1976—2015年上海市黄浦区消化系统恶性肿瘤发病和死亡趋势分析

Analysis on Incidence and Mortality Trends of Digestive System Cancer in Huangpu District of Shanghai,1976—2015

[目的]分析上海市黄浦区1976—2015年间消化系统恶性肿瘤的发病和死亡情况及流行趋势。[方法]根据黄浦区1976—2015年消化系统恶性肿瘤发病、死亡和相应人口资料,分别计算胃癌、肝癌和结直肠癌以及全部消化系统恶性肿瘤的粗发病率和死亡率、标化发病率和死亡率。利用Joinpoint软件分析标化率的趋势变化,计算其年度变化百分比(APC)和年均变化百分比(AAPC),并进一步构建年龄-时期-队列模型,分析年龄、时期和出生队列对发病率和死亡率的影响。[结果]2011—2015年黄浦区男性胃癌、肝癌和结直肠癌累计发病分别为1112、871、1504例,女性累计发病分别为661、375、1336例;男性胃癌、肝癌和结直肠癌累计死亡分别为935、784、971例,女性累计死亡分别为559、328、918例。消化系统恶性肿瘤标化发病率在男性(AAPC=-1.67%,95%CI:-3.12%~-1.67%)和女性(AAPC=-1.18%,95%CI:-1.82%~-0.54%)中均呈显著的下降趋势。分肿瘤类型看,肝癌和胃癌标化发病率和死亡率在男性和女性中均呈显著下降趋势,而结直肠癌标化发病率和死亡率在男性和女性中呈显著逐年上升趋势。年龄-时期-队列模型分析发现,男性中所有肿瘤的发病率与死亡率均随着年龄增长而递增,肝癌死亡及胃癌发病和死亡风险均随时间推移逐渐降低;胃癌、肝癌的发病风险随出生时间往后而逐渐降低,而男、女性结直肠癌发病和死亡风险均随出生时间推移有先上升后下降的趋势,20世纪20至40年代出生的人群发病和死亡风险最高。[结论]1976—2015年间上海市黄浦区胃癌、肝癌发病率和死亡率在男、女性中均呈显著下降趋势,但结直肠癌的发病率显著上升,对结直肠癌的预防和筛查亟需重视。

[Purpose]To analyze the time trends of incidence and mortality of digestive system cancer in the Huangpu District of Shanghai from 1976 to 2015.[Methods]Based on the cancer incidence and mortality data of Huangpu District of Shanghai from 1976 to 2015,the crude and the age-standardized incidence and mortality rates(ASR)by world standard population were calculated.Joinpoint regression was performed to obtain the annual percentage change(APC)and average annual percentage change(AAPC).Age-period-cohort model was constructed to evaluate the effects of age,period and cohort on digestive cancer incidence and mortality.[Results]From 2011 to 2015,1112,871,1504 male cases of gastric,liver and colorectal cancer were diagnosed;and the corresponding numbers of deaths were 935,784,971,respectively.During the same period,661 cases of gastric cancer,375 cases of liver cancer and 1336 cases of colorectal cancer were diagnosed in women;559,328,918 women died of those three cancers,respectively.The overall incidence rate of digestive cancers showed downward trends amongst both males(AAPC=-1.67%,95%CI:-3.12%~-1.67%)and females(AAPC=-1.18%,95%CI:-1.82%~-0.54%).Specifically,the incidence and mortality rates of liver cancer and gastric cancer descended considerably during the study period,while the incidence and mortality rates of colorectal cancer denoted ascending trends in both genders.As for age-period-cohort analysis,the incidence and mortality risk of digestive system cancer increased with age for both genders.The period effects showed that liver cancer mortality,gastric cancer incidence and mortality displayed similar monotonic decreasing temporal trends in both males and females.As for colorectal cancer incidence and mortality,cohort effects showed that people born between 1920 and 1940 had a higher risk of colorectal cancer incidence and mortality than other birth cohorts.[Conclusion]During 1976 to2015,the incidence and mortality rates of liver cancer and gastric cancer in Huangpu District of Shanghai showed an overall declining trend,but the incidence rate of colorectal cancer increased significantly,which indicates that the prevention and screening of digestive system cancer should be emphasized.