Comprehensive Measurement And Evaluation Of The Burden Of Lung Cancer In China

Background and Objectives:Lung cancer is the leading cause of cancer death and the most common incident cancer in China.As one of the most serious cancers in China,lung cancer has been the top priority for the Chinese government in carrying out cancer prevention and control program.So far the burden of disease has not been defined as a recognized and unified concept.Along with the change of medical model,the understanding of the content has also been gradually deepened and enriched.Many scholars have proposed that the existing evaluation indexes of burden of disease,mainly refers to the DALY,aim at the loss of life and/or disability of patients only,which is a comprehensive measure of the "consequences" of the disease,but cannot evaluate the "impact" of the disease,including the burden and health needs of the family,or social burden caused by disease.This makes it difficult to assess the burden of disease only according to the existing measurement and evaluation system.Using a systematic approach to the analysis of burden of disease,the study is to provide evidence-based suggestions for national and local governments to evaluate the family and social effect of lung cancer and make prevention and control strategy,with an emphasis on family and society aspects,through:i)analyzing the relationship between socioeconomic status and lung cancer;ii)assessing the full extent of family and social burden of lung cancer,developing the new methods used to quantitatively evaluating the burden of lung cancer.Materials and Methods:The dataset included in this study are abstracted from Global CancerObservatory dataset,WHO Cancer Mortality Databse,three national retrospective sampling surveys of death causes dataset,Global Burden Disease 2016(GBD2016),the hospital-based multicenter 10-year(2005-2014)retrospective clinical emidemiologic study of primary lung cancer cases(2015-2016),the cross-sectional survey of family caregivers of lung cancer in 2017.The study methods are as follows:1)The burden of lung cancer and the relationship between the socioeconomic status and lung cancer.The study used the descriptive analysis method to analyze the long-term trend and regional disparities of incidence,mortality and DALY of lung cancer.Principal Component Analysis(PCA)was performed to assess the area level socioeconomic status(SES)of lung cancer poluation in China.Multivariate analysis was undertaken using binary logistic regressions to describe association between individual/area-level SES and stage at diagnosis.In addition,we considered analysis of categorical data using a multinomial logit model to explore the effect across tertiles on stage among lung cancer patients.2)The methodological evalutation of burden of lung cancer from the aspect of family.The study included two parts:i)assessing the full extent of family burden of lung cancer:Questionnaire survey was conducted to collect the information of demographic characteristics,result of Caregiver Reaction Assessment(CRA)and result of WHO Quality of Life Questionnaire(WHOQOL-BREF).The multiple linear stepwise regression analysis was conducted to analyze the relationship between quality of life and caregiver burden.We also tested the reliability and validity of the CRA scale among the caregivers for lung cancer patients in China;ii)estimating the family burden:the first was to use the WHOQOL-BREF scale and calculate the weight value based on item options,resulting in disability weights of family caregivers of lung cancer patients,using multiple linear regression model;the second was to obtain the age of value increment of the Chinese population in 2016;the third was to make reference to the calculating principle and method of DALY,we calculated the disability adjusted human capital(DAHC)of caregivers,which was the estimate of the family burden of lung cancer.3)The study of burden of lung cancer from the aspect of society.Based on the Computable General Equilibrium(CGE)model,all the losses caused by lung cancer to the national economic system were estimated.The health effect end points of lung cancer can be divided into two categories:one is the loss of labor productivity caused by lung cancer death;the other is the medical expenses of lung cancer caused by hospitalization and outpatient service.Assuming that health effects cause losses to the national economic system,we estimated the result in nine scenarios of different combination models of health effect of lung cancer.Results:1)The burden of lung cancer and the relationship between the socioeconomic status and lung cancer.Over the past 30 years,the incidence and mortality of lung cancer in China have been increasing rapidly.The proportion of DALY of lung cancer increased from 1.7%(95%UI,1.6 to 1.8%)to 3.8%(95%UI,3.4 to 4.3%)between 1990 and 2016.In addition,the study showed that a clinical relevance existed between socioeconomic disparities and stage at diagnosis for primary lung cancer in mainland China.The least socioeconomic deprivation-areas were associated with a lower risk of having advanced-stage lung cancer.Moreover,we also found increasing educational level was associated with a decreased risk to be diagnosed at advanced-stage lung cancer in both men and women.Patients with higher education degree incurred a moderate decrease at the advanced-stage at diagnosis.2)The methodological evalutation of burden of lung cancer from the aspect of family.The CRA scale was used to confirm the family burden of lung cancer patients in China,which were summarized under four main categories:health and impact on schedule,esteem,impact on finances and lack of family support,of which impact on finances and lack of family support were the two aspects that caused the greatest pressure and the most urgent needs of the family caregivers.Regression results showed that impact on health,caregivers' esteem and impact on finances dimensions of caregiver burden were the negative factors which influenced the quality of life of caregivers.We estimated that the disability adjusted human capital(DAHC)of caregivers for lung cancer patients was 31.5 billion RMB in China in 2016,which revealed that the hidden cost of the lung cancer from family was large.3)The study of burden of lung cancer from the aspect of society.The impact of social burden of lung cancer included the loss of labor productivity and a substantial increase of medical expenses.The former will lead to a decrease in GDP and welfare.The latter will increase GDP but also lead to a decrease in welfare.The combination of the two will buffer the changes of GDP,but result in severe loss of the welfare of the residents.In 2020,2025 and 2030,GDP decreased by 0.026 ‰,0.044 ‰ and 0.043 ‰,respectively.Conclusions:1)The burden of lung cancer for the Chinese population remained high worldwide.In the past more than thirty years,the incidence and mortality rates of lung cancer had been rising rapidly,and the crude incidence and mortality rates of lung cancer in rural increased more steeply than in urban areas.A clinical relevance existed between socioeconomic disparities and stage at diagnosis for primary lung cancer in China.The burden of lung cancer was not matched with the level of social and economic development in China.This suggests that targeted prevention and control strategies of lung cancer according to the distribution,changing characteristics of disease and social and economic status should be taken for reducing the burden of lung cancer.2)The family burden of lung cancer in China was mainly reflected in four aspects:impact on health and schedule,caregiver's esteem,impact on finances and lack of family support.More attention should be paid to the needs of the family caregivers of the patients with lung cancer.The hospital and the community should strengthen the humanistic care of the family,improve the care model and the level of health management.The estimated value of disability adjustment human capital provides the possibility for assessing the invisible loss of family caregivers in psychological,physiological,emotional,social and other aspects.This method provides methodological reference for further research on the family burden of disease in China.3)Although the impact of lung cancer on the overall society and economy may not seem enormous,the welfare function results from an economic point of view or the health benefits reflected by multiple health indicators in the area of health both showed that lung cancer caused a loss of resident welfare.The government should adopt diversified prevention and control strategies,pay more attention to the fair and efficient distribution of lung cancer in the population,and strengthen the prevention and control of population from low socioeconomic status or living in the western region.