Urban-Rural Disparity in Helicobacter Pylori Infection–Related Upper Gastrointestinal Cancer in China and the Decreasing Trend in Parallel with Socioeconomic Development and Urbanization in an Endemic Area

Abstract

Background: Globally China has the largest urban-rural disparity in socioeconomic development, and the urban-rural difference in upper gastrointestinal cancer (UGIC) is similar to the difference between developed and developing countries. Objectives: To describe urban-rural disparity in UGIC and to emphasize prevention by socioeconomic development and urbanization in China. Methods: Age-standardized incidence rates (ASRs) of cancers in 2012 were compared between urban Shijiazhuang city and rural Shexian County, and trends from 2000-2015 in Shexian County were analyzed. Findings: Compared with urban Shijiazhuang city, the ASR of gastroesophageal cancers in rural Shexian County was 5.3 times higher in men (234.1 vs 44.2/100,000, 'P' 'Helicobacter pylori' infection prevalence of 75% vs 50%. From 2000-2015, the GDP per capita in Shexian County increased from US$860 to US$3000, urbanization rate increased from 22.4% to 54.8%, and prevalence of 'H pylori' infection among 3- to 10-year-old children decreased from 60% to 46.1% ('P' 'gallbladder cancers and leukemia in both sexes and breast, ovary, thyroid, and kidney cancer in women increased significantly. Despite this offset, ASR of all cancers combined decreased 25% in men (from 378.2 to 283.0/100,000, 'P' '=' '.'00) and 19% in women (from 238.5 to 193.6/100,000, 'P' '=' '.'00). ConclusionsUrban-rural disparity in UGIC is related to inequity in socioeconomic development. Economic growth and urbanization is effective for prevention in endemic regions in China and should be a policy priority.

Keywords

• socioeconomic development
• urbanization
• urban-rural disparity in cancer
• social determinants of health
• Helicobacter pylori infection
• disadvantaged population