Institute of Social and Preventive Medicine, University Bern, Switzerland.
Swiss Med Wkly. 2012 Aug 14;142:w13637. doi: 10.4414/smw.2012.13637. eCollection 2012.
It is crucial for aging societies to evaluate trends in cancer mortality rates of older adults. This study examined socio-demographic and regional characteristics specifically focused on the cancer mortality experience of older adults in Switzerland.
This study included all individuals ≥65 years based on 1990/2000 censuses linked to mortality records to end of 2008 in the Swiss National Cohort. Gender-age-specific (<65, 65-74, 75-84, 85+ years) mortality rates were calculated as observed (cancer deaths/person years) and expected from Poisson models adjusted for changes in death record coding over follow-up.
Cancer mortality, except for lung cancer, increased with advancing age. Older men in all age groups had overall higher cancer mortality rates than older women and showed a consistent decline in all-cancer mortality (age 65-74 years 1991 rate ratio (RR) = 1.13 [95%CI 1.08, 1.19]; 2008 RR = 0.88 [95%CI 0.86, 0.90], compared to rates 2000). In contrast, older women in all age groups showed early declines with a levelling-off of all-cancer mortality beginning in 2000 (age 65-74 years 1991 RR = 1.20 [95%CI 1.14, 1.27]; 2008 RR = 0.96 [95%CI 0.93, 0.98], compared to rates 2000). For older men there appeared to be an education effect for all-cancer and lung cancer mortality; highest rates in older men with compulsory education. Younger old women living alone or in suburban areas had the most sharpest increase in lung cancer mortality rates.
This comprehensive epidemiological analysis of cancer mortality trends in older adults provides further evidence that in Switzerland (like other developed countries) cancer is a disease of aging with important gender-age-specific variations representing major public health challenges for aging societies.
评估老年人群癌症死亡率趋势对老龄化社会至关重要。本研究专门探讨了瑞士老年人群的癌症死亡经验的社会人口学和地区特征。
本研究基于瑞士国家队列中 1990/2000 年人口普查与 2008 年底死亡率记录的关联，纳入所有年龄≥65 岁的个体。根据性别-年龄(<65 岁、65-74 岁、75-84 岁、85 岁及以上)计算特定年龄的死亡率(癌症死亡人数/人年)，并根据随访期间死亡记录编码变化进行泊松模型调整后的预期死亡率。
除肺癌外，癌症死亡率随年龄增长而增加。所有年龄组的老年男性总体上癌症死亡率均高于老年女性，所有癌症死亡率呈持续下降趋势(年龄 65-74 岁 1991 年率比(RR)=1.13[95%CI 1.08, 1.19]；2008 年 RR=0.88[95%CI 0.86, 0.90]，与 2000 年相比)。相比之下，所有年龄组的老年女性在所有癌症死亡率早期下降，2000 年开始趋于平稳(年龄 65-74 岁 1991 年 RR=1.20[95%CI 1.14, 1.27]；2008 年 RR=0.96[95%CI 0.93, 0.98]，与 2000 年相比)。对于老年男性，所有癌症和肺癌死亡率似乎都存在教育效应；受义务教育的老年男性死亡率最高。独居或居住在郊区的年轻老年女性肺癌死亡率增长最为明显。
本研究对老年人群癌症死亡率趋势进行了全面的流行病学分析，进一步证明，在瑞士(与其他发达国家一样)，癌症是一种与年龄相关的疾病，具有重要的性别-年龄特异性差异，这对老龄化社会构成了重大公共卫生挑战。
