摘要
目的了解1999—2015年天津市居民结直肠癌死亡率及其变化趋势,探讨其在不同特征人群中的特点,为结直肠癌的防治提供依据。方法采用回顾性研究的方法,分析天津市疾病预防控制中心收集的居民全死因监测数据,统计天津市居民1999年1月1日至2015年12月31日结直肠癌死亡率。户籍人口数据来自天津市公安局。计算每年结直肠癌新发病数和死亡数、发病率(包括粗发病率和经年龄调整后的标化发病率)及其95%CI、死亡率(包括粗死亡率和经年龄调整后的标化死亡率)及其95%CI。采用Segi′s世界标准人口年龄构成计算标化发病率和标化死亡率。采用JoinPoint回归和Cochran-Armitage趋势检验进行趋势分析。结果1999—2015年期间,天津市结直肠癌新发病31 376人,标化发病率为9.66/10万至15.36/10万,呈上升趋势[年度变化百分比(APC)=3.48%,Z=23.21,P<0.001];死亡14 893例,标化死亡率为5.18/10万至6.11/10万,呈上升趋势(APC=1.24%,Z=5.69,P<0.001)。结直肠癌死亡构成中,直肠癌所占比例下降(1999年:60.33%;2015年:48.57%),结肠癌所占比例升高(1999年:39.67%;2015年:50.33%)。发病年龄中位数在66岁附近平稳波动(APC=0.16%,T=1.75,P=0.100);死亡年龄中位数从69岁上升为73岁,呈上升趋势(APC=0.43%,T=8.81,P<0.001)。17年来,<35岁和35~44岁年龄组结直肠癌死亡率呈下降趋势,45~54岁、55~64岁和65岁及以上年龄组则呈上升趋势,差异均有统计学意义(均P<0.05)。结直肠癌男性标化死亡率从1999年的5.53/10万上升至2015年的7.33/10万,差异有统计学意义(APC=2.29%,Z=7.86,P<0.001);女性标化死亡率则整体平稳(1999:4.83/10万,2015年:4.89/10万;APC=0.10%,Z=-0.30,P=0.752)。结直肠癌城市标化死亡率从1999年的6.75/10万上升至2015年的7.33/10万,农村标化死亡率则从1999年的3.18/10万上升至2015年的4.38/10万,差异均有统计学意义,但农村标化死亡率上升速度更快(城市:APC=0.54%,Z=1.98,P=0.048;农村:APC=2.47%,Z=6.46,P<0.001)。结论1999—2015年天津市居民结直肠癌标化死亡率明显上升。老年、男性、城市居民为结直肠癌死亡高发人群;同时,男性、农村人群为结直肠癌死亡风险上升更快的人群。应针对此现象采取相应的防治措施。
Objective To investigate the mortality of colorectal cancer and its trend from 1999 to 2015 in Tianjin, China, and to explore the mortality features in different populations in order to provide data for prevention and control strategies of colorectal cancer. Methods Colorectal cancer mortality data between 1999 and 2015 were collected from Tianjin population - based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC). Population data of permanent residents were collected from Tianjin Municipal Public Security Bureau. The number of new cases and deaths, incidence [including crude incidence, age-adjusted standardized incidence and 95% confidence interval (95% CI)], and mortality (including crude mortality, age-adjusted standardized mortality and 95% CI) of colorectal cancer were calculated. Standardized incidence and mortality of colorectal cancer were calculated using the Segi′s world standard population, adjusted with age and gender. JoinPoint regression and Cochran-Armitage trend test were used to determine the statistical significance of differences in mortality trend. Results A total of 31 376 new onset cases and 14 893 death cases of colorectal cancer were observed in Tianjin from 1999 to 2015. Colorectal cancer incidence increased from 1999 to 2015 with a standardized rate from 9.66/100 000 to 15.36/100 000 [annual percent change(APC)=3.48%, Z=23.21, P<0.001]. Colorectal cancer mortality increased from 1999 to 2015 with a standardized rate from 5.18/100 000 to 6.11/100 000 (APC=1.24%, Z=5.69, P<0.001). Both showed an increasing trend. The death proportion of colon cancer increased (39.67% in 1999 and 50.33% in 2015), while the death proportion of rectal caner decreased (60.33% in 1999 and 48.57% in 2015). The median age of colorectal cancer onset fluctuated steadily around 66 years old (APC=0.16, T=1.75, P=0.100);the median age of death increased from 69 to 73 years old (APC=0.43, T=8.81, P<0.001). From 1999 to 2015, the mortality of colorectal cancer showed a downward trend (all P<0.05) in the age groups of <35 and 35-44 years, while an upward trend (all P<0.05) in the age groups of 45-54 years, 55-64 years and ≥ 65 years. Colorectal cancer mortality in males increased with a standardized rate of 5.53/100 000 in 1999 to 7.33/100 000 in 2015(APC=2.29%, Z=7.86, P<0.001), while colorectal cancer mortality in females flatted with a standardized rate of 4.83/100 000 in 1999 to 4.89/100 000 in 2015 (APC=0.10%, Z=-0.30, P=0.752). Colorectal cancer mortality increased with a standardized rate of 6.75/100 000 in 1999 to 7.33/100 000 in 2015 (APC=0.54%, Z=1.98, P=0.048) in urban areas and of 3.18/100 000 in 1999 to 4.38/100 000 in 2015 (APC=2.47, Z=6.46, P<0.001) in rural areas, whose differences were significant. Standardized mortality rate in rural area was lower but the rising velocity was faster as compared to urban area. Conclusions Crude mortality and standardized mortality of colorectal cancer increase from 1999 to 2015 in Tianjin population. The people of elder, male and urban area have higher mortality. The mortality in people of male and rural area presents a faster rising state. Further efforts to reduce colorectal cancer mortality in Tianjin are needed to prevention and control of colorectal cancer.
作者
王德征
张爽
张辉
沈成凤
张颖
宋桂德
庞硕
王冲
王卓
江国虹
Wang Dezheng;Zhang Shuang;Zhang Hui;Shen Chengfeng;Zhang Ying;Song Guide;Pang Shuo;Wang Chong;Wang Zhuo;Jiang Guohong(Department of Non-Communicable Disease Control and Prevention, Tianjin Centers for Diseases Control and Prevention, Tianjin 300011, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第6期579-586,共8页
Chinese Journal of Gastrointestinal Surgery
基金
大气重污染成因与治理攻关项目(DQGG0404).
关键词
结直肠肿瘤
死亡率
流行病学研究
Colorectal neoplasms
Mortality
Epidemiologic studies
