Ethnic and Sex Disparities in Esophageal Cancer and Related Medical Costs: A Population-Based Study of 18 Million People

OBJECTIVES: Nearly half of the Esophageal cancer (EC) cases were in China. Disparities in EC epidemiology exist, particularly unclear among Chinese ethnicities. We aimed to compare ethnicity, sex, and age differences in EC diagnoses and medical costs in Inner Mongolia.

METHODS: This retrospective cohort study used Inner Mongolia Regional Health Information Platform data from 2014 to 2020. EC patients were identified through the 10th revision of the International Statistical Classification of Diseases code and Chinese text-based diagnoses. Disease burden calculation including incidence and five-year prevalence (per million, as well as age-standardized rate) and survival rate. Medical costs within the initial year and first three years postdiagnosis were also calculated.

RESULTS: A total of 15 016 participants (median age 64.12 years, 10.28% were female) were identified as EC. The overall crude incidence of EC from 2014 to 2020 was 130.26 (95% confidence interval [CI], 128.18-132.35) per million, with a higher incidence among Mongolian ethnicity (Mongolian-to-Han ratio, 3.40:1) and males (male-to-female ratio, 8.73:1). The incidence (per million) of the Mongolian ethnicity population increased from 2014 (136.39 [95%CI, 114.35-158.44]) to 2020 (264.96 [95%CI, 242.40-287.52]). The overall five-year prevalence (per million) was 218.91 (213.44-224.39) per million in 2020, with a higher rate among Mongolian ethnicity (737.39 [95%CI, 699.76-775.02] v.s. 306.58 [95%CI, 298.05-315.11] in Han ethnicity) and males (653.53 [637.03-670.03] v.s. 74.87 [69.34-80.40] in females). However, Han ethnicity and females had higher 5-year survival rates. The median (interquartile range) of medical costs incurred during the first year and the first three years after diagnosis were $7244.52 ($2230.55-$16303.76) and $9500.08 ($2960.28-$20706.60), with higher medical costs in females and Han ethnicity.

CONCLUSIONS: Mongolian ethnicity and males face higher EC burden with lower survival rates, while EC-related medical costs are elevated in Han ethnicity and males, underscoring the urgent need to focus on disparities in minority ethnic groups.