Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
Estonian Cancer Registry, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
BMC Cancer. 2017 Aug 30;17(1):596. doi: 10.1186/s12885-017-3605-x.
Lung cancer (LC) is the leading cause of cancer deaths in men and the second most frequent cause of cancer deaths in women in Estonia. The study aimed to analyze time trends in LC incidence and mortality in Estonia over the 30-year period, which included major social, economic and health care transition. The results are discussed in the context of changes in tobacco control and smoking prevalence. Long-term predictions of incidence and mortality are provided.
Data for calculating the incidence and mortality rates in 1985-2014 were obtained from the nationwide population-based Estonian Cancer Registry and the Causes of Death Registry. Joinpoint regression was used to analyze trends and estimate annual percentage change (APC) with 95% confidence interval (CI). Nordpred model was used to project future incidence and mortality trends for 2015-2034.
Incidence peaked among men in 1991 and decreased thereafter (APC: -1.5, 95% CI: -1.8; -1.3). A decline was seen for all age groups, except age ≥ 75 years, and for all histological types, except adenocarcinoma and large cell carcinoma. Incidence among women increased overall (APC: 1.6, 95% CI: 1.1; 2.0) and in all age groups and histological types, except small cell carcinoma. Age-standardized incidence rate (world) per 100,000 was 54.2 in men and 12.9 in women in 2014. Changes in mortality closely followed those in incidence. According to our predictions, the age-standardized incidence and mortality rates will continue to decrease in men and reach a plateau in women.
The study revealed divergent LC trends by gender, age and histological type, which were generally consistent with main international findings. Growing public awareness and stricter tobacco control have stimulated overall favorable changes in men, but not yet in women. Large increase in incidence was observed for adenocarcinoma, which in men showed a trend opposite to the overall decline. LC will remain a serious public health issue in Estonia due to a high number of cases during the next decades, related to aging population, and previous and current smoking patterns. National tobacco control policy in Estonia should prioritize preventing smoking initiation and promoting smoking cessation, particularly among women.
肺癌（LC）是爱沙尼亚男性癌症死亡的主要原因，也是女性癌症死亡的第二大常见原因。本研究旨在分析 30 年来 LC 发病率和死亡率的时间趋势，其中包括重大的社会、经济和医疗保健转型。结果将结合烟草控制和吸烟流行率的变化进行讨论。提供了发病率和死亡率的长期预测。
1985-2014 年的发病率和死亡率数据来自全国基于人群的爱沙尼亚癌症登记处和死因登记处。使用 Joinpoint 回归分析趋势，并使用 95%置信区间（CI）估计年百分比变化（APC）。Nordpred 模型用于预测 2015-2034 年的未来发病率和死亡率趋势。
男性的发病率在 1991 年达到峰值，此后呈下降趋势（APC：-1.5，95%CI：-1.8；-1.3）。除了年龄≥75 岁的人群和腺癌和大细胞癌以外的所有年龄组和组织学类型都出现了下降。女性的总体发病率（APC：1.6，95%CI：1.1；2.0）和所有年龄组和组织学类型均呈上升趋势，除了小细胞癌。2014 年，男性每 100,000 人标准化发病率（世界）为 54.2，女性为 12.9。死亡率的变化与发病率的变化密切相关。根据我们的预测，男性的发病率和死亡率将继续下降，并在女性中达到稳定水平。
该研究揭示了按性别、年龄和组织学类型划分的 LC 趋势，这些趋势总体上与主要国际研究结果一致。公众意识的提高和更严格的烟草控制刺激了男性整体的有利变化，但尚未影响女性。腺癌的发病率大幅上升，而男性的腺癌发病率呈下降趋势，与整体下降趋势相反。由于未来几十年人口老龄化以及之前和当前的吸烟模式，LC 将仍然是爱沙尼亚的一个严重公共卫生问题。爱沙尼亚的国家烟草控制政策应优先预防吸烟的开始和促进戒烟，特别是在女性中。
