Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
Cancer Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Cancer Epidemiol. 2023 Oct;86:102415. doi: 10.1016/j.canep.2023.102415. Epub 2023 Jul 11.
We investigated the effects of factors including age, birth year (cohort) and diagnosis year (period) on colorectal cancer (CRC) incidence trends in Golestan, Northeast of Iran, 2004-2018.
We obtained data on incidence cases of CRC from the Golestan Population-based Cancer Registry by sex and area of residence (urban/rural). Age-standardized incidence rates (ASRs) were calculated using the World standard population and presented per 100,000 person-years. We calculated the estimated annual percentage change (EAPC) with 95 % confidence intervals (95 % CI) fitted age-period-cohort (APC) models to assess non-linear period and cohort effects as incidence rate ratios (IRRs).
Overall, 2839 new cases of CRC (ASR = 13.7) were registered in the GPCR over 2004-2018. Our findings suggested significantly increasing trends in CRC incidence rates from 2004 to 2018 (EAPC = 3.7; 95%CI: 0.4, 7.1), with the greatest changes occurring in rural women (EAPC= 4.7; 95%CI: 0.4, 9.2). We observed a strong cohort effect with a consistent increase in the IRR across successive birth cohorts, starting with the oldest birth cohort (1924) (IRR= 0.1 versus the reference birth cohort of 1955) through to the most recent cohort born in 1983 (IRR= 1.9). The largest cohort effects were found among rural females (IRR = 0.0, and IRR = 2.5 for the oldest and the youngest birth cohorts vs. the reference birth cohort, respectively).
The increasing trends in CRC rates in Golestan are largely driven by generational changes in exposure to underlying risk factors. Further investigations are warranted to deliver effective prevention strategies for the control of CRC in Golestan.
我们研究了包括年龄、出生年份（队列）和诊断年份（时期）在内的因素对 2004 年至 2018 年伊朗东北部戈勒斯坦地区结直肠癌（CRC）发病率趋势的影响。
我们通过性别和居住地（城市/农村）从戈勒斯坦人群癌症登记处获得 CRC 发病病例数据。使用世界标准人口计算年龄标准化发病率（ASR），并以每 100,000 人年表示。我们计算了估计的年百分比变化（EAPC），并使用 95%置信区间（95%CI）拟合了年龄-时期-队列（APC）模型，以评估非线性时期和队列效应作为发病率比（IRR）。
总体而言，2004 年至 2018 年期间，GPCR 共登记了 2839 例 CRC 新发病例（ASR=13.7）。我们的研究结果表明，CRC 发病率从 2004 年到 2018 年呈显著上升趋势（EAPC=3.7；95%CI：0.4，7.1），其中农村女性的变化最大（EAPC=4.7；95%CI：0.4，9.2）。我们观察到了强烈的队列效应，随着连续出生队列的 IRR 持续增加，最早的出生队列（1924 年）（IRR=0.1 与参考出生队列 1955 年相比）到 1983 年出生的最新队列（IRR=1.9）。农村女性的队列效应最大（IRR=0.0，和 IRR=2.5，最古老和最年轻的出生队列与参考出生队列相比，分别）。
戈勒斯坦 CRC 发病率的上升趋势主要归因于潜在危险因素暴露的代际变化。需要进一步研究，为戈勒斯坦的 CRC 控制提供有效的预防策略。
