Roush G C, McKay L, Holford T R
Institute of Environmental Medicine, New York University Medical Center, NY.
Cancer. 1992 Apr 1;69(7):1714-20. doi: 10.1002/1097-0142(19920401)69:7<1714::aid-cncr2820690712>3.0.co;2-z.
For a few years in the 1980s, United States mortality rates suggested a plateau in the long-term increase for malignant melanoma. However, temporary plateaus in the increase of the age-adjusted rate by year of death have occurred in previous decades, only to be followed by a continued upward increase, with a long-term rise of about 2% per year. To determine whether a cessation in the long-term increase might be in progress, death rates were analyzed by year of birth, age at death, and year of death: (1) the long-term patterns of change are best described by birth cohort rather than by time period of death, indicating that analyses by a year of birth are key to a better understanding of the long-term trends; (2) in both men and women, evidence for a change in slope begins among those born in the early 1930s; (3) the decline in the rates begins among women born since the early 1930s and among men born since the early 1950s: the slope for men is -0.2661 (95% confidence limits [CL] = -0.380 to -0.152), and, for women, the slope is -0.02354 (95% CL = -0.041 to -0.005); (4) long-term Connecticut and US mortality trends were similar in pattern and direction, and long-term Connecticut incidence rates showed a persistent increase through the 1955 to 1965 birth cohorts. These analyses suggest a persistent cessation in the long-term increase and a downward trend in death rates from this cancer.
在20世纪80年代的几年间，美国的死亡率显示恶性黑色素瘤的长期增长出现了平稳期。然而，在过去几十年中，按死亡年份调整后的发病率增长也曾出现过短暂平稳期，随后仍持续上升，长期增长率约为每年2%。为了确定长期增长是否可能正在停止，我们按出生年份、死亡年龄和死亡年份对死亡率进行了分析：（1）长期变化模式用出生队列来描述比用死亡时间段更好，这表明按出生年份进行分析是更好理解长期趋势的关键；（2）在男性和女性中，斜率变化的证据始于20世纪30年代初出生的人群；（3）自20世纪30年代初以来出生的女性和自20世纪50年代初以来出生的男性的死亡率开始下降：男性的斜率为-0.2661（95%置信区间[CL]=-0.380至-0.152），女性的斜率为-0.02354（95%CL=-0.041至-0.005）；（4）康涅狄格州和美国的长期死亡率趋势在模式和方向上相似，康涅狄格州的长期发病率在1955年至1965年出生队列中持续上升。这些分析表明，这种癌症的长期增长持续停止，死亡率呈下降趋势。
