1994–2019年中国鼻咽癌发病及死亡趋势的年龄-时期-队列模型分析

周宗磊; 厉坤鹏; 李楠楠; 周茹珍

doi:10.16462/j.cnki.zhjbkz.2023.08.001

1994–2019年中国鼻咽癌发病及死亡趋势的年龄-时期-队列模型分析

doi: 10.16462/j.cnki.zhjbkz.2023.08.001

1.
复旦大学公共卫生学院流行病学教研室，上海 200032
2.
上海中医药大学康复医学院，上海 201203
3.
上海长海医院肝胆胰脾外科，上海 200433
4.
上海长海医院肛肠外科，上海 200433

基金项目:

上海市青年科技英才扬帆计划 20YF1448700

详细信息

通讯作者:
周茹珍，E-mail: emilyzhou351@163.com

中图分类号: R739.63
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出版历程
- 收稿日期: 2022-03-18
- 修回日期: 2022-08-04
- 网络出版日期: 2023-09-02
- 刊出日期: 2023-08-10

Age-period-cohort analysis of incidence and mortality trends of nasopharyngeal carcinoma in the Chinese population, 1994-2019

1.
Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
2.
School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
3.
Department of Hepatobiliary and Pancreatic Splenic Surgery, Changhai Hospital of Shanghai, Shanghai 200433, China
4.
Department of Colorectal Surgery, Changhai Hospital of Shanghai, Shanghai 200433, China

Funds:

