Jemal A, Chu K C, Tarone R E
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda 20982, MD, USA.
J Natl Cancer Inst. 2001 Feb 21;93(4):277-83. doi: 10.1093/jnci/93.4.277.
Previous age-period-cohort analyses of lung cancer incidence and mortality rates in the United States have demonstrated a decrease in risk by birth cohort through 1950, consistent with declining trends in smoking prevalence. This study was conducted to examine recent lung cancer trends, including trends among the cohorts born after 1950.
Lung cancer mortality rates from 1970 through 1997 for whites aged 24--83 years and for blacks aged 30--83 years were investigated. Using age--period--cohort analyses with 2-year age and 2-year calendar-period intervals, we examined changes in the slope of the trends in birth-cohort and calendar-period effects. All statistical tests are two-sided.
There was an unexpected, statistically significant moderation in the rate of decrease of the birth-cohort trend in lung cancer mortality for whites born after 1950, with a corresponding smaller and statistically nonsignificant moderation for blacks. These data are consistent with smoking initiation rates: Rates of both cigarette and marijuana smoking initiation increased for children aged 12--17 years from 1965 through 1977. There was a statistically significant decrease in the slope of the calendar-period trend for lung cancer mortality in 1990 for both whites and blacks that was observed primarily in people 55 years of age and older.
The birth-cohort pattern of lung cancer mortality after 1950 appears to reflect the early impact of teenage cigarette smoking on lung cancer risk in people under the age of 45 years, although a contribution from marijuana smoking cannot be ruled out. This result provides additional support for increasing smoking cessation and prevention programs for teenagers. The calendar-period decrease in lung cancer mortality after 1990 may reflect the long-term benefits of reductions in tobacco carcinogens in cigarettes and increases in smoking cessation beginning around 1960.
此前对美国肺癌发病率和死亡率的年龄-时期-队列分析表明，到1950年出生队列的风险呈下降趋势，这与吸烟率的下降趋势一致。本研究旨在调查近期肺癌趋势，包括1950年后出生队列的趋势。
研究了1970年至1997年24 - 83岁白人及30 - 83岁黑人的肺癌死亡率。采用年龄-时期-队列分析，年龄间隔为2岁，日历时期间隔为2年，我们研究了出生队列和日历时期效应趋势斜率的变化。所有统计检验均为双侧检验。
1950年后出生的白人肺癌死亡率出生队列趋势下降率出现意外且具有统计学意义的放缓，黑人的相应放缓较小且无统计学意义。这些数据与吸烟起始率一致：1965年至1977年，12 - 17岁儿童的香烟和大麻吸烟起始率均有所上升。1990年，白人和黑人肺癌死亡率的日历时期趋势斜率均出现具有统计学意义的下降，主要见于55岁及以上人群。
1950年后肺癌死亡率的出生队列模式似乎反映了青少年吸烟对45岁以下人群肺癌风险的早期影响，尽管不能排除大麻吸烟的作用。这一结果为增加青少年戒烟和预防项目提供了额外支持。1990年后肺癌死亡率的日历时期下降可能反映了香烟中烟草致癌物减少以及约1960年开始的戒烟增加所带来的长期益处。
