| ObjectiveTo estimate the mortality rates of lung cancer in smokers and non-smokers in different characteristics of people aged 30-69 in six townships of Xuanwei City from 2014 to 2016.It can provide up-to-date research evidence for lung cancer deaths from smoking and provides parameters for estimating the burden of smoking attributable to the disease.Materials and Methods1.source of dataThis study contains 3 databases,including:health risk factor survey of 2014,investigation on smoking status of dead with lung cancer between 2014 and 2016.population data and death case data for 2014-2016.The specific collection methods are as follows:(1)Health risk factor survey was conducted in June-July 2014 and used a multi-stage cluster sampling approach.The sampling process for this survey was as follows:Firstly,according to the death data of the Xuanwei City Cause of Death Registration System from 2010 to 2012,the lung cancer mortality rate of each township in Xuanwei City was calculated,and 26 townships in Xuanwei City were divided into three areas according to the tertile of the lung cancer mortality distribution:high area,middle areaand low area.Secondly,two towns were randomly selected from different regions,namely Laibin Town,Wanshui Street(high area).Tangtang Town,Geyi Town(middle area).Wenxing Township and Reshui Town(low area).Then,four administrative villages were randomly selected as survey points in each township.Finally,we select 100 households according to the prescribed survey route in each administrative village,and the household members over 30 years old in the selected households were randomly sampled and one of the qualified subjects was selected for investigation.The survey mainly includes:basic personal information,living environment,indoor exposure to bituminous coal,eating habits,smoking and exposure history of second hand smoke.(2)Investigation on smoking status of deceased with lung cancer between 2014 and 2016 was conducted from April to July 2017.The survey extracted the list of all lung cancer deaths in the above six townships from Xuanwei City Center for Disease Control and Prevention,2014-2016 death cause monitoring database.A face-to-face household survey of the family members of the deceased people on the list was conducted.The survey mainly includes:information on the death time of the lung cancer,the cause of death,the age of death,and the smoking status who die of lung cancer.(3)The population data of this study was derived from the 2014-2016 Xuanwei City Statistical Yearbook Population.Includes population data of 6 townships,and population data by township,gender,age(0-17,18-34,35-59,60+).Because the above population data lacks a population of 5 years old,it was adjusted according to the age composition of 5 years old in the 6 township censuses in Xuanwei City in 2010.(4)The deaths data of all-causes of death in various townships in Xuanwei from 2014 to 2016 were derived from the regular death registration network direct reporting system.2.Data cleaning and statistical analysis methodThe data cleaning mainly includes:checking duplicated records,database check,and imputation of missing data.The data in this study covers the three-year data for 2014-2016.Since the data did not fluctuate greatly during different years,and to ensure the stability of the data,this study will report the three-year data for 2014-2016.The statistical analysis in this paper mainly includes:Firstly,a design-based weighted estimation method was used to estimate the number of smokers and non-smokers aged 30-69 in six townships in 2014.Secondly,the number of smokers and non-smokers in 2015-2016 was estimated based on the weighted smoking rate in 2014.Finally,we combined the smoking survey data of 6 township lung cancer deceased in 2014-2016 to estimate the lung cancer mortality rate of smokers and non-smokers in townships,gender and age in 2014-2016.Finally,combined with the smoking survey data of 6 township lung cancer deceased in 2014-2016,we estimated the lung cancer mortality and 95%confidence interval(CI)of smokers and non-smokers in different township,gender and age in 2014-2016.risk of death from lung cancer caused by smoking(Risk Ratio,RR)and its 95%CI.Results1.Description of investigation data on smoking status in 6 townships of Xuanwei about residents’ health risk factors in 2014 and prenatal smoking information who die of lung cancer between 2014 and 2016The 2014 health risk factor survey database contains 2,346 residents aged 30-69.The number of women(55%)was slightly more than that of men,the number of people was basically same in different age groups and area.The total number of lung cancer deaths in the six townships of 30-69 years old was 1.030,accounting for 13.4%of the total number of deaths in 6 townships between 2014 and 2016.The family members of the deceased lung cancer people who participated in the survey were mainly spouses,children,and parents,and most of them lived with them for a long time.2.Smoking data imputation resultsThe 2014 risk factor survey database totally includes 2,346 subjects,of