山东省1970--2005年恶性肿瘤死亡率变化趋势分析

Time trends on the prevalence of cancer during 1970 -- 2005 in Shandong province

目的分析山东省1970-2005年肿瘤变化趋势。方法分析山东省1970－1974、1985-1989、1990-1992和2004-2005年全死因回顾调查资料（除1985-1989年为山东省组织的调查外，其余3次都是全国调查资料的一部分），1985--2005年3次抽样调查点的选择依据1970-1974年资料进行评估其代表性，观察指标为死亡率和标化死亡率，采用Joinpoint回归模型分析肿瘤变化速率。结果山东省肿瘤死亡率2005年比1970年上升了143．15％。标化率分析显示1970-1984年间年增长速率为0．54％，1985-1992年为1．24％，而1992年以后上升速率为0．18％。2004-2005年前8位主要恶性肿瘤位次为：肺癌、胃癌、肝癌、食管癌、肠癌、白血病、乳腺癌和宫颈癌，其中肺癌由第4位上升为首位，宫颈癌由第5位下降为第8位。主要恶性肿瘤中食管癌和宫颈癌呈逐年下降，胃癌呈前期上升后期下降，其余则为逐年上升趋势。城市人群肺癌和乳腺癌高于农村，而胃癌和食管癌低于农村人群。结论35年中山东省肿瘤死亡率明显上升，主要恶性肿瘤死因谱发生了很大变化。

Objective To analyze time trend of cancer during 1970--2005 in Shandong province so as to develop strategies for control and prevention of cancer at the community level. Methods Data was from 4 retrospective surveys regarding all causes of death during 1970-- 1974, 1985- 1989, 1990-- 1992 and 2004 -- 2005, in Shandong province. Other than one set of data collected in 1985 -- 1989 by Shandong province itself, the other 3 set of data were from the national surveys, in which the survey-point sampling of choice was based on data of 1970-- 1974 for assessing its representativeness. The observing indices would include standardized mortality and mortality. A join-point regression model was used to analyze the changing rate of tumor. Results The mortality rate of the entire tumor increased 143.15 percent in 2005 than in 1970. The changing slope of standardized rate of all tumors in the regression model showed that the inter-annual growth rate were 0.54 and 1.24 percent from 1970 to 1984 and from 1985 to 1992. The rate of increase since 1992 had been 0.18 percent. During 2004 -- 2005, the main malignant cancers were lung, stomach, liver, esophageal, colorectal, leukemia, breast and cervical cancer, in order. Lung cancer rose from the 4th ranking to the first while cervical cancer dropped from the fifth ranking to the 8th place. Esophageal cancer and cervical cancer were decreased annually while gastric cancer was increased in the early days but decreased later on. The rest of the cancers were on the rise year by year. Rates of lung and breast cancers were higher while gastric and esophageal cancers were lower seen in the urban than in rural areas. Conclusion In Shandong province, a marked increase was seen in the mortality rate of tumors in the past 35 years. Evidence showed that the spectrum of death among main malignant tumors had changed which might provide a scientific basis for the development of a community-based prevention and control program on cancer.