Shanghai Youth Science and Technology Talents Sailing Program 20YF1448700

More Information

Corresponding author: ZHOU Ruzhen, E-mail: emilyzhou351@163.com

摘要

摘要: 目的了解中国人群鼻咽癌发病率及死亡率的流行趋势，评估不同年龄、时期、出生队列对鼻咽癌发病及死亡风险的影响。方法通过全球健康数据交换库获得1994–2019年中国不同性别人群的鼻咽癌发病及死亡数据，描述鼻咽癌发病率与死亡率的时间变化趋势，并基于年龄-时期-队列(age-period-cohort, APC)模型和内生因子法估算鼻咽癌发病及死亡的年龄效应、时期效应、队列效应。结果 1994–2019年，中国男性与女性鼻咽癌年龄标准化发病率分别从1994年4.16/10万、2.26/10万增至2019年8.55/10万、2.83/10万，男性与女性鼻咽癌年龄标准化死亡率分别从1994年3.57/10万、1.80/10万降至2019年2.20/10万、0.72/10万。APC模型分析结果显示，1994–2019年，中国男性与女性鼻咽癌发病的年龄效应均随年龄增加先升高后降低再升高[效应系数(男性)：-1.94~0.68~0.18~0.54，均P < 0.05；效应系数(女性)：-1.49~0.49~0.20~0.38，均P < 0.05]，时期效应随年份增加呈现升高的趋势[效应系数(男性)：-0.44~0.53，均P < 0.05；效应系数(女性)：-0.12~0.24，均P < 0.05]，队列效应随出生队列推移呈现先降低后升高再降低的趋势[效应系数(男性)：0.82~-0.36~-0.05~-0.36，均P < 0.05；效应系数(女性)：0.63~-0.17~-0.01~-0.57，均P < 0.05]；中国男性与女性鼻咽癌死亡的年龄效应均随年龄增加呈现上升趋势[效应系数(男性)：-2.08~1.04，均P < 0.05；效应系数(女性)：-1.75~1.08，均P < 0.05]，男性鼻咽癌死亡的队列效应随出生队列推移而逐渐降低(效应系数：0.95~-0.89，P < 0.05)，但未观察到我国鼻咽癌死亡率存在明显的时期效应，同时女性鼻咽癌死亡的队列效应也不明显。结论中国男性与女性鼻咽癌发病风险均不同程度地受年龄效应、时期效应及队列效应的影响，男性鼻咽癌死亡风险受年龄效应、队列效应的影响，而女性鼻咽癌死亡风险仅受年龄效应的影响。建议加强40岁以上人群尤其男性群体的鼻咽癌健康宣教、早期癌症筛查工作以降低我国鼻咽癌发病与死亡风险。
- 鼻咽癌 /
- 发病率 /
- 死亡率 /
- 年龄-时期-队列模型
Abstract: Objective To understand the incidence and mortality trends of nasopharyngeal carcinoma among the Chinese population, and to evaluate the effect of age, period and birth cohort on the risk of nasopharyngeal carcinoma incidence and mortality. Methods Data on gender-specific incidence and mortality of nasopharyngeal carcinoma among the Chinese population between 1994 to 2014 were obtained through the Global Health Data Exchange Database. We described the temporal trend of nasopharyngeal carcinoma incidence and mortality, and the age effect, period effect, and cohort effect were estimated using an age-period-cohort (APC) model and intrinsic estimator method. Results The standardized incidence of nasopharyngeal carcinoma among Chinese male and female population increased from 4.16/100 000 and 2.26/100 000 in 1994 to 8.55/100 000 and 2.83/100 000 in 2019, while the standardized mortality of nasopharyngeal carcinoma decreased from 3.57/100 000 and 1.80/100 000 in 1994 to 2.20/100 000 and 0.72/100 000 in 2019. Results of APC analysis showed that during 1994-2019, age effect of nasopharyngeal carcinoma incidence in both Chinese male and female population increased first, then decreased and increased afterward with the increase of age [effect coefficient (male): -1.94-0.68 to 0.18-0.54, all