which 32(1.4%)subjects were missing smoking exposure data.Male smoking information was missing 15,of which 9 people should be filled as smokers,others should be filled as non smokers.Among people who die of lung cancer,142(13.8%)had missed smoking information.There were 95 male and 47 female smoking information missing and 86 male and 1 female were filled as smokers.3.The estimated smokers and non-smokers aged 30-36 in 6 townships of Xuanwei city between 2014 and 2016According to the weighting adjustment the smokers of 6townships was 88.8 thousand in 2014,accounting for 98.63%.The total smoking rate of the sample was 32.44%.the rate increased after weighting adjustment(38.93%).Among them,the weighted smoking rate for men was 73.5%which increased 2.5%comparing with the sample;the weighted smoking rate for women was basically the same,the rate was about 1%.The smoking rates in the high area and middle area were similar.while the smoking rate in low area was 64%.Among them.Smoking rate was the highest in Laibin and Geyi.There was no difference between the weighted smoking rate and sample smoking rate under different characteristics of male and female.However,the total smoking rate after combining men and women has a larger increase than the sample smoking rate.The total population of men and women aged 30-69 in six townships of Xuanwei was 119,236 and 108,767 respectively in 2015.Finally,the estimated number of men and women smokers was 87,665 and 1219 respectively.In 2016,the total population of men and women aged 30-69 in six townships of Xuanwei city was 120,804 and 110,335,respectively.Finally,the estimated number of men and women smokers was 8,815 and 1,232 respectively.4.The distribution of lung cancer deaths among smokers and non-smokers aged 30-69 in six townships of Xuanwei City in 2014-2016 and the Risk ratio of lung cancer deaths caused by smoking:The average lung cancer mortality rate of 30-69 years old in 6 townships of Xuanwei City was 149.89/100.000 between 2014 and 2016.The rate of smokers and non-smokers was 215.19/100.000(95%CI:185.75-247.96)and 107.00/100.000 respectively.(95%CI:90.51～125.62),and the difference was statistically significant.Among them,the average lung cancer mortality rate of males(177.12/100.000.95%CI:148.65～196.56)was higher than that of females(1.210 million,95%CI:108.53～132.56),but the average lung cancer mortality rate of smokers(216.27/10)and non-smokers(68.37/100.000)was lower than that of women(243.51/100,000 and 118.68/100,000 respectively),especially for non-smokers with lung cancer mortality.The difference was statistically significant.From different ages,the mortality rate of lung cancer among smokers and non-smokers increased with age,and the average lung cancer death rate of smokers was much higher than that of non-smokers.From different regions,the lung cancer mortality rate of smokers and non-smokers in high school and low-incidence areas was similar to the total lung cancer mortality rate,showing a significant regional difference.In different towns and villages,the lung cancer mortality rate of smokers in the high-incidence area was much higher than that of the other 4 townships(the difference was statistically significant),the hot water was the lowest,far lower than other townships(the difference was also statistically significant)Non-smokers had the highest lung cancer mortality rate except for the highest guest,hot water and Wenxing minimum,and the rest of the townships were relatively stable,fluctuating between 77.40/10～115.61/100,000.The risk ratio of lung cancer deaths caused by smoking in the 30-69-year-old population in 6 townships of Xuanwei City was 2.02 in 2014-2016(95%CI:1.79 to 2.28).The RR of lung cancer deaths caused by smoking in men was slightly higher than that in women,3.16(95%CI:2.45-4.09)and 2.07(95%CI:1.07-4.00),respectively,but the difference was not statistically significant.The RR was relatively stable for over 40 years age group,fluctuating within 1.61～2.897.The RR of lung cancer deaths caused by smoking in high areas(1.94,95%Cl:1.67～2.25)and middle areas(1.51,95%CI:1.16～1.96)was relatively stable,except for the low areas.In general,although lung cancer mortality among smokers and non-smokers was different under different characteristics,the risk of lung cancer caused by smoking is always relatively stable.Conclusion1.In this study,we combine basic sampling weights and post-stratification adjustment weights to estimate the overall rate of different characteristic populations.2.The results of this study show that lung cancer mortality in smokers and non-smokers was different under different characteristics and higher than the average results of Chinese history and Asian population.3.The results of this study confirm the results of previous studies,that is,the risk of lung cancer caused by smoking is always relatively stable under different characteristics.However,it suggests that health risks from tobacco will be further highlighted if effective tobacco control measures are not implemented. |
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