Income differences in screening, incidence, postoperative complications, and mortality of thyroid cancer in South Korea: a national population-based time trend study

BMC Cancer

Yeon-Yong Kim¹  Ikhan Kim²  Jinwook Bahk³  Hee-Yeon Kang⁴  Young-Ho Khang⁵ 

[1] Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea;Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea;Department of Health Policy and Management, Jeju National University School of Medicine, Jeju, Republic of Korea;Department of Public Health, Keimyung University, Daegu, Republic of Korea;Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea;Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea;Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea;

关键词: Incidence;    Income;    Medical overuse;    Overdiagnosis;    Postoperative complication;    Thyroid cancer;   

DOI  :  10.1186/s12885-020-07597-4

来源: Springer

【 摘 要 】

BackgroundThe incidence of thyroid cancer (TC) has increased rapidly over the past few decades in Korea. This study investigated whether the TC epidemic has been driven by overdiagnosis.MethodsWe calculated the TC screening rate from mid-2008 through mid-2014, and the incidence, postoperative complication, and mortality rates of TC between 2006 and 2015, using data from the Korea Community Health Survey, the National Health Insurance Database, and the cause-of-death data of Statistics Korea. Trends in age-standardized rates of all indicators were examined, along with income gaps therein. Analyses were conducted for lung cancer and stroke as negative control outcomes.ResultsThe incidence rate of TC increased from 46.6 per 100,000 to 115.0 per 100,000 between 2006 and 2012, and then decreased to 63.5 per 100,000 in 2015. Despite these remarkable changes in incidence, mortality did not fluctuate during the same period. High income was associated with high rates of screening, incidence, and postoperative complications, while low income showed an association with a high mortality rate. Analyses using negative control outcomes showed that high income was associated with low rates of both incidence and mortality, which contrasted with the patterns of TC. The recent decreases in TC incidence and postoperative complications, which reflect societal concerns about the overdiagnosis of TC, were more pronounced in high-income individuals than in low-income individuals.ConclusionsThe time trends in income gaps in screening, incidence, postoperative complications, and mortality of TC, as well as negative control outcomes, provided corroborating evidence of TC overdiagnosis in Korea.

【 授权许可】

CC BY