| [Objective]To describe the mortality, the proportion and the distribution of all death causes mainly comprised malignant tumor among residents in the areas of Dawen River, and detailedly explore the distribution of primary malignant tumors and their disease burden, and ascertain the difference between study areas and control areas. This study was a part of "Ten Technology Demonstration Project" (Project of Comprehensive Prevention and Treatment for Upper Gastrointestinal Malignant Tumor) in Shandong province in 2005, and to provide basic information for the investigation of comprehensive prevention and treatment of upper gastrointestinal malignant tumor in the areas. [Methods]All townships of eight counties in Laiwu city in the upriver areas and in Taian city in the mid-river and downriver areas were regarded as study areas. In order to compare the mortality of malignant tumor among residents in the areas Dawen River flows through and that in the adjacent areas, cluster sampling was adopted to randomly choose one or two townships in the areas Dawen River dosen't flow through as control areas in every county. Control areas might accord with some conditions. As for decided study areas and control areas, we adopted the cross-sectional study method and referred to the malignant tumor sampling program instituted by the national office for tumor prevention, then confirmed the number of deaths and the death list by some methods, such as checking the information on the death of residence in public security departments, consulting death registers for the death information in medical institutions and talking with some relational people. The medical certificates of death planned by the minister of health were used as original questionnaires to investigate the death causes. The death causes were coded based on ICD-10, and the ultimate death causes were concluded by qualified professionals after training above the county level. The statistic indexes were calculated with mortality rate and its proportion and the disease burden, etc. [Results]1. 54 townships including 41 as study areas and 13 as control areas were investigated in 8 counties in the areas of Dawen River. Aggregated number of the deaths in study areas was 44 554 people ,and the yearly mortality rate was 666.79 per 100 000 population (95% CI, 660.60/100 000-672.99/100 000), and the standardized mortality rate was 527.74 per 100 000 population. In control areas, number of the deaths was 9 704 people in all, and the yearly mortality rate was 649.36 per 100 000 population (95% CI, 636.44/100 000-662.28/100 000), and the standardized mortality rate was 547.57 per 100 000 population. The standardized mortality rate of all causes of death in study areas was significantly higher than that in control areas (x~2=327.78, P<0.05).2. Aggregated number of the malignant tumor deaths was 11 937 people in study areas in Dawen River, and the yearly average standardized mortality rate was 140.64 per 100 000 population, and the yearly average SPYLL rate was 13.39‰. In control areas, number of the malignant tumor deaths was 2 554 people in all, and the yearly standardized mortality rate was 139.42 per 100 000 population, and the yearly average SPYLL was 12.10‰. Both the yearly average mortality rate and the yearly average SPYLL rate of malignant tumor in study areas of Dawen River were significantly higher than that in control areas.3. The first cause of death among residents was malignant tumor in study and control areas. And the second cause of death to the fifth was cerebrovascular diseases (represented 22.27%), cardiovascular diseases (represented 17.86%), respiratory diseases (represented 15.11%) and external causes of death (represented 8.82%) in turn.4. The top four mortality rate of malignant tumor in study areas of Dawen River were esophageal cancer (represented 24.64%), gastric cancer (represented 21.08%), lung cancer (represented 20.21%) and liver cancer (represented 16.49%) in turn. However, the top four PYLL of malignant tumor were liver cancer (represented 20.27%), esophageal cancer (represented 19.05%), lung cancer (represented 16.75%) and gastric cancer (represented 15.98%) in turn.5. The yearly standardized mortality rate and SPYLL rate among residents in study areas in the upriver and mid-river areas were 128.25 per 100 000 population and 12.20‰, and in control areas in the downriver areas were 161.08 per 100 000 population and 15.24‰. Both The yearly standardized mortality rate and SPYLL rate in upriver areas were significantly lower than that in the mid-river and downriver areas (x~2=3 356.82, P<0.001; x~2=1 111.70, P<0.001) .6. The standardized mortality rate of malignant tumor in Feicheng city was the highest in study areas in all 8 counties, was up to 197.57 per 100 000 population, and that in Xintai was the lowest, 103.08 per 100 000 population. The standardized mortality rate of malignant tumor in Ningyang was the highest in control areas in all 8 counties, was up to 197.10 per 100 000 population, and that in Xintai city was the lowest, 118.91 per 100 000 population.7. The mortality rate of malignant tumor in group of 75～ years old was the highest in Dawen River, and the mortality rate increased in accordance with the increase of age(x~2=11.15, P<0.001) . The mortality rate of malignant tumor in males was usually higher than that in females. [Conclusions ]As the results revealed, the main-stream areas of Dawen River belongs to the high incidence areas of malignant tumor, including both the areas along the drainage area and the neighboring control areas. People in study areas are found with higher incidence of malignant tumor than those in the neighboring control areas. Malignant tumors mainly comprised of esophageal cancer, gastric cancer and lung cancer are most differential in the areas of Dawen River, however, Years of life lost leaded by liver tumor is the highest among residents in malignant tumors. The mortality rate of esophageal cancer, gastric cancer, lung cancer and liver cancer are inhomogenous in study and control areas in the main-stream areas of Dawen River, and for study areas, the rate of esophageal cancer among residents in the upriver and mid-river areas is lower than that in the downriver areas, however, and the rate of lung cancer, gastric cancer and liver cancer in the upriver and mid-river areas is higher.Choosing one city in the areas of Dawen River as the object area for further study, related researches about factors of esophageal cancer were advised to be done as soon as earlier. Meanwhile, it is urgent to sampling water from Dawen River, detecting the contents of microelement, organic and inorganic contamination, etc. Samples of environmental factors, such as soil, foodstuff and so on, should also be detected. Considering the mortality rate of malignant tumors are lack of inhomogeneity, farther research should be conducted to find the reason.
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