〔記者吳亮儀／台北報導〕頂尖醫學期刊《The Lancet》（刺胳針）在25日刊登一篇中國的公共衛生研究，將我國列為中國一省，引發大批台灣網友抗議；副總統陳建仁昨深夜也在臉書發文，將和多名中研院院士一起致函《The Lancet》編輯部，要求該期刊立即更正錯誤。
To the Editor:
We read the recent article by Zhou et al. comparing mortality, morbidity and risk factors in China and its provinces, 1990-2017. The authors used data from Global Burden of Diseases, Injuries, and Risk Factors Study （GBD） 2017 to analyse health patterns in 34 province-level administrative units in China. This is a misleading and biased report due to the inclusion of Taiwan in the analyses.
The authors made an obvious flaw by including Taiwan in the study. The national health system, government system and administrative system are independent in Taiwan. The completeness and accuracy of national databases of health insurance, cancer registry, death certification, cancer screening and health surveillance in Taiwan is totally different from those of China. The health outcomes measured by different methods should not be included in the same hierarchical models. Taiwan has its own cancer and death registration system, and the information were not collected by the Chinese Center for Disease Control and Prevention as described wrongly in the article. The data source from the Global Health Data Exchange （http://ghdx.healthdata.org/countries） that the authors used in this paper also clearly showed Taiwan and China are two distinguished countries under the category of Eastern Asia.
Taiwan has an independent National Health Insurance system which covers more than 95% of 23 million people since 1995. Taiwan has also implemented a series of public health programs to reduce mortality and morbidity which are not implemented in China. For example, Taiwan is the first country in the world to implement universal newborn hepatitis B vaccination program since 1984 whereas China started in 1992. We reimbursed antiviral treatment for chronic viral hepatitis since 2003 and decreased liver disease burdens continuously. Taiwan started to reimburse direct antiviral agents for chronic hepatitis C patients with advance fibrosis since 2017 and for all chronic hepatitis C patients since 2019, and has committed to eliminating hepatitis C infection in 2025, 5 years earlier than the 2030 deadline set by WHO.
The inclusion of Taiwan in the analysis leads definitely to a significant bias of the findings of Zhou et al. In their similar publication in 2016 （Lancet 387:251-272）, Taiwan was not included in the analyses. We would like to urge the authors to re-run the analyses and remove Taiwan from their analyses in order to yield unbiased estimates of mortality, morbidity and risk factors in China. Lancet, as an esteemed medical journal, has the reputation to publish accurate and precise research findings. Such a major categorization mistake in the methods section by Zhou et al. should be rectified.
Maggie Dai-Hua TSAI RIEDIKER