Population-based cancer control: where is the greatest benefit from proven strategies to 'regain' years of life lost prematurely?

Construction and results of a comprehensive index for gastrointestinal health monitoring in China: a nationwide study

Background

The disease burden of gastrointestinal disease (GD) in China is high, with significant variation across provinces. A comprehensive agreed set of indicators could guide rational resource allocation to support better GD outcomes.

Methods

This study collected data from multiple sources, including national surveillance, surveys, registration systems, and scientific research. Literature reviews and Delphi methods were used to obtain monitoring indicators; the analytic hierarchy process was used to determine indicator weights.

Findings

The China Gastrointestinal Health Index (GHI) system consisted of four dimensions and 46 indicators. The weight of the four dimensions from high to low included the prevalence of gastrointestinal non-neoplastic diseases and gastrointestinal neoplasms (GN) (0.3246), clinical treatment of GD (0.2884), prevention and control of risk factors (0.2606), and exposure to risk factors (0.1264). The highest indicator weight of GHI rank was the successful smoking cessation rate (0.1253), followed by the 5-year survival rate of GN (0.0905), and the examination rate of diagnostic oesophagogastroduodenoscopy (0.0661). The overall GHI for China in 2019 was 49.89, varying from 39.19 to 76.13 across all sub-regions. The top five sub-regions in the total GHI score were in the eastern region.

Interpretation

GHI is the first system designed to monitor gastrointestinal health systematically. In the future, data from sub-regions of China should be used to test and improve the GHI system for its impact.

Funding

This research was supported by the National Health Commission of China, the First Affiliated Hospital of Naval Medical University (2019YXK006), and the Science and Technology Commission of Shanghai Municipality (21Y31900100).

A financial case to enable state health jurisdictions to invest in tobacco control

State health departments bear considerable expenditure due to tobacco-related hospitalisations. We present a straightforward formula, based on aetiological fractions (attributable risks), with which to estimate tobacco-related expenditure in a way relevant and meaningful to state health departments and hospital managers. Tobacco was responsible for 43 571 hospitalisations in New South Wales in 1999-2000 alone, incurring $178 527 370 in hospital costs (nearly $500 000 per day). If the equivalent of a specified percentage of expenditure as calculated for one year were "invested" in tobacco control in the next year, then commitments to a substantive suite of health promotion programs could be made. For example, using our formula, a contribution of 3% would secure an annual tobacco control budget of $5 355 821 in NSW. Once securely funded, evidence-based tobacco control would reap dividends by reducing hospital expenditure and enhancing population health.