天津市1999-2015年宫颈癌死亡率和过早死亡损失寿命年变化趋势分析

Analysis on long-term trends of cervical cancer mortality and years of life lost in Tianjin,1999-2015

目的 分析天津市宫颈癌死亡长期趋势,为开展相关研究和预防工作提供参考。方法 计算1999-2015年天津市宫颈癌的死亡率、标化死亡率、累积死亡率(0~74岁)、截缩死亡率(35~64岁)和过早死亡损失寿命年(YLL),应用Joinpoint回归分析宫颈癌死亡率、YLL率的趋势和年度变化百分比(APC),并分析不同年龄组变化趋势。结果 1999-2015年天津市户籍居民因宫颈癌死亡1 741人,平均粗死亡率为2.15/10万,中国人口标化率为1.47/10万,世界人口标化率为1.50/10万,平均每年YLL为3 347.97人年。宫颈癌死亡者中,0~34岁占3.10%,35~64岁占57.84%,≥ 65岁占39.06%;城市宫颈癌死亡率高于农村,城乡比为1.37:1。1999-2015年宫颈癌年龄别死亡率随年龄的增加而上升。2014-2015年年龄别死亡率呈现双峰分布的特征,50岁为第一个高峰,75岁为第二个高峰;1999-2011年天津市女性宫颈癌死亡率呈稳定状态(APC=-0.2%,P=0.80),2011-2015年呈快速上升趋势(APC=21.6%,P<0.01);20~49岁组1999-2015年呈上升趋势(APC=6.9%,P<0.01);50~69岁组1999-2007年呈下降趋势(APC=-9.2%,P<0.01),2007-2015年呈上升趋势(APC=14.5%,P<0.01);≥ 70岁组1999-2009年呈下降趋势(APC=-10.2%,P<0.01),2009-2015年变化差异无统计学意义(APC=7.8%,P=0.10)。自2008年开始,50~70岁组宫颈癌的YLL率超过≥ 70岁组,并且差距逐渐扩大。结论 自2011年天津市地区宫颈癌死亡率呈快速上升趋势,50~70岁人群将是宫颈癌寿命损失的主要群体。

Objective To analyze the mortality and years of life lost (YLL) trends of cervical cancer in Tianjin, and provide references for the research and prevention programs of cervical cancer. Methods Mortality rate, standard mortality rate, cumulative rate (0-74 years-old) and truncated rate (35-64 years-old) of cervical cancer from 1999 to 2015 were calculated. The annual percentage change of the mortality rate and YLL rate were analyzed by using Joinpoint regression analysis, and the trend in different age-groups were analyzed. Results From 1999 to 2015, 1 741 cases died of cervical cancer in Tianjin, the average crude mortality rate was 2.15/100 000. The average age-standardized rate of (ASR) China and ASR world were 1.47/100 000 and 1.50/100 000 respectively. The average YLL was 3 347.97 person-years. Deaths occurred in those aged 0-34 years, 35-64 years and 65 years and over accounted for 3.10%, 57.84% and 39.06% of the total, respectively. The mortality rate of cervical cancer in urban area was higher than that in rural area, with a ratio of 1.37:1 between urban area and rural area. The age-specific mortality rate of cervical cancer during 1999-2015 increased with age. Two peaks of mortality rate were observed in those aged 50 years and aged 75 years, during 2014-2015. From 1999 to 2011, the mortality rate of cervical cancer was stable (APC=-0.2%, P=0.80), but there was a rapid increase from 2011 to 2015 (APC=21.6%, P<0.01). But group aged 20-49 years, it showed an upward trend from 1999 to 2015 (APC=6.9%, P<0.01). For group aged 50-69 years, it showed a downward trend from 1999 to 2007 (APC=-9.2%, P<0.01), and an upward trend from 2007 to 2015 (APC=14.5%, P<0.01). For group aged 70 years and over, it showed a downward trend from 1999 to 2009 (APC=-10.2%, P<0.01), but the difference in the mortality were not significant from 2009 to 2015 (APC=7.8%, P=0.10). Since 2008, the YLL rate of cervical cancer in group aged 50-70 years had exceeded that in group aged >70 years and the gap gradually widened. Conclusions There had been a rapid increase trend of cervical cancer mortality since 2011 in Tianjin. Women aged 50-70 years were the main group of life loss.