P < 0.05; effect coefficient (female): -1.49-0.49 to 0.20-0.38, all P < 0.05]; period effect showed an increasing trend as year increased [effect coefficient (male): -0.44-0.53, all P < 0.05; effect coefficient (female): -0.12-0.24, all P < 0.05]; cohort effect decreased first, then increased and then decreased with the year of birth [effect coefficient (male): 0.82--0.36 to-0.05--0.36, all P < 0.05; effect coefficient (female): 0.63--0.17 to-0.01--0.57, all P < 0.05]. Age effect of nasopharyngeal carcinoma mortality in Chinese population exhibited an upward trend with the increase of age [effect coefficient (male): -2.08-1.04, all P < 0.05; effect coefficient (female): -1.75-1.08, all P < 0.05]; cohort effect of nasopharyngeal carcinoma mortality among Chinese male population decreased with year of birth (effect coefficient: 0.95--0.89, P < 0.05). However, significant period effect of nasopharyngeal carcinoma mortality in the whole population and cohort effect of nasopharyngeal carcinoma mortality among Chinese female population were not observed. Conclusions Age effect exerts impacts on the risk of nasopharyngeal carcinoma incidence in both Chinese male and female population to varying degrees. The risk of nasopharyngeal carcinoma mortality among Chinese male population is affected by age effect and cohort effect, while the risk of nasopharyngeal carcinoma mortality in Chinese female population is only affected by age effect. Health education and screening for nasopharyngeal cancer are suggested to be strengthened for individuals aged over 40 years, especially for males to reduce the risk of nasopharyngeal carcinoma incidence and mortality.
- Nasopharyngeal carcinoma /
- Incidence /
- Mortality /
- Age-period-cohort model

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图 1 1994–2019年中国男性和女性鼻咽癌发病率流行趋势

CIR：粗发病率; ASIR：年龄标准化发病率。

Figure 1. Incidence trend of nasopharyngeal carcinoma in Chinese males and females from 1994 to 2019

CIR: crude incidence rate; ASIR: age-standardized incidence rate.

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图 2 1994–2019年中国不同年龄组人群鼻咽癌发病率流行趋势

Figure 2. Incidence trend of nasopharyngeal carcinoma among different age groups from 1994 to 2019

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图 3 1994–2019年中国男性和女性鼻咽癌死亡率流行趋势

CDR：粗死亡率; ASDR：年龄标准化死亡率。

Figure 3. Mortality trend of nasopharyngeal carcinoma in Chinese males and females from 1994 to 2019

CDR: crude death rate; ASDR: age-standardized death rate.

