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

TLDR

The two regions studied are considered high‑risk areas for oesophageal cancer. The study aimed to establish MIS‑CASS and assess its completeness and timeliness by reporting cancer incidence rates from claims data in two Chinese regions. MIS‑CASS was built by extracting, cleaning, and processing insurance claims, applying text‑based diagnosis with ICD‑10 codes for case ascertainment while ensuring privacy protection. The system revealed overall age‑standardised incidence rates of 167.39 and 159.78 per 100,000 in Hua County and Shantou City, with lung and breast cancers most common in males and females, respectively, and highlighted Hua County as a high‑risk oesophageal cancer area (ASR 25.95) versus Shantou’s lower rate (11.43), with Nanao Island showing the highest oesophageal incidence (36.39) and a lower male‑to‑female ratio in Hua County (1.69 vs. 4.02).

Abstract

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