| Background:In both developed and developing countries,the society bears an enormous burden from cancer.With the development of urbanization and economy,growth and aging problems of the population are getting more and more serious.Also,there is an increasing prevalence of existing risk factors such as smoking,obesity,physical inactivity.All of these lead to the increasing of the morbidity and mortality rates of cancer.Based on the GLOBOCAN 2018 criteria of the assessement on cancer incidence and mortality released by IARC,there will be an estimated 18.1 million new cancer cases and 9.6 million cancer deaths in 2018.Such a burden is shifting to the less developed areas.Almost half of new cancer cases and 70% of cancer deaths were estimated in Asia.In 2014,380.4 million new cases and 229.6 million cancer deaths were reported in China.Lung caner,stomach cancer,colorectal cancer,liver cancer and breast cancer are ranked as top five in terms of morbidity,with breast cancer as the top one in female.Lung cancer,liver cancer,stomach cancer,esophageal cancer and colorectal cancer are top 5 leading causes of cancer death.Although the morbidity rates in developed areas are twice as high as that in developing countries,mortality rates are only 8% to 15% higher in more developed countries.This disparity is identified to be associated with risk factors,screening methods and the progress on medical diagonosis and therapy.Exposure to risk factors,which are various in different areas,has primary correlation with cancer related death.Proper public health actions can not only reduce the exposure,but also improve the tertiary prevention system with participation among all fields in our society.An integrated monitoring system with collection of risk factors and end-point index is essential for making policies,evaluating diseases and monitoring trends.Only in this way,can we improve the prevention for malignancy,including chronic diseases.Center for disease control(CDC)in Yangpu district has already established two disease monitoring systems separately for death registration and chronic disease morbidity reporting.As a traditional industry area,Yangpu district is a characteristic epitome for Shanghai.ObjectiveTo study on cancer mortality monitoring data of Shanghai Yangpu District between 1974 and 2014 for descriptive analysis and time trend analysis of major changes in tumor mortality;To identify the main factors affecting the cancer mortality trend of Yangpu District in 41 years from relevant public health data;to predict major cancer mortality of Yangpu District in the next 15 years based on mathematical models,to provide the basis for the setting of health programs and cancer prevention strategies and to provide information support to cancer etiology and prevention research.Materials and methods1.MaterialsIn this study,cancer related death Information(1974-2014)and cancer incidence information of Yangpu(2002-2011)was obtained from the death registration system of Yangpu District Center for Disease Control,the hospital cancer-related death reporting system and community cancer patients follow-up system.In this study,statistical data cover the geographical scope of Yangpu District and the population data are from the public security department of Yangpu District.2.MethodsDescriptive statistical analysis was performed with EXCEL and SPSS software;Joinpoint Regression Programm3.5.1 prepared by the US National Cancer Institute of cancer was used for time trend analysis of cancer mortality and to calculate the annual percentage change(APC)and cancer mortality Average annual Percent Change(AAPC)values in the past 10 years(2005-2014)and 5 years(2009-2014).According to Leslie matrix,assuming a stable sex ratio at birth,age-specific mortality and fertility data were obtained from the sixth census in 2010.The Matlab6.1 software was employed to predict the population of Yangpu Distric in 2015-2019,2020-2024 and 2025-2029.Age-Period-Cohort model(APC)was used to predict all ages cancer mortality of different sexes and the adjusted model was…The Nordpred software package application was implemented for APC model;To test the accuracy of tumor mortality predictions by the APC model,first the 1975-2009 data were used for modeling to predict the overall deaths in 2010-2014 and then the generalized linear model was used to compare the real data with the predictions of 2010--2014.The GENMOD module of SAS 9.3 was used for fit test.Results1.From 1974 to 2014,the population of Shanghai Yangpu District presents a tendency of rising,but the total population peaked in 2012 and will begin to decline.The 41 years period was divided into four groups by age demographic.The population proportion which was more than 60 years old showed as follows: 10.73%,15.18%,18.37%,22.87%,with a significant tendency of rising;The population proportion which was less than 20 years old showed as follows: 