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图 4 1994–2019年中国不同年龄组人群鼻咽癌死亡率流行趋势

Figure 4. Mortality trend of nasopharyngeal carcinoma among different age groups from 1994 to 2019

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图 5 中国男性与女性鼻咽癌发病的年龄、时期及队列效应RR值

Figure 5. Age, period, and cohort effects on the relative risk of nasopharyngeal carcinoma incidence in Chinese males and females

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图 6 中国男性与女性鼻咽癌死亡的年龄、时期及队列效应RR值

Figure 6. Age, period, and cohort effects on the relative risk of nasopharyngeal carcinoma mortality in Chinese males and females

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表 1 1994–2019年中国男性与女性鼻咽癌发病率APC模型分析结果

Table 1. Results of APC model analysis on nasopharyngeal carcinoma incidence in Chinese males and females from 1994 to 2019

变量 Variable	男性Male				女性Female
变量 Variable	效应系数 Coef	SE	95% CI	P值 value	效应系数 Coef	SE	95% CI	P值 value
年龄组/岁 Age group/years
20~ < 25	-1.94	0.38	-2.70~-1.19	< 0.001 ^①	-1.49	0.46	-2.40~-0.58	0.001 ^①
25~ < 30	-1.50	0.28	-2.05~-0.94	< 0.001 ^①	-1.09	0.35	-1.78~-0.40	0.002 ^①
30~ < 35	-0.70	0.21	-1.10~-0.29	0.001 ^①	-0.49	0.27	-1.03~0.04	0.072
35~ < 40	-0.20	0.18	-0.55~0.15	0.255	-0.20	0.25	-0.68~0.28	0.422
40~ < 45	0.25	0.16	-0.06~0.55	0.114	0.12	0.22	-0.32~0.55	0.599
45~ < 50	0.45	0.15	0.17~0.73	0.002 ^①	0.27	0.21	-0.14~0.68	0.193
50~ < 55	0.56	0.14	0.29~0.82	< 0.001 ^①	0.39	0.20	-0.01~0.78	0.054
55~ < 60	0.68	0.12	0.43~0.92	< 0.001 ^①	0.49	0.19	0.12~0.86	0.010 ^①
60~ < 65	0.59	0.12	0.36~0.82	< 0.001 ^①	0.49	0.18	0.14~0.84	0.007 ^①
65~ < 70	0.52	0.11	0.30~0.74	< 0.001 ^①	0.36	0.18	0.00~0.71	0.047 ^①
70~ < 75	0.36	0.11	0.15~0.58	0.001 ^①	0.33	0.17	-0.01~0.67	0.058
75~ < 80	0.21	0.11	-0.01~0.42	0.059	0.25	0.17	-0.09~0.59	0.145
80~ < 85	0.18	0.11	-0.03~0.39	0.094	0.20	0.17	-0.14~0.54	0.256
85~ < 90	0.54	0.11	0.33~0.75	< 0.001 ^①	0.38	0.18	0.03~0.73	0.033 ^①
时期/年 Period/year
1994	-0.44	0.09	-0.62~-0.26	< 0.001 ^①	-0.12	0.12	-0.37~0.12	0.328
1999	-0.30	0.08	-0.46~-0.14	< 0.001 ^①	-0.11	0.12	-0.34~0.13	0.373
2004	-0.21	0.08	-0.37~-0.06	0.008 ^①	-0.13	0.12	-0.37~0.11	0.279
2009	0.08	0.07	-0.06~0.23	0.278	0.01	0.12	-0.22~0.24	0.910
2014	0.34	0.07	0.20~0.48	< 0.001 ^①	0.11	0.11	-0.12~0.33	0.352
2019	0.53	0.07	0.39~0.66	< 0.001 ^①	0.24	0.11	0.02~0.46	0.034 ^①
队列/年 Cohort/year
1905–1909	0.82	0.22	0.38~1.26	< 0.001 ^①	0.63	0.34	-0.04~1.30	0.067
1910–1914	0.73	0.17	0.39~1.07	< 0.001 ^①	0.56	0.26	0.05~1.07	0.031 ^①
1915–1919	0.46	0.16	0.16~0.77	0.003 ^①	0.42	0.23	-0.02~0.87	0.063
1920–1924	0.35	0.13	0.09~0.61	0.008 ^①	0.30	0.20	-0.10~0.70	0.144
1925–1929	0.28	0.12	0.05~0.51	0.016 ^①	0.21	0.19	-0.16~0.58	0.273
1930–1934	0.17	0.11	-0.04~0.38	0.115	0.11	0.18	-0.24~0.45	0.550
1935–1939	-0.01	0.12	-0.24~0.23	0.961	-0.05	0.20	-0.43~0.33	0.788
1940–1944	-0.13	0.13	-0.39~0.12	0.305	-0.16	0.21	-0.57~0.25	0.448
1945–1949	-0.21	0.14	-0.48~0.06	0.128	-0.13	0.21	-0.55~0.29	0.556
1950–1954	-0.29	0.15	-0.58~-0.01	0.045 ^①	-0.12	0.22	-0.55~0.32	0.598
1955–1959	-0.36	0.16	-0.67~-0.06	0.021 ^①	-0.17	0.24	-0.63~0.29	0.466
1960–1964	-0.36	0.17	-0.69~-0.03	0.030 ^①	-0.13	0.25	-0.61~0.35	0.586
1965–1969	-0.31	0.18	-0.65~0.04	0.085	-0.10	0.26	-0.61~0.40	0.689
1970–1974	-0.27	0.19	-0.63~0.10	0.157	-0.07	0.27	-0.60~0.46	0.801
1975–1979	-0.17	0.20	-0.57~0.23	0.401	-0.01	0.30	-0.59~0.57	0.973
1980–1984	-0.05	0.23	-0.51~0.40	0.814	-0.04	0.35	-0.73~0.64	0.902
1985–1989	-0.05	0.29	-0.62~0.52	0.864	-0.22	0.45	-1.10~0.67	0.633
1990–1994	-0.24	0.45	-1.12~0.64	0.597	-0.45	0.69	-1.80~0.89	0.509
1995–1999	-0.36	0.83	-1.98~1.26	0.664	-0.57	1.25	-3.02~1.88	0.648
AIC	5.00				4.15
BIC	-206.18				-210.74
注：APC, 年龄-时期-队列模型; AIC, 赤池信息准则; BIC, 贝叶斯信息准则。 ① P＜0.05。 Note: APC, age-period-cohort model; AIC, Akaike information criterion; BIC, Bayesian information criterion. ① P＜0.05.

