| ObjectiveTo analyze the incidence,mortality and disease burden of cancer in Hubei Province in 2012-2015 and the tendency of their changes,this study conducted a comprehensive and systematic evaluation of the health hazards of malignant tumors in Hubei Province,and provided a suitable reference basis for exploring etiology and developing scientific strategies of cancer prevention and control.MethodsIn our study,we collected data of cancer registration from Hubei Provincial Central Cancer Registry in 2012-2015,and utilized incidence/mortality,standardized incidence/mortality,age-specific incidence/mortality to analyze the incidence and mortality of cancer from 2012 to 2015 comprehensively with descriptive epidemiological methods,and calculated the disability-adjusted life years(DALY)and the DALY rate with the formula provided by the World Health Organization(WHO)to estimate the disease burden of malignant tumors.Meanwhile,Joinpoint regression model was used to calculate the annual percentage change(APC)and its 95%confidence interval(CI)to analyze the trend of the incidence,mortality and disease burden of cancer.Results(1)Percentage of population coverage and quality control overviewThe total population covered by the cancer registries in Hubei province from 2012-2015 was 43,957,239,of which 22,447,225 were males and 21,510,014 were females.The data quality control indicators including the proportion of morphological verification(MV%),percentage of cancer cases identified with death certification only(DCO%),mortality to incidence ratio(M/I),the proportion of unknown basis of diagnosis(UB%)were 76.96%,0.71%,0.60 and 0.11%,respectively.(2)IncidenceFrom 2012 to 2015,there were a total of 121,854 new cases of cancer in the cancer registration areas of Hubei Province(67249 males and 54605 females).The crude incidence rate was 277.21/100,000(299.59/100,000 for males and 253.86/100,000 for females).The age-standardized incidence rate by 2000’s Chinese standard population(ASIRC)was 188.00/100,000(205.98/100,000 for males and 172.59/100,000 for females).The age-standardized incidence rate by World Segi’s population(ASIRW)was 184.05/100,000(205.20/100,000 for males and 165.42/100,000 for females).The top 5 most common cancers were lung cancer,female breast cancer,liver cancer,colorectal cancer and stomach cancer in order.The age-specific incidence of cancer was at a low level before the age of 40,and rose rapidly after that,reaching a peak in the age group of 80-84 years.In general,the crude incidence,ASIRC and ASIRW for males were higher than those for females,and the crude incidence,ASIRC and ASIRW in urban areas were higher than those in rural areas.Among the common cancers,there were huge disparities in the incidence between urban and rural areas.From 2012 to2015,the overall incidence of cancer kept stable.The incidence of liver cancer and lung cancer for rural males and breast cancer for urban females showed downward trends,with the APC of 3.47%(P=0.02),2.68%(P=0.05),and 1.30%(P=0.02),respectively.(3)MortalityFrom 2012 to 2015,there were a total of 73,334 deaths of cancer in the cancer registration areas of Hubei Province(47836 males and 25498 females).The crude mortality rate was 166.83/100,000(213.10/100,000 for males and 118.54/100,000 for females).The age-standardized mortality rate by 2000’s Chinese standard population(ASMRC)was 107.64/100,000(143.68/100,000 for males and 73.36/100,000 for females).The age-standardized mortality rate by World Segi’s population(ASMRW)was 107.25/100,000(143.88/100,000 for males and 72.52/100,000 for females).The top 5 death cancers were lung cancer,liver cancer,stomach cancer,colorectal cancer and esophageal cancer.The age-specific mortality of cancer was at a low level before40 years old,and rose rapidly after that,reaching a peak in the age group of 80-84 years.In general,the crude incidence,ASMRC and ASMRW for males were higher than those for females.The crude mortality rate in urban was higher than that in rural,however,the ASMRC and ASMRW were lower in urban.Among the common cancers,there were huge disparities in the mortality between urban and rural areas.From 2012 to 2015,the overall mortality of cancer kept stable.The mortality of colorectal cancer for rural males and cervical cancer for urban females both showed upward trends with the APC of 8.84%(P=0.05)and 21.0%(P=0.01),respectively.(4)Cancer burdenFrom 2012 to 2015,the overall DALY of cancer was 993,430.99 person-years,and the rate of the DALY was 22.60/1,000.The top five malignancies of DALY rates were lung cancer,liver cancer,stomach cancer,colorectal cancer and female breast cancer.The DALY rate of cancer was low before the age of 30,then increased gradually,reached the peak in the age group of 70-79,and decreased slightly after the age of 80.In general,the DALY rate of cancer was higher in males than that in females.The DALY rate of cancer in urban areas was slightly higher than that in rural areas.Among the common cancers,the gap of cancer burden between urban and rural areas was small.From 2012 to 2015,the DALY rate kept stable on the whole.The DALY rates of liver cancer for rural males,stomach cancer for urban males and lung cancer for urban females decreased with the APC of 5.15%(P=0.02),4.85%(P=0.03)and 2.54%(P=0.04).The DALY rate of colorectal cancer for rural males increased(APC=6.49%,P=0.05).ConclusionsDuring 2012-2015,the incidence and mortality rates of cancer in Hubei Province were comparable to the national average level,and the rate of the DALY was lower than the national average level.Lung cancer,gastrointestinal malignant tumors and breast cancer were the cancers with the heaviest disease burden.The incidence,mortality and disease burden of cancers kept stable generally.The government should further strengthen the prevention and control of tumors,attach importance to the tertiary prevention of malignant tumors,and promote the implementation of early diagnosis and treatment of malignant tumors.Meanwhile,we should rationally allocate medical resources and implement targeted prevention and control measures based on the characteristics of the respective cancer spectrums in urban and rural areas,in order to achieve the goal of reducing the burden of malignant tumors.Highlights and limitationsThe innovation of this study includes the following two points.Firstly,this study used the cancer registration data of 4 consecutive years collected by Hubei Provincial Central Cancer Registry from 2012 to 2015.Based on these data,incidence/mortality,standardized incidence/mortality,age-standardized incidence/mortality,the DALY and the DALY rate were calculated to comprehensively describe the cancer prevalence and the burden of malignant tumors in cancer registration areas of Hubei Province.In addition,Joinpoint regression model was used to analyze the trends of incidence,mortality and disease burden intensity of common cancers in Hubei Province.However,there were some limitations in this study.Firstly,since the collected data covered just a short period of time,the significance of the trend analysis of cancer incidence,mortality,and disease burden intensity is not prominent.Besides,until 2015,the population covered by the cancer registries was approximately one-third,which may not represent the entire Hubei Province population,therefore,bias may exist.Secondly,due to the lack of data on the average course and disability weight of malignant tumors in Hubei Province,Year of Lived with Disability(YLD)was calculated by the indirect method,and the results may differ from the real situation.Finally,owing to the time required for data collection,quality control and analysis,the latest cancer statistics in the domestic have an about 3 or 4-year lag behind the current year,therefore,the timeliness of this study has some limitations. |
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