上升还是下降?1967年至1999年欧盟15国肺癌流行情况的变化阶段
Going up or coming down? The changing phases of the lung cancer epidemic from 1967 to 1999 in the 15 European Union countries.
作者信息
Bray F, Tyczynski J E, Parkin D M
机构信息
Unit of Descriptive Epidemiology, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
出版信息
Eur J Cancer. 2004 Jan;40(1):96-125. doi: 10.1016/j.ejca.2003.08.005.
Lung cancer, the most common cause of cancer death in the European Union (EU), continues to have an enormous impact on the health experience of the men and women living in the constituent countries. Information on the course of the lung cancer epidemic is essential in order to formulate an effective cancer control policy. This paper examines recent trends in lung cancer mortality rates in men and women in each of the 15 countries, comparing cross-sectional rates of death in younger (aged 30-64 years) and older populations (aged 65 years or over), and the age, period of death, and birth cohort influences in the younger age group. The latter analysis establishes the importance of year of birth, related to modifications in the tobacco habit among recently born generations. The stage of evolution of the lung cancer epidemic varies markedly by sex and country in terms of the direction, magnitude, and phase of development of national trends. In males, there is some consistency in the direction of the trends between EU countries, declines are apparent in most countries, at least in younger men, with rates in older men either reaching a plateau, or also falling. In younger persons, a decreasing risk of lung cancer death reflects changes in successive birth cohorts, due to modifications in the smoking habit from generation to generation, although these developments are in very different phases across countries. Portugal is the exception to the male trends; there are increases in mortality in both age groups, with little sign of a slowing down by birth cohort. In women, there are unambiguous upsurges in rates seen in younger and older women in almost all EU countries in recent decades, and little sign that the epidemic has or will soon reach a peak. The exceptions are the United Kingdom (UK) and Ireland, where lung cancer death rates are now declining in younger women and stabilising in older women, reflecting a declining risk in women born since about 1950. It is too early to say whether the observed plateau or decline in rates in women born very recently in several countries is real or random. To ascertain whether recent trends in lung cancer mortality will continue, trends in cigarette consumption should also be evaluated. Where data are available by country, the proportion of adult male smokers has, by and large, fallen steadily in the last five decades. In women, recent smoking trends are downwards in Belgium, Denmark, Sweden and the Netherlands, although in Austria and Spain, large increases in smoking prevalence amongst adults are emerging. Unambiguous public health messages must be effectively conveyed to the inhabitants of the EU if the lung cancer epidemic is to be controlled. It is imperative that anti-tobacco strategies urgently target women living in the EU, in order to halt their rapidly increasing risk of lung cancer, and prevent unnecessary, premature deaths among future generations of women.
肺癌是欧盟(EU)癌症死亡的最常见原因,继续对欧盟成员国男女的健康状况产生巨大影响。了解肺癌流行趋势对于制定有效的癌症控制政策至关重要。本文研究了15个国家中男性和女性肺癌死亡率的近期趋势,比较了年轻人群(30 - 64岁)和老年人群(65岁及以上)的横断面死亡率,以及年轻年龄组中年龄、死亡时期和出生队列的影响。后一项分析确定了出生年份的重要性,这与最近几代人吸烟习惯的改变有关。肺癌流行的演变阶段在性别和国家之间,在国家趋势的发展方向、幅度和阶段方面存在显著差异。在男性中,欧盟国家之间的趋势方向存在一定的一致性,大多数国家的肺癌死亡率都有下降,至少在年轻男性中如此,老年男性的死亡率要么达到平稳状态,要么也在下降。在年轻人中,肺癌死亡风险的降低反映了连续出生队列的变化,这是由于吸烟习惯代代相传的改变,尽管这些变化在不同国家处于非常不同的阶段。葡萄牙是男性趋势的例外;两个年龄组的死亡率都在上升,几乎没有迹象表明出生队列的变化会使其放缓。在女性中,近几十年来,几乎所有欧盟国家的年轻女性和老年女性的肺癌死亡率都出现了明显上升,几乎没有迹象表明这种流行已经或即将达到峰值。例外的是英国(UK)和爱尔兰,在那里年轻女性的肺癌死亡率现在正在下降,老年女性的死亡率趋于稳定,这反映了自1950年左右出生的女性患肺癌风险的下降。现在判断几个国家中最近出生的女性中观察到的死亡率平稳或下降是真实的还是随机的还为时过早。为了确定肺癌死亡率的近期趋势是否会持续,还应评估香烟消费趋势。在有各国数据的情况下,在过去五十年中,成年男性吸烟者的比例总体上一直在稳步下降。在女性中,比利时、丹麦、瑞典和荷兰的近期吸烟趋势呈下降趋势,尽管在奥地利和西班牙,成年人吸烟率正在大幅上升。如果要控制肺癌流行,必须有效地向欧盟居民传达明确的公共卫生信息。迫切需要将反烟草战略的目标对准欧盟的女性,以阻止她们患肺癌风险的迅速上升,并防止未来几代女性不必要的过早死亡。