30.96%,20.27%,20.18%,11.90%,with an evidently decrease trend.According to the current mortality and fertility of Yangpu District,the trend of aging population is severe.2.From 1974 to 2014,78,817 cases were dead caused by severe cancer in Yangpu District.Among them 47,869 cases were male(60.73%)and 30,948 cases were female(39.27%).Male to female ratio was 1.55: 1.During the 41-year period,the top five cancer mortality were: lung cancer,stomach cancer,liver cancer,colorectal cancer,esophageal cancer in turn.Cancer mortality among female were: lung cancer,gastric cancer,colorectal cancer,liver cancer and breast cancer.In 41 years,the rank of cancer mortality has changed in different period.Lung cancer became the first place from the second,colorectal cancer increased No.3 from No.5 to,breast cancer was up to from No.5 from No.6,liver cancer was down to the fourth place from the first,and esophageal cancer dropped to six place from the forth.The proportion of cancer mortality in total mortality rose to 30.49% from 26.74%.3.Results of cancer mortality time trend analysis in Yangpu District from 1974 to 2014: the total crude cancer mortality presents a tendency of rising and the standardized mortality has a declining trend.However standardized mortality trend in the past 10 years is not obvious.Changing trends in different cancers were not the same,among which crude mortality and standardized mortality rates were on the rise in colorectal cancer and breast cancer.4.According to population forecasting,in 2015--2019 population proportion of people over 60 years will be 37.14% in Yangpu District and the proportion will rise to 41.21% in 2020-2024 while in 2025-2029 it will be 34.02%.In the period of 2020--2024,the proportion of elderly population in Shanghai Yangpu District reached a peak.5.Prediction of cancer mortality in Yangpu District: among the six major cancers analyzed,standardized mortality rates of lung cancer,esophageal cancer,colorectal cancer among male and female breast cancer,colorectal cancer among female increase and the crude death rate will reach the peak in 2020-2024.Standardized mortality rate of stomach cancer for men and women,female lung cancer,stomach cancer and liver cancer decrease,and the crude death rate will reach peak in 2020-2024;Standardized mortality and crude death rate of male liver cancer,liver cancer of both sexes decrease.Conclusions and suggestions1.Aging is significant in Yangpu District.The increased cancer overall crude death rate was mainly correlated to population aging,while the aging trend of Yangpu District cannot be reversed in a short term and the proportion of the elderly population is still rising.Thus,the crude death rate of malignancies in Yangpu District is still rising,which poses a great challenge for cancer prevention.2.In Yangpu District,the industrial structure adjustment and environmental management,popularity of home appliances,abundant food supply,smoking,obesity,lifestyle characteristics,early screening and treatment of cancer exert impacts on cancer mortality trends changes.3.Differences in mortality trends in different malignancies exist.Lung cancer,stomach cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer account for a large portion of death,requiring sustained attention and screening.Among them,lung cancer,colorectal cancer,breast cancer is on the rise which should be given special attention to strengthen the prevention and screening.4.Cancer prevention is a public problem and needs participations of individuals,families,communities and governments.First,strengthen community and media-based health education and promote of healthy lifestyles;Second,the government should pay focus on cancer screening,select the appropriate census population and high-risk groups and employ convenient,minimally invasive and efficient means for detection,develop an information-based data acquisition and analysis platform according to the patient past and current medical history,genetics classification screening data;Meanwhile intensify the basic studies of pathogenesis and treatment methods of cancers.InnovationsData analyzed in this study were employed from Yangpu District CDC spanning from 1974 to 2014 covering population death registration data of 41 years.The integral information and the large time span have never been reported previously domestically.This study combines the process of urban development history of the Changes in Yangpu District to analyze trends in cancer mortality changes,which shows certain geographical features.In this study,malignancy-related deaths over the next 15 years were predicted and recommendations were proposed from the perspective of tumor-related health management to provide scientific basis and data support for the development of public health policy,allocation of medical resources adjustment and tertiary prevention. |
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