磁县1988-2011年食管癌死亡趋势分析

1988-2011 mortality trend of esophageal cancer in Ci county

目的磁县是世界上食管癌发病率最高的地区之一。分析北方食管癌高发区磁县1988-2011年食管癌死亡趋势,探讨趋势成因,为食管癌防治研究提供参考依据。方法截取磁县肿瘤登记处1988-01-01-2011-12-31登记ICD编码为150或C15的死亡数据,计算食管癌死亡率、年龄标准化死亡率和死亡年龄结构,采用Joinpoint软件估计年度变化百分比(annual percent change,APC)、年龄别APC和贡献率。结果 1988-2011年食管癌死亡12 813人,男7 953人,女4 860人。男女合计平均年死亡率为112.92/10万,男性为153.86/10万,女性为79.37/10万。24年来食管癌总死亡世标率、男性死亡世标率和女性死亡世标率均呈下降趋势(P<0.01),APC(95%CI)分别为-2.49%(-3.29%^-1.68%)、-2.18%(-3.08%^-1.27%)和-2.95%(-3.74%^-2.16%)。死亡人数自40岁以后明显升高,40~74岁组死亡人数占总死亡人数的81.19%。各年龄组对食管癌死亡率下降贡献率显示,40岁以后人群贡献率明显升高,40~74岁组贡献率为97.13%。年龄别APC显示40岁组死亡率下降最快,APC为-10.60%(P<0.05),后随年龄增长,下降速度变慢。结论磁县24年来食管癌死亡率呈下降趋势,但仍远高于全国平均水平,防治形势依然严峻;40~74岁人群死亡率下降对整体死亡率下降贡献最大,加强对这一人群的早诊早治内镜筛查,特别是提高筛查依从性有助于磁县食管癌死亡率下降。

OBJECTIVE Ci county is one of the area with the highest esophageal cancer incidence in the world. The objective of this study was to analyze the mortality time trends of esophageal cancer in Ci county, a high risk area of esophageal cancer in northern China, and to investigate the trend of causes, in order to provide scientific basis for esophageal cancer prevention. METHODS Cancer mortality data （ICD code： 150 or C15） assembled by Ci county＇s cancer registry system from January 1, 1988 to December 31, 2011 were used in statistic analysis, which consisted of the crude mortality, age standardized mortality rate （ASR）, age structure of died, annual percent change （APC） and contribution rate. The Join Point regression program was applied to detect the trend of cervical cancer mortality. RESULTS There were 12 813 people （7 953 males and 4 860 females） died from esophageal cancer. The ASR was 112.92 per 100 000; among which male was 153.86 per 100 000 and female was 79.37 per 100 000. The trend of mortality was declining, annual percent change was -2.49%（P〈0.01）, for male it was -2.18% （P〈0.01） and for female it was -2. 95% （P〈 0.01 ）. The death toll was significantly elevated after 40 years of age, in 40-74 year old group the total of deaths accounted for 81.19 %. The contribution rate of esophageal cancer mortality rate in each age group showed a significant increase in the population after 40 years of age, the contribution rate of 40- 74 years group was 97.13%. The annual percent change by age showed in 40 years old group the fastest decline in mortality（APC was -10.60 %, P〈0.05）, and with age increase, the decline rate was slow. CONCLUSIONS In the last 24 years, the mortality trend of esophageal cancer was declining in Ci county, it is still higher than the average level, prevention and control of the situation is still important.The decrease of mortality rate of aged 40-74 years old had the largest contribution for the declining of overall mortality To strengthen the early diagnosis and treatment of endoscopic screening in covering this population and increase the corn pliance are helpful to the decrease of the mortality of esophageal cancer in Ci County.