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表 2 1994–2019年中国男性与女性鼻咽癌死亡率APC模型分析结果

Table 2. Results of APC model analysis on nasopharyngeal carcinoma mortality in Chinese males and females from 1994 to 2019

变量 Variable	男性 Male				女性 Female
变量 Variable	效应系数 Coef	SE	95% CI	P值 value	效应系数 Coef	SE	95% CI	P值 value
年龄组/岁 Age group/years
20~ < 25	-2.08	0.74	-3.53~-0.63	0.005 ^①	-1.75	0.97	-3.65~0.15	0.071
25~ < 30	-1.84	0.60	-3.02~-0.67	0.002 ^①	-1.43	0.76	-2.92~0.06	0.060
30~ < 35	-1.17	0.44	-2.04~-0.30	0.008 ^①	-1.04	0.62	-2.26~0.19	0.097
35~ < 40	-0.66	0.36	-1.36~0.04	0.063	-0.68	0.52	-1.69~0.34	0.192
40~ < 45	-0.10	0.28	-0.65~0.46	0.731	-0.30	0.43	-1.14~0.54	0.483
45~ < 50	0.13	0.25	-0.36~0.61	0.612	-0.07	0.37	-0.80~0.66	0.845
50~ < 55	0.36	0.21	-0.06~0.78	0.094	0.16	0.32	-0.48~0.79	0.628
55~ < 60	0.59	0.18	0.23~0.94	0.001 ^①	0.31	0.28	-0.25~0.86	0.281
60~ < 65	0.62	0.16	0.30~0.94	< 0.001 ^①	0.49	0.25	0.00~0.98	0.050
65~ < 70	0.71	0.15	0.42~1.00	< 0.001 ^①	0.56	0.23	0.10~1.02	0.017 ^①
70~ < 75	0.79	0.14	0.51~1.06	< 0.001 ^①	0.80	0.22	0.37~1.24	< 0.001 ^①
75~ < 80	0.76	0.15	0.46~1.05	< 0.001 ^①	0.90	0.24	0.44~1.36	< 0.001 ^①
80~ < 85	0.88	0.16	0.56~1.20	< 0.001 ^①	0.97	0.26	0.45~1.49	< 0.001 ^①
85~ < 90	1.04	0.19	0.66~1.41	< 0.001 ^①	1.08	0.31	0.47~1.69	0.001 ^①
时期/年 Period/year
1994	0.02	0.13	-0.23~0.27	0.873	0.35	0.18	-0.01~0.70	0.058
1999	0.08	0.10	-0.12~0.27	0.443	0.22	0.15	-0.08~0.51	0.151
2004	-0.02	0.09	-0.20~0.17	0.869	0.04	0.14	-0.25~0.32	0.799
2009	-0.05	0.10	-0.25~0.14	0.595	-0.14	0.16	-0.45~0.17	0.385
2014	-0.02	0.11	-0.24~0.19	0.829	-0.23	0.18	-0.58~0.12	0.205
2019	-0.01	0.13	-0.25~0.24	0.967	-0.23	0.21	-0.64~0.17	0.259
队列/年 Cohort/year
1905–1909	0.95	0.29	0.39~1.51	0.001 ^①	0.65	0.43	-0.20~1.50	0.132
1910–1914	0.78	0.23	0.33~1.23	0.001 ^①	0.58	0.35	-0.10~1.26	0.095
1915–1919	0.53	0.20	0.13~0.92	0.009 ^①	0.48	0.30	-0.11~1.07	0.112
1920–1924	0.44	0.18	0.09~0.80	0.014 ^①	0.42	0.27	-0.12~0.96	0.126
1925–1929	0.41	0.17	0.08~0.74	0.014 ^①	0.42	0.26	-0.09~0.94	0.106
1930–1934	0.37	0.16	0.05~0.69	0.023 ^①	0.40	0.26	-0.11~0.91	0.121
1935–1939	0.31	0.18	-0.04~0.66	0.081	0.38	0.29	-0.19~0.94	0.192
1940–1944	0.24	0.20	-0.16~0.64	0.237	0.32	0.32	-0.32~0.95	0.332
1945–1949	0.16	0.23	-0.28~0.61	0.475	0.32	0.36	-0.39~1.03	0.380
1950–1954	0.05	0.26	-0.46~0.56	0.855	0.26	0.41	-0.55~1.06	0.533
1955–1959	-0.09	0.29	-0.67~0.49	0.757	0.08	0.47	-0.84~0.99	0.872
1960–1964	-0.20	0.33	-0.85~0.45	0.554	-0.03	0.52	-1.06~1.00	0.958
1965–1969	-0.27	0.37	-1.00~0.46	0.470	-0.14	0.58	-1.29~1.00	0.807
1970–1974	-0.39	0.42	-1.21~0.43	0.354	-0.28	0.65	-1.56~0.99	0.663
1975–1979	-0.46	0.49	-1.43~0.51	0.356	-0.40	0.79	-1.94~1.15	0.614
1980–1984	-0.51	0.62	-1.73~0.72	0.417	-0.59	1.02	-2.60~1.42	0.565
1985–1989	-0.66	0.85	-2.33~1.01	0.441	-0.85	1.43	-3.66~1.95	0.551
1990–1994	-0.79	1.25	-3.24~1.66	0.529	-0.99	2.01	-4.94~2.96	0.622
1995–1999	-0.89	2.20	-5.22~3.43	0.685	-1.01	3.50	-7.88~5.85	0.773
AIC	4.21				3.41
BIC	-211.20				-212.02
注：APC，年龄-时期-队列模型; AIC，赤池信息准则；BIC，贝叶斯信息准则。 ① P＜0.05。 Note: APC, age-period-cohort model; AIC, Akaike information criterion; BIC, Bayesian information criterion. ① P＜0.05.

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