| 秦天燕,高彩云,聂筱瑜,等.2011—2020年甘肃省肿瘤登记地区肺癌发病和死亡趋势及年龄-时期-队列分析[J].中国肿瘤,2026,35(2):118-126. |
| 2011—2020年甘肃省肿瘤登记地区肺癌发病和死亡趋势及年龄-时期-队列分析 |
| Trends and Age-Period-Cohort Analysis of Incidence and Mortality of Lung Cancer in Gansu Cancer Registration Areas from 2011 to 2020 |
| 投稿时间：2025-05-30 |
| DOI：10.11735/j.issn.1004-0242.2026.02.A006 |
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| 中文关键词: 肺癌 发病率 死亡率 年龄-时期-队列分析 甘肃 |
| 英文关键词:lung cancer incidence mortality age-period-cohort analysis Gansu |
| 基金项目:甘肃省省级人才项目（2021RCXM037）；武威市科技计划项目（WW23B02SF037） |
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| 中文摘要: |
| 摘 要：［目的］ 分析 2011—2020 年甘肃省肿瘤登记地区肺癌发病率和死亡率的时间变化趋势，以及年龄、时期和队列对肺癌发病率和死亡率的影响。［方法］ 基于甘肃省肿瘤登记系统 2011—2020年质量审核合格的肺癌发病与死亡数据，计算其中国人口标化发病率和死亡率（中标发病率和中标死亡率）。采用Joinpoint回归模型计算中标发病率和中标死亡率的平均年度变化百分比（average annual percentage change，AAPC）及95%置信区间（confidence interval，CI），分析肺癌发病率和死亡率的时间趋势；采用内在估计法（intrinsic estimator，IE）的年龄-时期-队列（age-period-cohort，APC）模型，分解年龄、时期、队列效应对肺癌发病与死亡风险的独立影响，以率比（rate ratio，RR）及 95%CI表示效应强度。［结果］ 2020年甘肃省肿瘤登记地区肺癌中标发病率为23.72/10万，中标死亡率为16.95/10万，男性中标发病率和死亡率均高于女性。2011—2020年，甘肃省肿瘤登记地区肺癌中标发病率呈显著上升趋势，年均增长5.78%（P<0.01），其中城乡地区（城市 AAPC=8.58%，农村 AAPC=8.58%）及男女性（男性 AAPC=5.98%，女性 AAPC=5.46%）中标发病率均显著上升（P均<0.01）。同期，肺癌中标死亡率也呈显著上升趋势，年均增长5.04%（P=0.01），其中城市地区增幅显著（AAPC=7.62%，P=0.01），农村地区趋于稳定（AAPC=1.18%，P=0.17）；性别分层显示，男性城乡地区死亡率均显著上升（P均<0.05），女性无明显变化（P均>0.05）。APC 模型分析显示：男女性肺癌发病率与死亡率的净漂移值与局部漂移值变化趋势均无统计学意义；年龄效应上，女性 25~69 岁年龄段肺癌死亡风险较高（RR>1），且随年龄增长风险逐渐降低，70 岁及以上趋于平稳；时期效应上，2019—2020 年肺癌发病风险显著上升（RR=1.17，95%CI：1.03~1.33），同期女性死亡风险显著下降（RR=0.67，95%CI：0.56~0.80）；队列效应上，女性仅部分出生队列（1979—1980 年）发病与死亡风险均降低（RR<1），男性仅部分出生队列（1977—1984年）死亡风险降低，整体队列影响有限。 ［结论］ 2011—2020年甘肃省肺癌发病率和死亡率均呈现显著上升趋势，且存在明显的性别和城乡差异。年龄、时期是影响肺癌风险的关键因素，近年发病风险上升趋势需警惕，建议重点强化对男性及城市地区人群的肺癌防控工作。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze the temporal trends of lung cancer incidence and mortality in Gansu cancer registration areas from 2011 to 2020， and explore the effects of age， period， and birth cohort on lung cancer risk. ［Methods］ Based on the qualified lung cancer incidence， mortality， and population data from Gansu Cancer Registration System after quality audit， the age-standardized incidence rate and age-standardized mortality rate by Chinese standard population in 2000 (ASIRC/ASMRC) were calculated. Joinpoint regression model was used to calculate the average annual percentage change (AAPC） and 95% confidence interval (CI） of standardized rates for trend analysis； the age-period-cohort (APC） model with intrinsic estimator (IE） method was applied to decompose the independent effects of age， period， and cohort on lung cancer risk， expressed by rate ratio (RR） and 95%CI. ［Results］ In 2020， the ASIRC and ASMRC of lung cancer in Gansu cancer registration areas were 23.72/105 and 16.95/105， respectively， with both rates higher in men (31.92/105， 24.95/105） than in women (15.66/105， 9.15/105）. The ASIRC of men was 2.04 times that of women， and the ASMRC was 2.73 times. From 2011 to 2020， the ASIRC of lung cancer increased significantly by 5.78% annually (95%CI： 3.41%~8.19%， P<0.01）， with consistent growth in urban and rural areas (AAPC=8.58%， both P<0.01） and significant increases in both sexes (AAPC=5.98% for men， 5.46% for women， both P<0.01）. During the same period， the ASMRC increased by 5.04% annually (95%CI： 1.27%~8.95%， P=0.01）， with a significant increase in urban areas (AAPC=7.62%， 95%CI： 2.39%~13.12%， P=0.01） and stability in rural areas (AAPC=1.18%， 95%CI： -0.64%~3.02%， P=0.17）； sex-stratified analysis showed that lung cancer mortality increased significantly in men (both urban and rural areas， P<0.05）， while no significant change was observed in women (AAPC=2.10%， 95%CI： -2.42%~6.83%， P=0.32）. APC model analysis revealed that the net drift value and local drift trend of lung cancer incidence and mortality in both sexes were not statistically significant. In terms of age effect， women aged 25~69 had higher lung cancer mortality risk (RR>1）， which gradually decreased with age within this range and stabilized after 70 years old， while there was no significant difference in incidence and mortality risks among all age groups in the overall population and men (RR≈1）. In terms of period effect， the incidence risk increased significantly in 2019—2020 (RR=1.17， 95%CI： 1.03~1.33）， while the mortality risk of women decreased significantly in the same period(RR=0.67， 95%CI： 0.56~0.80）. In terms of cohort effect， only some female birth cohorts (1979—1980） had reduced incidence and mortality risks (RR<1）， and only a few of male birth cohorts (1977—1984) had reduced mortality risks (RR<1）， with limited overall cohort impact. ［Conclusion］ From 2011 to 2020， both incidence and mortality of lung cancer in Gansu Province showed significant upward trends， with obvious sex and urban-rural differences. Age and period are key factors affecting lung cancer risk， and the recent upward trend of incidence risk requires vigilance. It is recommended to focus on strengthening lung cancer prevention and control in men and urban populations. |
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