恶性肿瘤发病率的时间趋势分析方法  

Methods for time trend analysis of cancer incidence rates

作　　者：项永兵[1] 张薇[1] 高立峰[1] 刘振伟[1] 徐望红[1] 刘恩菊[1] 季步天 

机构地区：[1]上海交通大学肿瘤研究所 上海市肿瘤研究所 [2]National Cancer Institute,Bethesda,Maryland 20852,USA

出　　处：《中华流行病学杂志》2004年第2期173-177,共5页Chinese Journal of Epidemiology

摘　　要：目的 介绍恶性肿瘤发病率或死亡率的时间趋势分析方法。方法 利用上海市肿瘤登记处积累的1991～1999年的登记资料为例,分析了上海市区常见肿瘤发病率的变化趋势。首先是计算粗率、标化率和变化百分比(PC);并通过配合标化率的线性回归模型,估计发病率的年度变化百分比(APC);同时分析各部位肿瘤发病率变化在全部上升或下降的肿瘤趋势改变中的贡献,即年度变化贡献率,及其统计学检验方法。结果 9年间上海市区男性主要恶性肿瘤中食管癌和胃癌发病率呈现下降趋势,而结肠癌、直肠癌、胆囊癌、胰腺癌、前列腺癌、膀胱癌、肾癌、白血病发病率上升;女性肿瘤中也是食管癌和胃癌发病率下降,而结肠癌、直肠癌、肺癌、乳腺癌、胆囊癌、子宫内膜癌、卵巢癌、膀胱癌、肾癌发病率上升;男女性这些变化都达到了统计学意义(P<0.05或P<0.01)。其他部位有较小的趋势变化,没有统计学意义。男性癌症中,以胃癌和食管癌下降显著,APC和贡献率分别为-2.99％(加权估计值,下同)和-65.72％、-2.90％和-17.07％;上升显著的是前列腺癌(2.30％和21.46％)、结肠癌(2.94％和18.62％)和直肠癌(3.11％和15.09％)。女性肿瘤中,同样以胃癌和食管癌下降显著,APC和贡献率分别为-6.05％和-39.55％、-1.08％和-35.19％;上升显著的是乳腺癌(2.Objective To introduce statistical methods of time trend analysis on cancer rates. Methods Cancer incidence data collected by the Shanghai Cancer Registry during 1991 to 1999 was used in the analysis to calculate the crude and age-adjusted rates, percent changes (PCs) and annual percent changes (APCs). APCs were estimated by a linear regression of the logarithm on the incidence rates during the nine years. It also introduced a method for partitioning a linear trend in age-adjusted rates into site- specific contributions to the overall floating trend. 95 % confidence intervals for the APCs and contributions were described in the paper. Results A decreasing rates were observed for cancer of stomach and esophagus among both men and women in urban Shanghai from 1991 to 1999. The increasing rates among men would include cancers of colon, rectum, gall bladder, pancreas, prostate, urinary bladder, kidney and leukemia. The rates of cancers among women increased for colon, rectum, lung, breast, gall bladder, endometrium, ovary, urinary bladder and kidney. The changes of above cancers over time were statistically significant (P<0. 05 or P<0. 01), but rates for other cancer sites changed little. The APCs (weighted method) and contributions for the cancers of stomach, esophagus, colon, rectum and propstate were --2.99% and --65. 72%, --2. 90% and -- 17. 07%, 12. 30% and 21.46%, 2.94% and 18. 62%, and 3. 11% and 15.09% among men, and --6.05% and -- 39. 55%, -- 1.08% and -- 35. 19%, 2.81% and 28. 64%, and 3. 69% and 15. 70% for the cancers of stomach, esophagus, breast and colon in women, respectively. Conclusion APC, and related statistics could be used to describe and analyze the time trend of cancer rates rather than PC or/and graphical method alone.

关 键 词：恶性肿瘤 发病率 时间 线性回归模型 

分 类 号：R73-31[医药卫生—肿瘤]