Shibuya Kenji, Inoue Mie, Lopez Alan D
Measurement and Health Information Systems, Evidence and Information for Policy, World Health Organization, Geneva, Switzerland.
Int J Cancer. 2005 Nov 10;117(3):476-85. doi: 10.1002/ijc.21078.
The purpose of this work was to model lung cancer mortality as a function of past exposure to tobacco and to forecast age-sex-specific lung cancer mortality rates. A 3-factor age-period-cohort (APC) model, in which the period variable is replaced by the product of average tar content and adult tobacco consumption per capita, was estimated for the US, UK, Canada and Australia by the maximum likelihood method. Age- and sex-specific tobacco consumption was estimated from historical data on smoking prevalence and total tobacco consumption. Lung cancer mortality was derived from vital registration records. Future tobacco consumption, tar content and the cohort parameter were projected by autoregressive moving average (ARIMA) estimation. The optimal exposure variable was found to be the product of average tar content and adult cigarette consumption per capita, lagged for 25-30 years for both males and females in all 4 countries. The coefficient of the product of average tar content and tobacco consumption per capita differs by age and sex. In all models, there was a statistically significant difference in the coefficient of the period variable by sex. In all countries, male age-standardized lung cancer mortality rates peaked in the 1980s and declined thereafter. Female mortality rates are projected to peak in the first decade of this century. The multiplicative models of age, tobacco exposure and cohort fit the observed data between 1950 and 1999 reasonably well, and time-series models yield plausible past trends of relevant variables. Despite a significant reduction in tobacco consumption and average tar content of cigarettes sold over the past few decades, the effect on lung cancer mortality is affected by the time lag between exposure and established disease. As a result, the burden of lung cancer among females is only just reaching, or soon will reach, its peak but has been declining for 1 to 2 decades in men. Future sex differences in lung cancer mortality are likely to be greater in North America than Australia and the UK due to differences in exposure patterns between the sexes.
这项工作的目的是将肺癌死亡率建模为过去接触烟草情况的函数，并预测特定年龄和性别的肺癌死亡率。通过最大似然法，为美国、英国、加拿大和澳大利亚估计了一个三因素年龄-时期-队列（APC）模型，其中时期变量被平均焦油含量与人均成人烟草消费量的乘积所取代。特定年龄和性别的烟草消费量根据吸烟流行率和总烟草消费的历史数据进行估算。肺癌死亡率来自人口动态登记记录。未来的烟草消费、焦油含量和队列参数通过自回归移动平均（ARIMA）估计进行预测。结果发现，在所有4个国家，最佳暴露变量是平均焦油含量与人均成人香烟消费量的乘积，男性和女性均滞后25至30年。平均焦油含量与人均烟草消费量乘积的系数因年龄和性别而异。在所有模型中，时期变量的系数在性别上存在统计学显著差异。在所有国家，男性年龄标准化肺癌死亡率在20世纪80年代达到峰值，此后下降。预计女性死亡率将在本世纪的第一个十年达到峰值。年龄、烟草暴露和队列的乘法模型对1950年至1999年期间的观测数据拟合得相当好，时间序列模型得出了相关变量过去合理的趋势。尽管在过去几十年中烟草消费和所售香烟的平均焦油含量大幅下降，但对肺癌死亡率的影响受到暴露与确诊疾病之间时间滞后的影响。因此，女性肺癌负担刚刚达到或即将达到峰值，但男性肺癌负担已在1至2个十年中下降。由于两性暴露模式的差异，北美未来肺癌死亡率的性别差异可能比澳大利亚和英国更大。
