Peer-reviewed article
Regional disparities in pediatric radiotherapy utilization in Japan: analysis of a nationwide database.
Aoyama T, Koide Y, Kitagawa T, Tomoda R, Hashimoto S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed regional differences in pediatric radiotherapy use across Japan using national health data from 2023. The researchers found that access to radiotherapy for children under 15 varied widely between regions, ranging from 0 to 161 treatment fractions per 100,000 children. Prefectures with dedicated pediatric cancer hospitals provided significantly more radiotherapy services than those without. The findings suggest that strengthening cancer hub hospitals and improving referral networks could help reduce these geographic disparities in childhood cancer treatment.
Key points
- National mean utilization was 58.7 fractions per 100,000 children, with marked inter-prefectural variability (range 0.0-161.0)
- Prefectures with a designated pediatric cancer hub hospital had significantly higher utilization (80.9 vs. 50.2 per 100,000, p=0.046)
- The number of board-certified pediatricians correlated with total treatment counts but not with population-normalized rates
- Several prefectures (Mie, Miyagi, Tokyo) consistently maintained higher utilization rates over a 5-year period
- Regional disparities in pediatric radiotherapy access persist across Japan despite national healthcare systems
Limitations
This is a descriptive analysis of utilization patterns and cannot determine the clinical appropriateness of disparities or explain why some regions underutilize radiotherapy. The study does not assess patient outcomes or whether regional differences reflect unmet clinical need versus appropriate variation in treatment.
Abstract
Background Pediatric radiotherapy (RT) plays a key role in childhood cancer care, yet regional disparities in its utilization and delivery persist. We aimed to quantify prefecture-level disparities in pediatric RT utilization and examine associations with workforce and facility factors. Procedure Using the Ministry of Health, Labour and Welfare National Database Open Data, we extracted counts of pediatric RT add-on claims (fractions) for fiscal year 2023. Utilization was calculated as claims per 100,000 children (< 15 years). Explanatory variables were the number of board-certified pediatricians and the presence of a designated pediatric cancer hub hospital in each prefecture. We conducted Pearson/Spearman correlation analyses and Welch's t-test, reporting Cohen's d. Supplementary analyses summarized prefecture-level distributions and 5-year trends (2019-2023). Results The national mean utilization was 58.7 fractions per 100,000 children (range, 0.0-161.0), with marked inter-prefectural variability. Pediatrician numbers strongly correlated with claim counts (r = 0.94, p < 0.001) but not with claims per 100,000 children (r = 0.18, p = 0.22). Prefectures with a pediatric cancer hub hospital had significantly higher utilization than those without (80.9 vs. 50.2 per 100,000; p = 0.046), with Cohen's d = 0.66. In a multi-year view, several prefectures (e.g., Mie, Miyagi, Tokyo) repeatedly maintained higher utilization. Conclusions This study examined prefecture-level disparities in pediatric radiotherapy across Japan. The number of board-certified pediatricians was associated with crude treatment counts but not with population-normalized rates, whereas prefectures with a designated pediatric cancer hub hospital showed significantly higher rates. These findings can inform policy making and healthcare resource allocation, particularly efforts to strengthen hub hospitals and cross-prefectural referral networks.