Shen Xiaoping, Wang Limin, Zhu Li
Department of Geography, Central Connecticut State University, New Britain, Connecticut.
Division of Surveillance, National Center for Chronic Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, P.R. China.
Cancer Epidemiol Biomarkers Prev. 2017 Apr;26(4):569-577. doi: 10.1158/1055-9965.EPI-16-0922. Epub 2017 Feb 21.
China's lung cancer crude death rate has increased 6.9-fold from 1973 to 2014. During this time, the country experienced extremely rapid economic growth and social change. It is important to understand the effects of risk factors on lung cancer mortality (LCM) for better allocation of limited resources of cancer prevention and control in China. Using three nationwide mortality surveys from 1973 to 2005, Global Health Data Exchange data in 2013, three nationwide smoking surveys from 1984 to 2013, four population censuses from 1964 to 2000, and other datasets, we have compiled datasets and developed spatial random effect models to assess the association of various area-level-contributing factors on LCM. Spatial scan statistics are used to detect high-risk clusters of LCM. LCM is higher in urban and more industrialized areas (RR = 1.17) compared with those in rural areas. The level of industrial development's effect is higher for men, which accounts for about 70% of all LCM. Smoking is positively associated with regional variation of LCM rates, and the effect is higher for women than for men. The geographic pattern of high LCM in China is different from that of Western countries. LCM is positively associated with higher socioeconomic status, with more urbanized areas at a higher level of industrial development. There is a need to further explore additional risk in the high-risk clusters. The study is about China, but this situation may happen in other countries experiencing rapid industrialization and other developing countries.
从1973年到2014年，中国肺癌粗死亡率增长了6.9倍。在此期间，中国经历了极其快速的经济增长和社会变革。了解风险因素对肺癌死亡率（LCM）的影响，对于中国更合理地分配有限的癌症预防和控制资源至关重要。利用1973年至2005年的三次全国死亡率调查、2013年全球卫生数据交换数据、1984年至2013年的三次全国吸烟调查、1964年至2000年的四次人口普查以及其他数据集，我们编制了数据集并开发了空间随机效应模型，以评估各种地区层面影响因素与肺癌死亡率之间的关联。空间扫描统计用于检测肺癌死亡率的高风险聚集区。与农村地区相比，城市和工业化程度较高地区的肺癌死亡率更高（相对风险=1.17）。工业发展水平对男性的影响更大，男性肺癌死亡病例约占总数的70%。吸烟与肺癌死亡率的地区差异呈正相关，且对女性的影响大于男性。中国肺癌死亡率高的地理模式与西方国家不同。肺癌死亡率与较高的社会经济地位呈正相关，城市化程度较高、工业发展水平较高的地区肺癌死亡率更高。有必要进一步探索高风险聚集区的其他风险因素。该研究聚焦于中国，但这种情况可能在其他经历快速工业化的国家以及其他发展中国家出现。
