1972-2021年江苏省启东市肝癌发病年龄-时期-队列趋势分析

Age-Period-Cohort Analysis of Liver Cancer Incidence in Qidong City of Jiangsu Province from 1972 to 2021

[目的]分析江苏省启东市1972-2021年全人群肝癌发病变化趋势,评估其年龄、时期和队列效应。[方法]从启东市癌症登记病例数据库中提取1972-2021年肝癌发病登记资料,计算粗发病率、世界人口标化率(世标率)和平均年度变化百分比(AAPC)。采用年龄-时期-队列模型分析启东市1972-2021年肝癌发病率的年龄、时期和队列效应。[结果]启东市1972-2021年共计发生肝癌36127例,世标率从1972-1981年的56.93/10万下降至2012-2021年的29.87/10万。其中男性26710例,世标率从1972-1981年的91.06/10万下降至2012-2021年的44.27/10万;女性9417例,世标率从1972-1981年的26.28/10万下降至2012-2021年的16.21/10万。50年世标率的AAPC为-1.47%(男性-1.67%,女性-1.02%)(P均<0.001)。净漂移值为-2.65%(男性-2.95%,女性-2.10%),均呈下降趋势;局部漂移表现为15~59岁年龄段(男性15~64岁,女性15~54岁)呈下降趋势。年龄效应表现为男性曲线为双峰型,第一峰在45~49岁年龄组(发病率为216.35/10万),第二峰在80岁及以上年龄组(发病率为186.35/10万);女性为单峰型,最高峰在75~79岁年龄组(发病率为108.75/10万)。时期效应以1992-1996年为参考组,1972-1976年RR为2.10(男性2.20,女性1.99),后逐渐下降,至2017-2021年至最低点,RR为0.50(男性0.46,女性0.62)。出生队列效应以1952-1956年出生组为参考组,1932-1936年为最高点,RR为1.18,后逐渐下降,至1982年后一直处于低位。APC模型的Waldχ2检验结果显示,男女合计、男性和女性肝癌发病风险的年龄效应、时期效应和出生队列效应趋势变化差异均具有统计学意义(P均<0.001)。[结论]启东肝癌发病率下降趋势明显,年龄、时期和队列均是影响启东肝癌发病的主要因素,老年人群及男性中年人群是肝癌防控重点关注对象,同时需继续监测肝癌发生的高危因子。

[Purpose]To analyze the trends of liver cancer incidence in Qidong City from 1972 to 2021 with an age-period-cohort model.[Methods]The crude rate(CR),age-standardized incidence rates by the world population(ASRW)and average annual percentage change(AAPC)were calculated using the liver cancer registration database of Qidong City from 1972 to 2021.An age-period-cohort model was used to analyze the age,period and cohort effects on liver cancer incidence.[Results]A total of 36127 cases of liver cancer occurred in Qidong City from 1972 to 2021.The ASRW decreased from 56.93/105(1972-1981)to 29.87/105(2012-2021).There were 26710 male cases and 9417 female cases.The ASRW in male and in female decreased from 91.06/105 and 26.28/105(1972-1981)to 44.27/105 and 16.21/105(2012-2021),respectively.The AAPC of ASRW over 50 years was-1.47%(-1.67%for males and-1.02%for females,P<0.001).The net drift value was-2.65%(-2.95%for males and-2.10%for females),indicating decreasing trends.Similarly,the local drift showed downward trends in the age group of 15~59 years old(15~64 years old for males and 15~54 years old for females).Age effect:for males there was bimodal peak with the first peak in age group of 45~49 years old(incidence of 216.35/105),and the second peak in age group of above 80 years old(incidence of 186.35/105);while for females there was a unimodal peak in the age group of 75~79 years old(incidence of 108.75/105).Period effect:with 1992-1996 as the reference group,the rate ratio(RR)was 2.10(2.20 for males and 1.99 for females)in 1972-1976,then gradually decreased to its lowest point in 2017-2021,with a RR of 0.50(0.46 for males and 0.62 for females).Birth cohort effect:with 1952-1956 as the reference group,the RR was 1.18 in 1932-1936,reaching its highest point,and then gradually decreased to the low level for those born after 1982.Waldχ2 test results of APC model showed that the age,period and birth cohort effect trends of liver cancer incidence risk were statistically significant for both sexes,males and females(P<0.001).[Conclusion]The incidence of liver cancer in Qidong has shown a significant decreasing trend.Age,period and cohort are the main factors affecting the incidence of liver cancer in Qidong.The elderly and middle-aged males are the primary focus for liver cancer prevention and control.It is necessary to continue monitoring emerging high-risk factors associated with the incidence of liver cancer.