011 and 2021 revealed by robust estimates reconciling multiple data sources

Gabriella Gálffy #  1 , Géza Tamás Szabó #  2 , Lilla Tamási  3 , Veronika Müller  3 , Judit Moldvay  4   5 , Veronika Sárosi  6 , Anna Kerpel-Fronius  7 , Tamás Kardos  8 , Edit Csada  5 , Zsolt Pápai-Székely  9 , Zoltán Szász  10 , Zsolt Király  11 , Gábor Hódi  2 , Zsuzsanna Kovács  2 , Éva Balogh  2 , Krisztina Andrea Kovács  2 , Miklós Darida  2 , Viktória Buga  2 , György Rokszin  12 , Zsolt Abonyi-Tóth  12   13 , Zoltán Kiss #  2   14 , Zoltán Vokó #  15   16 , Krisztina Bogos #  17
Affiliations

Decreasing incidence and mortality of lung cancer in Hungary between 2011 and 2021 revealed by robust estimates reconciling multiple data sources

Gabriella Gálffy et al. Pathol Oncol Res. .

Abstract

Objective: Hungary has repeatedly been shown to have the highest cancer-related mortality and incidence in Europe. Despite lung cancer being the most abundant malignant diagnosis in Hungary, numerous concerns have been raised recently regarding the bias inherent to reported incidence estimates. Re-analysis of reimbursement claims has been suggested previously by our group as an alternative approach, offering revised figures of lung cancer incidence between 2011 and 2016. Leveraging on this methodology, we aimed at updating Hungarian lung cancer incidence estimates with an additional 5 years (2017-2021), including years affected by the COVID-19 pandemic. Additionally, we also attempted to improve the robustness of estimates by taking additional characteristics of the patient pathway into account.

Methods: Lung cancer patients between 2011 and 2021 were identified based on reimbursement-associated ICD-10 codes, histology codes and time patterns. Multiple query architectures were tested for sensitivity and compared to official estimates of the Hungarian National Cancer Registry (HNCR). Epidemiological trends were estimated by Poisson-regression, corrected for age and sex.

Results: A total of 89,948 lung cancer patients diagnosed in Hungary between 2011 and 2021 have been identified by our study. In 2019 alone, 7,887 patients were diagnosed according to our optimized query. ESP2013 standardized rate was estimated between 92.5/100,000 (2011) and 78.4/100,000 (2019). In 2019, standardized incidence was 106.8/100,000 for men and 59.7/100,000 for women. Up until the COVID-19 pandemic, lung cancer incidence was decreasing by 3.18% (2.1%-4.3%) yearly in men, while there was no significant decrease in women. Young age groups (40-49 and 50-59) featured the largest improvement, but women aged 60-79 are at an increasing risk for developing lung cancer. The COVID-19 pandemic resulted in a statistically significant decrease in lung cancer incidence, especially in the 50-59 age group (both sexes).

Conclusion: Our results show that using an optimized approach, re-analysis of reimbursement claims yields robust estimates of lung cancer incidence. According to this approach, the incidence rate of male lung cancer is declining in Hungary, in concordance with the trend observed for lung cancer mortality. Among women aged 60-79, the incidence of lung cancer has risen, requiring more attention in the near future.

Keywords: COVID-19; Hungary; incidence; lung cancer; mortality.

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Conflict of interest statement

GS, GH, ÉB, and KK are employees of MSD Pharma Hungary Ltd. ZV is an employee of Semmelweis University where his contribution to this project was financially compensated. ZKis is also an employee of MSD Pharma Hungary Ltd. and has an affiliation at the Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary. GR and ZA-T are employees of RxTarget Ltd. where their contribution to this project was financially compensated. The project was financed by MSD Pharma Hungary Ltd. VM has received consultation fees from AstraZeneca, Boehringer Ingelheim, Roche, Berlin-Chemie, Chiesi, BMS, Novartis, Actelion, Gilead, Pfizer, Richter, Lilly, Orion Pharma and Ipsen and served as PI for over 10 LC studies. LT is an employee of Semmelweis University. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) Standardized incidence rates of lung cancer in Hungary between 2011 and 2021. Direct standardized rates using the ESP2013 population weights. Grey ribbon around the lines represents the 95% confidence interval. (B) Standardized mortality rates of lung cancer in Hungary between 2011 and 2021 (ESP2013 standardized rates). Direct standardized rates using the ESP2013 population weights. Grey ribbon around the lines represents the 95% confidence interval.
FIGURE 2
FIGURE 2
(A) Age-specific incidence of lung cancer in Hungary in the studied age groups. Values indicate the number of patients diagnosed in a given year out of 100,000 individuals of the age group. (B) Age-specific mortality of lung cancer in Hungary in the studied age groups. Values indicate the number of patients deceased in a given year out of 100,000 individuals of the age group.
FIGURE 3
FIGURE 3
The average annual change in lung cancer incidence and mortality in Hungary between 2011 and 2019 for the total population, as well as by age groups. Estimated using Poisson regression and robust confidence intervals (95% CI) with the sandwich method.
FIGURE 4
FIGURE 4
Change in lung cancer incidence and mortality in Hungary during the COVID year 2020 expressed as the risk ratio (RR) of 2020 vs. 2019. Confidence intervals (95% CI) of RR are given in brackets.
See this image and copyright information in PMC

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