中国2013—2018年≥30岁居民肺癌死亡率变化轨迹分析

Changing trajectory of lung cancer mortality in Chinese residents 30 years old and above, 2013-2018

目的分析中国2013—2018年≥30岁居民肺癌死亡率变化轨迹,为制定肺癌防治策略提供科学依据。方法收集2013—2018年中国死因监测数据集中2013年1月1日—2018年12月1日报告的全国31个省(自治区、直辖市)605个监测点588245例≥30岁居民的肺癌死亡数据,采用2010年中国人口普查数据作为标准人口计算标化死亡率,并选取不同性别分地区、城乡和年龄别肺癌死亡率数据应用潜分类增长模型对不同发展趋势的亚组进行轨迹分析。结果中国≥30岁居民2013、2014、2015、2016、2017和2018年肺癌粗死亡率分别为40.2/10万、40.0/10万、44.8/10万、44.9/10万、45.4/10万和46.5/10万,标化死亡率分别为35.4/10万、37.2/10万、38.8/10万、36.5/10万、36.6/10万和36.1/10万,肺癌标化死亡率呈先升后降的趋势(χ2趋势=3.42,P<0.001)。轨迹分析结果显示,男性肺癌死亡率随年份变化的轨迹可分为4个亚组,第1组呈线性下降趋势,其余3组均呈二次项曲线;东、中、西部30~70岁居民的肺癌死亡率随年份变化的轨迹相同,且随着年龄的增加进入更高死亡率亚组的发展轨迹;女性肺癌死亡率随年份变化的轨迹可分为3个亚组,均呈先升后降的趋势;东部农村45~49岁居民更早进入下一个更高死亡率亚组的发展轨迹。结论中国2013—2018年≥30岁男性和女性居民肺癌死亡率变化存在不同轨迹模式,识别我国分地区、城乡和年龄别居民肺癌死亡率的变化轨迹有助于有针对性地制定相应的肺癌防治策略。

Objective To analyze changing trajectory of lung cancer mortality among Chinese residents aged 30 years and above from 2013 to 2018 and to provide evidences for developing strategies on lung cancer treatment and prevention.Methods From cause-of-death data in the National Disease Surveillance Point system, we extracted the data on all lung cancer deaths at ages of 30 and above(n = 588 245) registered from 2013 through 2018 at 605 surveillance sites in 31 provincial level regions across China. The population census data of 2010 was used in calculation of standardized mortality rate(SMR). Latent variable growth model was adopted to analyze gender-, age-, and region-specific changing trajectory of lung cancer mortality. Results For years of 2013 – 2018, the annual crude mortality rates(1/100 000) of lung cancer were40.2, 40.0, 44.8, 44.9, 45.4, and 46.5 for the Chinese residents aged 30 years and above, respectively and the corresponding SMRs(1/100 000) were 35.4, 37.2, 38.8, 36.5, 36.6, and 36.1, with an up-down trend(χ2 trend = 3.42, P < 0.001). Four patterns of changing trajectory of lung cancer mortality in male residents could be identified, with a pattern of linearly downward trend and other three patterns of quadratic curving. Similar changing trajectories of lung cancer mortality over years were observed in the residents aged 30 – 70 years in eastern, central and western China;but in the residents at older age with higher lung cancer mortality, different patterns of changing trajectories were identified. For female residents, three patterns of lung cancer mortality trajectories changing over years were found and the trajectories showed a trend of rising first and then decreasing;the changing trajectory for female rural residents aged 45 – 49 years in eastern China differed from that for the residents of same ages in other regions and the trajectory was similar to that for the residents at elder age with higher lung cancer mortality rates. Conclusion There are different changing trajectories of lung cancer mortality between male and female residents in China. Identifying gender-, age-, and region-specific changing trajectory of lung cancer mortality is meaningful for developing targeted measures for lung cancer prevention and control.