Gastroenterology, Portland VA Medical Center, Portland, OR 97239, USA.
J Epidemiol Community Health. 2011 Nov;65(11):1059-64. doi: 10.1136/jech.2010.121368. Epub 2011 May 19.
The aim of this study was to follow the long-term trends of mortality from gastric cancer, gastric ulcer and duodenal ulcer in the USA. It was hypothesised that the time trends among different ethnic groups would be shaped by similar birth cohort patterns.
The US ulcer and cancer data were available from 1923 to 2006 and 1930 to 2006, respectively. Age-specific death rates were calculated for consecutive 10-year periods and 10-year age groups, stratified by sex and race. They were plotted against the period of death as period-age contours and against the period of birth as cohort-age contours. The time trends were also summarised as standardised cohort mortality ratios.
The occurrence of birth cohort patterns with an initial rise and a subsequent decline was observed in gastric cancer and both ulcer types. It occurred similarly in white and non-white population, as well as men and women. In all ethnic groups alike, the initial rise in mortality from gastric cancer and gastric ulcer preceded the rise of duodenal ulcer by 10-20 years. The two time lags between gastric cancer and gastric ulcer and between gastric and duodenal ulcer were most pronounced in white patients. In non-white patients, the rise of gastric cancer occurred later than in white patients and coincided with that of gastric ulcer. The initial rise in mortality from gastric cancer was more evident in non-white than in white patients.
The birth cohort pattern has shaped the time trends of Helicobacter pylori-related disease similarly among different ethnic and socioeconomic groups. Its cause remains unknown and warrants further investigation.
本研究旨在探讨美国胃癌、胃溃疡和十二指肠溃疡死亡率的长期趋势。研究假设不同种族之间的时间趋势将受到相似的出生队列模式的影响。
美国溃疡和癌症数据分别来自 1923 年至 2006 年和 1930 年至 2006 年。按性别和种族分层，计算了连续 10 年和 10 年年龄组的特定年龄死亡率。将死亡率与死亡期绘制成时期-年龄轮廓图，与出生期绘制成队列-年龄轮廓图。时间趋势也被总结为标准化队列死亡率比。
在胃癌和两种溃疡类型中，观察到了出生队列模式的出现，即最初上升，随后下降。这种模式在白人和非白人人群中，以及男性和女性中，表现相似。在所有种族中，胃癌和胃溃疡死亡率的最初上升都比十二指肠溃疡的上升提前了 10-20 年。胃癌和胃溃疡之间以及胃癌和十二指肠溃疡之间的两个时间滞后在白人患者中最为明显。在非白人患者中，胃癌的上升晚于白人患者，与胃溃疡的上升同时发生。非白人患者中胃癌死亡率的最初上升比白人患者更为明显。
出生队列模式在不同种族和社会经济群体中相似地塑造了与幽门螺杆菌相关疾病的时间趋势。其原因尚不清楚，需要进一步研究。
