Trends And The Risk Analysis Of Female Lung Cancer In China

Background:The incidence of female lung cancer in China has been rising and the incidence ratio of lung cancer in men and women has continued to be shrink.Current smoking rates of Chinese women were relatively low over the past three decades.The risk factors of female lung cancer in China remained unclear.Female lung cancer has become a prominent public health problem in China.Objective:The objective of this study was to explore the trends of temporal and spatial and analyse age,period,and cohort effects.The risk differences of female lung cancer in different regions were compared and some risk factors related to female lung cancer in China were explored.Methods:We obtained age-sex-and province-specific incidence,mortality,and years of life lost due to premature death(YLL)rate between 1992 and 2016 from the global burden of disease(GBD)2016 results.We computed age-standardized rates(ASR)with world standard population and applied joinpoint regression models together with age-period-cohort(APC)models based on IE(intrinsic estimator)algoritlhm to identify both the secular national trend and province-specific trends and age,period,cohort effect.Finally,the spatial and temporal distribution characteristics of female lung cancer from 1992 to 2016 were studied by bayesian spatiotemporal model and ecological regression model was used to study some risk factors for female lung cancer.Results:a.Female lung cancer trends:From 1992 to 2016,the national ASR of incidence(ASIR)of female lung cancer rose up(AAPC=0.7%,95%CI:0.6～0.8%)and the national ASR of mortality(ASMR)of female lung cancer fell down(AAPC=-0.3%,95%CI:-0.5～-0.2%).There were 5 patterns of integrated trends in ASIR,ASMR,and YLL rate among 33 provincial administrative regions.b.Age-period-cohort effect:The age relative risk(RR)of incidence and mortality were similar in whole China and the peak RR were found in age 75-79 and 80-84 age group and RR= 4.14(95%CI:3.53～4.87),RR=4.82(95%CI:3.77～6.16)respectively.Both the period risks of incidence and mortality became significant since 2007 and the peak RR =1.34(95%CI:1.19～1.51)and RR=1.19(95%CI:1.04-1.37)respectively.The risk of national female lung cancer fell over all successive birth cohorts for both incidence and mortality.The maximum cohort effect(RR)of incidence and mortality were 2.42(95%CI:1.77～3.33)and 2.59(95%CI:1.82～3.69)respectively.A similar pattern of age effect were found among female lung cancer in 33 provincial administrative regions.The pattern of cohort effects varied among different regions.As for the period effect of incidence,there were significant period risks,however,the risk patterns of period effect of mortality were varied among all 33 provincial administrative regions.There were two pattern cohort effects both for incidence and mortality which were descending over all successive cohorts and an upsurge or a plateau followed by falling over the rest of successive cohorts.c.The characteristic of spatial and temporal distribution:There was spatial correlation between female lung cancer in China and it is affected by the interaction of time and space.The spatial risk of female lung cancer in different regions was varied,and the risk of female lung cancer between provinces was varied with time.The provinces with high relative risk were mainly distributed in Jilin,Beijing,Shanxi,Shanxi,Ningxia,Shandong and other provinces.The provinces with low relative risk were mainly distributed in Inner Mongolia,Gansu,Xinjiang,Hubei,Jiangxi and other provinces.The results of space-time interactions indicate that the spatial correlation changes with time,and the main high-risk areas gather in the southeastern regions such as Yunnan-Guizhou-Sichuan and the northeastern three provinces,d.Influencing factors analysis:The results of univariate analysis fitting of Bayes Spatiotemporal model showed that smoking rate with no lagged,lagged for five years,and lagged for ten years had no significant effect on the spatial and temporal evolution trend of smoking and female lung cancer.Passive smoking rate with no lagged,GDP with lagged 5 years,and the coal consumption with laggd 5 years,and the incidence of AIDS with no lagged,lagged 5 years indicated correlations with lung cancer in women.When the multivariate analysis was carried out,the results showed that only the amount of resident hood lagged for 5 years showed statistically significant and its RR was 0.9984(95%CI:0.9969-0.9999).There was no significant association between the risks including smoking rate lagged for 10 years,passive smoking rate,the emmissions of SO2,GDP and the spatial and temporal evolution trend of Chinese female lung cancer.Conclusion:In summary,the secular trend of incidence rose upward and the trend of mortality fell downward in the past 25 years.Female lung cancer has a certain degree of spatial clustering in different provinces.Different trend patterns of female lung cancer in different regions suggested different risks.Cooking oil fume exposure may be a common risk factor for Chinese women with lung cancer.The female lung cancer risks of passive smoking,SO2 emissions,and other factors are worthy of further study.