EFFECTIVE COVERAGE OF STOMACH CANCER PREVENTION IN CHILE 2009-2024
Author(s)
René Lagos, PhD1, Cristobal Cuadrado, MD, PhD2, Arnoldo Riquelme, MD3.
1University of Chile, Independencia, Chile, 2University of Chile, Santiago, Chile, 3Center for Cancer Prevention and Control CECAN, Santiago, Chile.
1University of Chile, Independencia, Chile, 2University of Chile, Santiago, Chile, 3Center for Cancer Prevention and Control CECAN, Santiago, Chile.
OBJECTIVES: Gastric cancer (GC) is the fifth most diagnosed malignant tumor worldwide, with South America—Chile in particular—representing a hotspot for high mortality. In this study we evaluated the association between GC mortality and two preventive strategies in Chile: H. pylori (HP) eradication and opportunistic screening via upper gastrointestinal endoscopy (UGE).
METHODS: An ecological and descriptive study of the Chilean population was conducted for the 2009-2024 period. The effective coverage framework was applied across the country's 29 Health Services (HS). The target population for HP treatment was the general population, and for GC diagnosis, incident cases among individuals aged 40+ were estimated using incidence-mortality ratios. Available capacity was measured by gastroenterology consultations and UGE production; utilization was measured by HP treatments and GC confirmations and treatments; and effectiveness was measured by GC deaths. Linear mixed models with random intercepts by HS were used to evaluate associations between utilization-availability and mortality-utilization. Covariates included sex, age group, rurality percentage, private insurance coverage (ISAPRE), and time period.
RESULTS: Diagnostic confirmations and treatments showed a positive association with UGE availability (p-valor<0.0001) and a negative association with mortality (p<0.0001) for a given incidence level. However, when we included ISAPRE coverage as a covariate, it showed a negative association with mortality (p≤0.012), treatments had a positive association (p=0.020), and confirmations lost their association. HP treatments showed no significant association with consultation availability but were negatively associated with mortality in men under 50 (p<0.02) and women under 70 (p<0.05). Rurality and ISAPRE coverage were positively associated with mortality, while the time period showed a negative association.
CONCLUSIONS: Given a fixed incidence level, UGE availability improves diagnostic utilization coverage; however, these are not associated with lower mortality, most probably because of late diagnosis. In contrast, H. pylori treatment is associated with lower mortality in young and middle-aged adults.
METHODS: An ecological and descriptive study of the Chilean population was conducted for the 2009-2024 period. The effective coverage framework was applied across the country's 29 Health Services (HS). The target population for HP treatment was the general population, and for GC diagnosis, incident cases among individuals aged 40+ were estimated using incidence-mortality ratios. Available capacity was measured by gastroenterology consultations and UGE production; utilization was measured by HP treatments and GC confirmations and treatments; and effectiveness was measured by GC deaths. Linear mixed models with random intercepts by HS were used to evaluate associations between utilization-availability and mortality-utilization. Covariates included sex, age group, rurality percentage, private insurance coverage (ISAPRE), and time period.
RESULTS: Diagnostic confirmations and treatments showed a positive association with UGE availability (p-valor<0.0001) and a negative association with mortality (p<0.0001) for a given incidence level. However, when we included ISAPRE coverage as a covariate, it showed a negative association with mortality (p≤0.012), treatments had a positive association (p=0.020), and confirmations lost their association. HP treatments showed no significant association with consultation availability but were negatively associated with mortality in men under 50 (p<0.02) and women under 70 (p<0.05). Rurality and ISAPRE coverage were positively associated with mortality, while the time period showed a negative association.
CONCLUSIONS: Given a fixed incidence level, UGE availability improves diagnostic utilization coverage; however, these are not associated with lower mortality, most probably because of late diagnosis. In contrast, H. pylori treatment is associated with lower mortality in young and middle-aged adults.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH162
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Gastrointestinal Disorders, SDC: Oncology