Regional disparities in pediatric radiotherapy utilization in Japan: analysis of a nationwide database.
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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.