Levi F, La Vecchia C, Decarli A, Randriamiharisoa A
Registre Vaudois des Tumeurs, CHUV BH-06, Lausanne, Switzerland.
Int J Cancer. 1987 Oct 15;40(4):439-49. doi: 10.1002/ijc.2910400402.
Swiss death certification data over the period 1951-1984 for total cancer mortality and 30 major cancer sites in the population aged 25 to 74 years were analysed using a log-linear Poisson model with arbitrary constraints on the parameters to isolate the effects of birth cohort, calendar period of death and age. The overall pattern of total cancer mortality in males was stable for period values and showed some moderate decreases in cohort values restricted to the generations born after 1930. Cancer mortality trends were more favourable in females, with steady, though moderate, declines in both cohort and period values. According to the estimates from the model, the worst affected generation for male lung cancer was that born around 1910, and a flattening of trends or some moderate decline was observed for more recent cohorts, although this decline was considerably more limited than in other European countries. There were decreases in cohort and period values for stomach, intestine and oesophageal cancer in both sexes and (cervix) uteri in females. Increases were observed in both cohort and period trends for pancreas and liver in males and for several other neoplasms, including prostate, brain, leukaemias and lymphomas, restricted, however, for the latter sites, to the earlier cohorts and hence partly attributable to improved diagnosis and certification in the elderly. Although age values for lung cancer in females were around 10-times lower than in males, upward trends in female lung cancer cohort values were observed in subsequent cohorts and for period values from the late 1960's onwards. Therefore, future trends in female lung cancer mortality should continue to be monitored. The application of these age/period/cohort models thus provides a summary guide for the reading and interpretation of cancer mortality trends, although it cannot replace careful inspection of single age-specific rates.
分析了1951 - 1984年瑞士25至74岁人群全癌死亡率及30个主要癌症部位的死亡证明数据，采用对数线性泊松模型，对参数施加任意约束以分离出生队列、死亡日历期和年龄的影响。男性全癌死亡率的总体模式在时期值上较为稳定，且出生队列值在1930年后出生的代际中有适度下降。女性癌症死亡率趋势更为有利，队列值和时期值均呈稳定但适度的下降。根据模型估计，男性肺癌受影响最严重的代际是1910年左右出生的那一代，近期队列的趋势趋于平缓或有适度下降，不过这种下降幅度比其他欧洲国家要小得多。男女胃癌、肠癌和食管癌以及女性子宫颈癌的队列值和时期值均有所下降。男性胰腺癌和肝癌以及包括前列腺癌、脑癌、白血病和淋巴瘤在内的其他几种肿瘤的队列趋势和时期趋势均有所上升，但对于后几种肿瘤，仅限于早期队列，部分原因是老年人诊断和认证的改善。尽管女性肺癌的年龄值比男性低约10倍，但在随后的队列中以及从20世纪60年代末开始的时期值中，女性肺癌队列值呈上升趋势。因此，应继续监测女性肺癌死亡率的未来趋势。这些年龄/时期/队列模型的应用为解读癌症死亡率趋势提供了一个总结指南，尽管它不能替代对单一年龄别率的仔细检查。
