Su Binbin, Zhong Panliang, Xuan Yundong, Xie Junqing, Wu Yu, Chen Chen, Zhao Yihao, Shen Xinran, Zheng Xiaoying
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Urology, The Third Medical Centre, Chinese PLA (People's Liberation Army) General Hospital, Beijing 100853, China.
Cancers (Basel). 2023 Jan 12;15(2):476. doi: 10.3390/cancers15020476.
China has the highest number of new cancer cases and deaths worldwide, posing huge health and economic burdens to society and affected families. This study comprehensively analyzed secular trends of national cancer mortality statistics to inform future prevention and intervention programs in China.
The annual estimate of overall cancer mortality and its major subtypes were derived from the National Health Commission (NHC). Joinpoint analysis was used to detect changes in trends, and we used age-period-cohort modeling to estimate cohort and period effects in Cancers between 1987 and 2020. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks were calculated.
The age-standardized cancer mortality in urban China has shown a steady downward trend but has not decreased significantly in rural areas. Almost all cancer deaths in urban areas have shown a downward trend, except for colorectal cancer in men. Decreasing mortality from cancers in rural of the stomach, esophagus, liver, leukemia, and nasopharynx was observed, while lung, colorectal cancer female breast, and cervical cancer mortality increased. Birth cohort risks peaked in the cohorts born around 1920-1930 and tended to decline in successive cohorts for most cancers except for leukemia, lung cancer in rural, and breast and cervical cancer in females, whose relative risks were rising in the very recent cohorts. In addition, mortality rates for almost all types of cancer in older Chinese show an upward trend.
Although the age-standardized overall cancer mortality rate has declined, and the urban-rural gap narrowed, the absolute cancer cases kept increasing due to the growing elderly population in China. The rising mortality related to lung, colorectal, female breast, and cervical cancer should receive higher priority in managing cancer burden and calls for targeted public health actions to reverse the trend.
中国的新发癌症病例数和死亡人数位居全球之首，给社会和受影响家庭带来了巨大的健康和经济负担。本研究全面分析了全国癌症死亡率统计数据的长期趋势，为中国未来的预防和干预计划提供参考。
总体癌症死亡率及其主要亚型的年度估计值来自国家卫生健康委员会（NHC）。采用Joinpoint分析来检测趋势变化，并使用年龄-时期-队列模型来估计1987年至2020年间癌症的队列效应和时期效应。计算了净漂移（总体年度百分比变化）、局部漂移（各年龄组的年度百分比变化）、纵向年龄曲线（预期的特定年龄纵向率）以及时期（队列）相对风险。
中国城市地区的年龄标准化癌症死亡率呈稳步下降趋势，但农村地区下降不明显。城市地区几乎所有癌症的死亡率都呈下降趋势，男性结直肠癌除外。农村地区胃癌、食管癌、肝癌、白血病和鼻咽癌的死亡率下降，而肺癌、女性结直肠癌、乳腺癌和宫颈癌的死亡率上升。出生队列风险在1920 - 1930年左右出生的队列中达到峰值，除白血病、农村地区肺癌以及女性乳腺癌和宫颈癌外，大多数癌症的后续队列风险呈下降趋势，而这些癌症在最近队列中的相对风险正在上升。此外，中国老年人中几乎所有类型癌症的死亡率都呈上升趋势。
尽管年龄标准化的总体癌症死亡率有所下降，城乡差距缩小，但由于中国老年人口不断增加，癌症绝对病例数持续上升。与肺癌、结直肠癌、女性乳腺癌和宫颈癌相关的死亡率上升应在管理癌症负担方面得到更高优先重视，并需要采取有针对性的公共卫生行动来扭转这一趋势。
