Department of Child, Adolescent Health and Maternal Care, School of Public Health, Capital Medical University, Beijing, 100069, China.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (China CDC), Beijing, 100050, China.
Mil Med Res. 2024 Aug 13;11(1):55. doi: 10.1186/s40779-024-00561-4.
Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.
Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China's National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.
From 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35-64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5-7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: - 0.7%, 95% CI - 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI - 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: - 2.7%, 95% CI - 4.6 to - 0.7%, P = 0.007) in urban areas. Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas, periods, and regions in China.
Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities. Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.
在中国，宫颈癌和乳腺癌是导致女性癌症相关死亡的前四大原因。本研究旨在分析 2009 年至 2021 年中国城乡地区宫颈癌和乳腺癌的特定年龄死亡率的时间趋势。
从中国国家疾病监测点系统获取了 2009 年至 2021 年期间年龄在 20-84 岁的中国女性宫颈癌和乳腺癌的特定年龄死亡率数据。采用负二项回归模型评估城乡死亡率比值的差异，采用估计平均年百分比变化（AAPC）和斜率的 Joinpoint 模型比较不同年龄组死亡率的时间趋势和变化速度。
2009 年至 2021 年，与城市地区相比，农村地区宫颈癌和乳腺癌的特定年龄死亡率呈相对上升趋势。农村地区宫颈癌的筛查年龄呈上升趋势（35-64 岁，AAPC：4.0%，95%可信区间（CI）0.5-7.6%，P=0.026），而城市地区则呈稳定趋势（AAPC：-0.7%，95%CI-5.8 至 4.6%，P=0.78）。对于乳腺癌，农村地区呈稳定趋势（AAPC：0.3%，95%CI-0.3 至 0.9%，P=0.28），而城市地区呈下降趋势（AAPC：-2.7%，95%CI-4.6 至-0.7%，P=0.007）。农村地区宫颈癌死亡率的城乡差异随时间增加，而乳腺癌死亡率的城乡差异则随时间减少。在中国城乡地区的不同时期和不同地区，宫颈癌和乳腺癌的死亡率趋势均随年龄增加而上升，其中 35-54 岁年龄组的死亡率上升幅度最大。
由于死亡率趋势和城乡差异，应特别关注 35-54 岁的女性。关注脆弱年龄组和解决癌症控制项目在城乡地区的差异，可以提高资源效率并促进健康公平。
