Spatiotemporal inequality and financial toxicity of leukemia in post-poverty China: a national analysis of 832 counties (2019-2024).

Abstract

Background: Leukemia remains a critical public health challenge in China's post-poverty regions, where high treatment costs perpetuate the "disease-poverty" trap. Despite nationwide efforts to improve healthcare access, the evolving spatiotemporal dynamics and economic burden of leukemia in these regions remain understudied.

Methods: Using population-based data from China's Health Poverty Alleviation Platform (2019-2024), we analyzed 97,472 leukemia cases across 832 poverty-alleviated counties. Age/sex-standardized incidence and mortality rates were calculated using 2020 census data. Spatiotemporal trends were evaluated via Joinpoint regression, and spatial clustering was mapped through global/local Moran's I and Getis-Ord Gi* analyses. The economic burden was assessed by Out-Of-Pocket (OOP) payment ratios and costs.

Results: Longitudinal analysis of 97,472 leukemia cases across 832 Chinese poverty-alleviated counties (2019-2024) revealed: (1) Significant reductions in age-standardized incidence (AAPC = -59.4%, p = 0.015) and mortality (AAPC = -67.5%, p = 0.012), with persistently higher male incidence (χ² = 1554.4, p < 0.001); (2) Spatiotemporal transition from Northeast/Central clustering (Moran's I > 0.38, p < 0.001; 2019-2021) to Western hotspot expansion (Getis-Ord Gi*, p < 0.001; 2022-2024), indicative of improved diagnostic coverage; (3) Severe financial toxicity in Eastern China (median OOP ratio = 39.7%, approaching WHO catastrophic thresholds) and high absolute OOP cost clustering in Central regions, driven by therapy costs and insurance fragmentation.

Conclusion: While China's poverty alleviation policies effectively reduced the leukemia burden, persistent regional disparities and financial toxicity demand targeted interventions. The westward hotspot migration post-2022 marks a diagnostic catch-up in resource-limited regions. Crucially, elevated male/youth incidence necessitates targeted screening in emerging clusters, while diverging financial toxicity demands region-specific solutions: for Eastern China's catastrophic OOP ratios (39.7%), reform must prioritize novel-therapy reimbursement; Central China's cost-clustering urges cross-provincial care networks to offset abandonment risks.