1973—2017年上海市结直肠癌流行趋势及年龄-时期-队列分析

Colorectal cancer incidence and mortality trends in urban Shanghai,China from 1973 to 2017:a Joinpoint regression and age-period-cohort analysis

目的:分析1973—2017年上海市结直肠癌发病、死亡现状及流行趋势。方法:采用Joinpoint回归分析,描述结直肠癌的时间变化趋势和年度百分比变化。采用年龄-时期-队列分析以进一步估计年龄、时期和出生队列效应对结直肠癌发病和死亡的影响。结果:1973—2017年上海市市区居民共有105847例新发结直肠癌病例和60447例死亡病例,均呈现逐年增长的趋势。上海市市区结直肠癌年龄标化发病率的上升趋势明显,由1973年的14.1/10万上升至2017年的27.7/10万,年龄标化死亡率则从8.2/10万上升至10.7/10万。总体年平均年龄标化发病率和死亡率分别为20.4/10万和11.0/10万。随着人群年龄的增加,结直肠癌年龄标化发病率和死亡率均呈现明显的上升趋势。以1993—1997年为参照,上海市市区居民结直肠癌发病风险在2013—2017年达到最高,相应的相对危险度(relative risk,RR)为1.2(95%置信区间:1.2~1.3),在1973—1977年则最低,为0.9(95%置信区间:0.8~1.0);死亡风险则与之相反,随时期的增长而降低。1953—1957年之前,上海市市区居民的结直肠癌发病风险随出生队列时间的增加而升高,之后则呈现下降趋势。1957年后出生的人群结直肠癌死亡风险也相应地呈现下降趋势。结论:1973—2017年上海市结直肠癌发病率和死亡率均呈上升趋势,但不同人群的流行趋势仍有所差异。

Objective:To describe the epidemiological features and temporal trends of colorectal cancer in urban Shanghai from 1973 to 2017.Methods:Data on colorectal cancer in urban Shanghai was obtained through Shanghai Cancer Registry and Vital Statistics System.Joinpoint analysis was used to describe the temporal trends and annual percent change(APC)and age-period-cohort analysis was used to estimate the association between age,period and birth cohort and colorectal cancer.Results:A total of 105847 cases and 60447 deaths of colorectal cancer were diagnosed in urban Shanghai over the 45-year study period.Both the number of new cases and the number of deaths showed an increasing trend.In the same period,the age-standardized incidence of colorectal cancer in urban areas of Shanghai increased significantly from 14.1/100000 in 1973 to 27.7/100000 in 2017,while the age-standardized mortality rate increased from 8.2/100000 to 10.7/100000.The overall average annual age-standardized incidence and mortality rates were 20.4/100000 and 11.0/100000,respectively.With the increase of age,the age-standardized morbidity and mortality of colorectal cancer showed an obvious upward trend.Taking 1993-1997 as reference,the risk of colorectal cancer in Shanghai reached the highest in 2013-2017,and the corresponding relative risk was 1.2(95%confidence interval:1.2-1.3),while the lowest was 0.9(95%confidence interval:0.8-1.0)during 1973-1977.Mortality risk,on the contrary,decreased with the increase of time.Before 1953-1957,the risk of colorectal cancer in urban Shanghai increased with the increase of birth cohort time,and then showed a downward trend.There was a corresponding decline in the risk of colorectal cancer death among people born after 1957.Conclusion:The incidence and mortality of colorectal cancer in Shanghai showed an increasing trend from 1973 to 2017,but the prevalence trend of colorectal cancer is still different among different populations.