| Objectives:The incidence and mortality of lung cancer in China is increasing.The aim is applying precise and practical epidemiological and health statistical methods to estimate and analyze the past mortality rates and distribution features of lung cancer,and predict the coming trend of it,in order to possess the burden of lung cancer in China,optimize the allocation of resources of the relative health service,and offer scientific basis for the formulation of health policies.Methods:The mortality rates of lung cancer by age,gender,and area(urban/rural)in China in 1987-2015 were aggregated from the WHO Cancer Mortality Database(International Agency for Research on Cancer,IARC,Lyon,France)and China Public Health Statistical Yearbooks(named as China Public Health and Family Planning Statistical Yearbooks after 2013).The population data by age,gender,and area(urban/rural)in China in 1990-2029 were aggregated from the China Population&Employment Statistics Yearbooks and World Population Prospects(the 2015 Revision).The age-standardized mortality rates of lung cancer were calculated for four groups-urban males,urban females,rural males and rural females—with Chinese standard population(as ASR-C),and world standard population(as ASR-W).The truncated rates of lung cancer mortality were calculated for the four groups aged between 35 and 64.Negative binomial regression models were used to analyze the risk factors of lung cancer mortality in China in 1987-2015.Joinpoint models were used to analyze the changes of ASR-C for the four groups with time in 1987-2015.Age-period-cohort models were used to analyze the age,period and cohort trends of lung cancer mortality rates for the four groups in 1988-2013.In the last,the numbers of lung cancer deaths between 2015 and 2029 in China were calculated with the World Population Prospects(by the United Nations)and Nordpred models.Results:1.The ranks of ASRs of lung cancer mortality almost presented to be urban males>rural males>urban females>rural females in China in 1987-2015.The rates of rural residents noticeably increased,and the ASRs of urban residents showed no significant trend although the truncated rates declined sharply.The gaps between urban and rural rates gradually narrowed and the rural rates exceeded the urban rates between 2007 and 2009.2.The regression analysis indicated that urban area,male,age and time were independent risk factors of lung cancer mortality.The death risk among urban residents was 1.41(95%CI=1.34～1.49,p<0.01)times as high as rural residents,and the risk among males was 2.29(95%CI=2.17～2.41,p<0.01)times as high as females in the same time and at the same age.The risks of lung cancer death increased with age-62%(95%CI=1.60～1.63,p<0.01)for every five years,and with time—1%(95%CI=1.00～1.01,p<0.01)every year.3.The results of Joinpoint models showed that there was no significant trend among urban males in 1987-2015(p = 0.16),during which time,the rates rose in 1987-2000(1.07%per year,p = 0.00)and 2003-2015(0.67%per year,p = 0.05)with no significant trends in 2000-2003(p = 0.27).The rates fell by 0.71%(p = 0.00)per year among urban females in 1987-2015,during which time,they rose by 0.68%(p = 0.03)in 1987-2001,followed by no significant trend(p>0.05).The rates rose by 2.52%(p = 0.00)per year among rural males in 1987-2015,during which time,they rose rapidly by 3.48%(p = 0.00)per year in 1987-2002 followed by no significant trend(p>0.05).The rates rose by 2.54%(p = 0.00)per year among rural females in 1987-2015,during which time,they rose rapidly by 3.72%(p = 0.00)per year in 1987-2000 and rose slowly by 1.76%(p = 0.00)per year in 2000-2015.Age-specific rates of lung cancer mortality illustrated that the rates declined from year to year among urban males aged 25-39 and 60-74 and significantly increased among those above 80 years old,declined among urban females aged 25-74 and increased among those above 75 years old,and gradually increased among rural males and females above 50 years old.4.The results of APC analysis illustrated that from ages 20-24 to 80-84,the lung cancer mortality risks increased by 161.42,175.47,87.77,and 98.22 times among urban males,urban females,rural males,and rural females,respectively;from 1988 to 2013,the risks increased by 1.09,0.71,1.83,and 1.56 times for the four groups,respectively;from the 1904-1908 to the 1989-1993 cohort,the risks decreased by 95%,91%,94%,and 89%among the four groups,respectively.5.The projection by Nordpred models showed that,from 2025-2029,the ASRs of lung cancer mortality among males and females would respectively decrease by 3.71 and 0.67(per 100,000)although the sum of deaths would increase by 44%and 52%.The overall increase for males(44%)would come from the impacts of the population ageing(50%),the increase of population size(5%)and the change in risk(-11%);the overall increase for females(52%)would come from the effects of the population ageing(50%),the increase of population size(4%)and the change in risk(-3%).The age-specific rates would fall among the middle-aged and rise among the elderly—the rates would decrease for males aged 40-69 and increase for those above 70,and would decrease for females aged 40-74 and increase for those above 75.The number of deaths from lung cancer would perform the same trend-the number would reduce among the residents under 54 years and grow among those above 55 years.Conclusions:1.The mortality rates of lung cancer were higher in urban than in rural areas and higher among males than among females,and they rose with age and time,fell with birth time in China over the past three decades.The middle-aged residents experienced rising rates and the elderly experienced falling rates over time.2.The patterns of mortality rates of lung cancer varied between urban and rural areas with the gap narrowed in China.Controlling tobacco smoking,preventing air pollution and improving medical insurance may be good points to tackle with lung cancer burden to a national level.3.The population structure would keep ageing in China in 2015-2029,the crude mortality rates of lung cancer would fall among males and females.However,the age-standardized mortality rates of lung cancer would stop rising and even turn to fall(the rates would notably decrease among males).Although the age-specific mortality rates of lung cancer would continue to rise among the elderly and the number of deaths from lung cancer would increase significantly,the rates as well as the number of deaths from lung cancer among the middle-aged residents would decrease.4.The number of deaths would still grow although the overall mortality risk of lung cancer would decrease in the coming fifteen years in China,which is mainly because of the change of population,including the considerably ageing population structure and the slightly growing population size. |
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