中国肺癌死亡趋势分析及发病、死亡的估计与预测

Mortality time trends and the incidence and mortality estimation and projection for lung cancer in China

背景与目的利用我国现有相对较完善的肺癌发病死亡资料,描述中国肺癌死亡趋势,并估计和预测2000年及2005年的肺癌发病与死亡状况,以期对我国肺癌临床、基础研究及防治策略制定提供依据及参考.方法利用Joinpoint模型对卫生部上报WHO的中国1987～1999年肺癌死亡数据进行趋势分析,结合我国1990～1992年第二次全死因调查结果及我国入选<五大洲癌症发病率>第八卷中肿瘤登记处的肺癌发病死亡数据,采用对数线性模型(基于Poisson分布),估计并预测2000年及2005年中国肺癌的发病、死亡状况.结果我国肺癌年龄调整死亡率总体呈上升趋势,尤以农村明显(男性年均上升2.7%,女性上升3.6%,均有统计学意义)且各年龄段(15岁以上)均呈不同程度上升趋势.自2000年至2005年,我国肺癌的死亡人数将增加10.1万(自2000年的32.7万增至2005年的42.8万),发病人数将增加11.6万(自2000年的38.1万增至2005年的49.7万).结论由于肺癌危险因素变化及人口增长、老龄化的双重作用,肺癌已成为中国近年来最常见、增幅最大的恶性肿瘤之一,其预防与控制将成为未来中国肿瘤控制计划制定和实施的重点之一,而控制烟草无疑成为其关键.

Background and objective Using the most comprehensive available data on lung cancer incidence and mortality in China, the mortality time trends were described and the incidence and mortality profile in 2000 and 2005 were estimated and projected, so as to provide evidence and reference for clinic, basic research and making prevention and control strategy for lung cancer in China. Methods The Joinpoint model was used to analyze the lung cancer mortality trends during 1987 -1999, based on data reported to WHO from the Ministry of Health in China. Combined with the data from the second national mortality survey in 1990-1992 and the lung cancer incidence and mortality data from several cancer registries in China which involved in Cancer Incidence in Five Continents, the 8th version, using the log linear model （based on Poisson distribution）, the incidence and mortality profile for lung cancer in 2000 and 2005 in China were estimated and projected. Results The age standardized mortality rates increased during the study period, especially in rural areas （the expected annual percentage changes were 2.7% in men and 3.6% for women, both were statistically significant） and showed among almost all age groups （above age 15）. From 2000 to 2005, there would be 0. 101 million more lung cancer deaths （from 327 643 in 2000 to 428 936 in 2005） and 0. 116 million more new incident cases （from 381 187 in 2000 to 497 908 in 2005）. Conclusion Due to the double effects from both changes in the risk factors for the disease and the population growth and aging, lung cancer is becoming one of the most common and increasing malignant neoplasm in China. The prevention and control for this disease will be the emphasis for future cancer control strategy of China in which tobacco control is critically important.