Levi F, La Vecchia C, Lucchini F, Negri E
Institut universitaire de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Eur J Cancer. 1996 Apr;32A(4):652-72. doi: 10.1016/0959-8049(95)00582-x.
Trends in age-standardised mortality for all cancers and 21 cancers or groups of cancers over the period 1955-1992 were analysed for 33 countries from four continents in a population aged 65-84 years. Mortality from all neoplasms in the elderly showed heterogeneous patterns in various countries and in the two sexes. Trends were generally more favourable for females than for males, reflecting essentially the earlier and more extensive impact of the lung cancer (and other tobacco-related neoplasms) epidemic in elderly males, in addition to the earlier decline of gastric cancer and a widespread decline of cervical cancer rates in females. In several countries, particularly from western Europe, but also Japan, cancer mortality trends were more favourable over the last two decades than in earlier calendar periods. Some countries of northern and central Europe (including Finland, Germany, Austria and Switzerland) showed stable or even downward trends over time for total cancer mortality in both sexes, particularly in males. This reflects the different patterns of the tobacco-related (lung) cancer epidemic in various countries, and the impact of a few other major neoplasms, including in particular the systematic downward trends in stomach cancer. In contrast, rates were moderately upwards in males in North America, and several countries of southern and eastern Europe, where cancer mortality in the elderly was comparatively low in the 1950s, showed appreciable upward trends, mostly in males. Thus, there was a generalised tendency towards a levelling of the differences in certified cancer mortality in the elderly population in various areas of the world. Although there are substantial limits and uncertainties in the reliability and validity of cancer death certification and their trends in the elderly, there is no widespread and generalised upward trend in cancer mortality, with a major exception of lung and other tobacco-related neoplasms. Furthermore, in several countries, cancer mortality trends over the last four decades have been favourable for elderly women.
对来自四大洲33个国家65至84岁人群在1955年至1992年期间所有癌症以及21种癌症或癌症组的年龄标准化死亡率趋势进行了分析。老年人所有肿瘤的死亡率在不同国家和两性中呈现出异质性模式。总体而言，女性的趋势比男性更有利，这主要反映出老年男性中肺癌（及其他与烟草相关的肿瘤）流行的影响更早且更广泛，此外还有老年女性胃癌发病率的早期下降以及宫颈癌发病率的普遍下降。在几个国家，特别是西欧国家以及日本，过去二十年的癌症死亡率趋势比早期更有利。北欧和中欧的一些国家（包括芬兰、德国、奥地利和瑞士）随着时间推移，两性的总癌症死亡率呈现稳定甚至下降趋势，尤其是男性。这反映了不同国家与烟草相关（肺癌）的癌症流行模式不同，以及其他一些主要肿瘤的影响，特别是胃癌发病率呈系统性下降趋势。相比之下，北美洲男性以及南欧和东欧的几个国家的癌症死亡率呈适度上升趋势，这些国家在20世纪50年代老年人群的癌症死亡率相对较低，且大多是男性呈现出明显的上升趋势。因此，世界各地区老年人群经认证的癌症死亡率差异普遍有趋于平稳的趋势。尽管癌症死亡证明的可靠性和有效性及其在老年人中的趋势存在很大局限性和不确定性，但除了肺癌及其他与烟草相关的肿瘤外，癌症死亡率并没有普遍的上升趋势。此外，在几个国家，过去四十年来老年女性的癌症死亡率趋势较为有利。
