Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China.
Department of Occupational and Environmental Health, School of Health Sciences, Wuhan University, Wuhan 430071, China.
Public Health. 2019 Jan;166:45-52. doi: 10.1016/j.puhe.2018.08.007. Epub 2018 Nov 15.
China is undergoing a rapid aging transition. The trends in age-specific mortality rates from colorectal cancer remain unknown, and a number of studies have not distinguished the age, period, and cohort effects simultaneously.
A descriptive study was implemented with a joinpoint regression analysis and age-period-cohort (APC) model based on the intrinsic estimator (IE).
Age-specific mortality rates of colorectal cancer (1987-2016) were collected by gender (men/women) and region (urban/rural). The average annual percentage change (AAPC) and relative risks in the trend were identified using joinpoint Poisson regression and APC model (IE), respectively.
Joinpoint regression analysis revealed that the rates decreased in the younger (men aged <45 years and women aged <75 years) but increased in the older (men aged >75 years and women aged >80 years) age groups. The APC model (IE) showed that the rates increased with age and time period but decreased with birth cohorts. But from 2000 to 2005, the period effects showed a substantial decline among urban residents. From the 1910-1914 to the 1915-1919 birth cohort, mortality increased among men, and from the 1925-1929 to the 1930-1934 birth cohort, mortality increased among rural residents.
The trends in colorectal cancer mortality are different between age groups. The younger age groups show a decreasing trend, whereas the older age groups an increasing trend. Cost-effective prevention and control should be implemented more in the elderly and for older cohorts at high risk.
中国正在经历快速老龄化转型。结直肠癌特定年龄死亡率的趋势尚不清楚，并且许多研究并未同时区分年龄、时期和队列效应。
本研究采用描述性研究，基于内在估计量（IE）进行 Joinpoint 回归分析和年龄-时期-队列（APC）模型分析。
按性别（男/女）和地区（城市/农村）收集了 1987 年至 2016 年结直肠癌的特定年龄死亡率数据。使用 Joinpoint 泊松回归和 APC 模型（IE）分别确定趋势中的平均年变化百分比（AAPC）和相对风险。
Joinpoint 回归分析显示，在较年轻的年龄组（男性<45 岁，女性<75 岁）中，死亡率下降，但在较年长的年龄组（男性>75 岁，女性>80 岁）中，死亡率上升。APC 模型（IE）表明，死亡率随年龄和时间的推移而增加，但随出生队列的推移而降低。但是，从 2000 年到 2005 年，城市居民的时期效应显著下降。从 1910-1914 年至 1915-1919 年出生队列，男性死亡率增加，从 1925-1929 年至 1930-1934 年出生队列，农村居民死亡率增加。
结直肠癌死亡率的趋势在不同年龄组之间存在差异。年轻年龄组呈下降趋势，而老年年龄组呈上升趋势。应在老年人和高危的老年队列中实施更具成本效益的预防和控制措施。
