2006—2019年上海市普陀区户籍居民结直肠癌过早死亡变化趋势

Tendency of premature mortality caused by colorectal cancer among registered residents in Putuo District of Shanghai from 2006-2019

目的了解上海市普陀区户籍居民结直肠癌死亡特征及早死情况,为完善防治方案,实现"健康2030"规划目标提供参考。方法收集2006—2019年上海市普陀区户籍居民结直肠癌死亡资料,通过编制寿命表,计算粗死亡率、标化死亡率和早死概率等指标,并采用年度变化百分比(APC)反映指标的变化趋势。结果 2006—2019年,上海市普陀区户籍居民结直肠癌粗死亡率从25.97/10万上升至39.03/10万(APC=3.18%,P<0.01),上升速度大于恶性肿瘤总体水平;标化死亡率从12.90/10万下降至10.66/10万(APC=-1.19%,P<0.05),下降速度慢于恶性肿瘤总体水平;占恶性肿瘤死亡的比例从10.93%上升至13.69%(APC=1.61%,P<0.01)。男、女性3类指标的变化情况与总体相似。不同年龄组死亡率变化有所不同,筛查推荐的50~74岁组结直肠癌粗死亡率从43.13/10万上升至44.08/10万(APC=0.24%,P>0.05),过早死亡年龄段(30~69岁)粗死亡率从14.99/10万上升至22.18/10万(APC=3.47%,P<0.01),其中男性上升趋势明显(APC=5.18%,P<0.01),上升速度快于恶性肿瘤总体水平。结直肠癌死亡中70岁以下占比从34.53%增加至37.25%(APC=1.13%,P=0.05),其中男性上升趋势明显(APC=2.08%,P<0.01),上升速度快于恶性肿瘤总体水平。结直肠癌早死概率从7.86‰下降至6.84‰(APC=-0.69%,P>0.05),其中男性从7.69‰增加至8.45‰(APC=0.48%,P>0.05),女性从8.08‰下降至5.24‰(APC=-2.53%,P>0.05)。与恶性肿瘤总体变化情况相比,结直肠癌早死概率下降趋势不明显,男性结直肠癌早死概率年度变化有所增加。结论 2006—2019年上海市普陀区结直肠癌所致过早死亡情况并未明显缓解,应进一步探索并完善现有筛查方案,合理确定目标人群,开展针对性的筛查动员,提供更充分的经费保障,切实增强筛查效能,促进早死概率降低。

Objective To describe the death characteristics and premature mortality of registered residents with colorectal cancer(CRC) in Putuo District of Shanghai,provide reference for improving the prevention and control program and achieving the goal of “health 2030”. Methods The death data of CRC among registered residents in Putuo District of Shanghai from 2006-2019 were collected. The life table was formulated to calculate the crude mortality,standardized mortality and the probability of premature mortality,and the annual percentage change(APC) was used to describe the change of these indexes. Results From 2006-2019,the crude mortality of CRC among registered residents in Putuo District of Shanghai increased from 25.97/lakh to 39.03/lakh(APC =3.18%,P<0.01),and the rising rate was faster than the overall level of cancer. The standardized mortality decrease from12.90/lakh to 10.66/lakh( APC =-1. 19 %, P < 0. 05), and the decreasing rate was slower than the overall level of cancer. The proportion of CRC deaths to cancer deaths increased from 10.93% to 13.69%(APC=1.61%,P<0.01). The changes of the three indexes for male and female respectively were similar to the overall. The change of mortality was difference among different age groups. The crude mortality of the screening target 50-74 year-old age group increased from 43.13/lakh to 44.08/lakh(APC=0.24%,P>0.05),The crude mortality of of the premature death age group of 30-69 years old increased from 14.99/10/lakh to 22.18/lakh(APC=3.47%,P<0.01),especially for the male with greater increase(APC=5.18%,P<0.01),which the rising rate was faster than the overall level of cancer. The proportion of deaths under 70 years old to CRC deaths increased from 34.53% to 37. 25 %( APC = 1.13%,P=0.05),especially for the male with greater increase(APC=2.08%,P<0.01),which the rising rate was faster than the overall level of cancer. The probability of premature mortality of CRC decreased from 7.86‰ to 6.84‰(APC=-0.69%,P >0.05),while that in male increased from 7.69‰ to 8.45‰ (APC =0.48%,P >0.05) and in female decreased from 8.08‰ to5.24‰ (APC =-2.53%,P >0.05). Compared with the overall change of cancer,the decreasing trend of probability of premature mortality of CRC was not obvious,and the annual change in probability of premature mortality of CRC in males increased.Conclusion The premature death caused by colorectal cancer has not been yielded in Putuo District of Shanghai from 2006-2019.It is necessary to further explore and improve the existing screening program,reasonably determine the target population,carry out targeted screening mobilization,provide more adequate funding support,effectively enhance the screening efficiency and reduce the probability of premature death.