Mortality and morbidity transition in Kuwait: the role of health and development policies.

Kuwait has, in recent years, achieved a marked improvement in the health status of its population, as measured by a variety of mortality and morbidity indicators. This can be attributed to the implementation of two sets of policies that impact upon health, namely the health and socio-economic development plans of the Kuwaiti government. This article seeks to outline these recent changes in mortality and morbidity levels, and traces out the key policies considered to be the major determinants for these changes. Data is presented on health status, and on patterns and trends of health services' utilization. These trends suggest strongly that, for Kuwait, the health goals set for the year 2000 are achievable.     

2015年重庆市常住人口脑卒中发病与死亡情况

目的 了解重庆市2015年居民脑卒中发病及死亡情况,为重庆市脑卒中防治方案的制定提供科学依据.方法 利用2015年重庆市心脑血管事件登记报告系统的数据,按2010年全国第六次普查标准人口构成,采用报告发病/死亡率、标化发病/死亡率等指标,采用Poisson回归模型检验不同人群间率的差异,以及率随年龄的变化趋势对脑卒中的发生和死亡情况进行统计分析.结果 2015年重庆市常住人口脑卒中报告发病率为278.82/10万,其中男性308.27/10万,女性248.65/10万;标化发病率为219.27/10万,其中男性232.41/10万,女性203.68/10万.2015年重庆市常住人口脑卒中报告死亡率为81.31/10万,其中男性93.02/10万,女性69.31/10万;标化死亡率为63.28/10万,其中男性68.98/10万,女性56.45/10万.男性发病率、死亡率均高于女性,发病率、死亡率在55岁前较低,55岁后呈快速上升的趋势.各型脑卒中以脑梗死最多,占总发病例数的59.54％,发病率亦为最高.结论 应加强心脑血管疾病的监测和管理,重点做好60岁以上老年人群,尤其是男性老年人群的脑卒中预防控制工作.     

Risk of Cardiovascular Morbidity and Mortality in Relation to Temperature

Objective

To examine the effects of temperature on cardiovascular-related (CVD) morbidity and mortality among New York City (NYC) residents.

Introduction

Extreme temperatures are consistently shown to have an effect on CVD-related mortality [1, 2]. A large multi-city study of mortality demonstrated a cold-day and hot-day weather effect on CVD-related deaths, with the larger impact occurring on the coldest days [3]. In contrast, the association between weather and CVD-related morbidity is less clear [4, 5]. The purpose of this study is to characterize the effect of temperature on CVD-related emergency department (ED) visits, hospitalizations, and mortality on a large, heterogeneous population. Additionally, we conducted a sensitivity analysis to determine the impact of air pollutants, specifically fine particulates (PM2.5) and ozone (O3), along with temperature, on CVD outcomes.

Methods

We analyzed daily weather conditions, ED visits classified as CVD-related based on chief complaint text, hospitalizations, and natural cause deaths that occurred in NYC between 2002 and 2006. ED visits were obtained from data reported daily to the city health department for syndromic surveillance. Inpatient admissions were obtained from the Statewide Planning and Research Cooperative System, a data reporting system developed by New York State. Mortality data were obtained from the NYC Office of Vital Statistics. Data for PM2.5 and O3 were obtained from all available air quality monitors within the five boroughs of NYC. To estimate risk of CVD morbidity and mortality, we used generalized linear models using a Poisson distribution to calculate relative risks (RR) and 95% confidence intervals (CI). A non-linear distributed lag was used to model mean temperature in order to allow for its effect on the same day and on subsequent days. Models were fit separately for cold season (October through March) and warm season (April through September) given season may modify the effect on CVD outcomes. For our sensitivity analysis, we included PM2.5 and O3 in our model.

Results

During the cold season, CVD-related ED visits and hospitalizations increased, while mortality decreased, with increasing mean temperature on the same day and lagged days. Extremely cold temperature was associated with a small increase of same day in-hospital mortality though generally cold temperatures did not appear to be associated with higher mortality. The opposite was observed in the warm season as ED visits and hospitalizations decreased, and mortality increased, with increasing mean temperature on the same day and on lagged days. Our sensitivity analysis, in which we controlled for PM2.5 and O3, demonstrated little effect of these air pollutants on the relationship between temperature and CVD outcomes.

Conclusions

Our results suggest a decline in risk of a CVD-related ED visit and hospitalization during extreme temperatures on the same day and on recent day lags for both cold and warm seasons. In contrast, our findings for mortality indicate an increase in risk of CVD-related deaths during hot temperatures. No mortality effect was observed during cold temperatures. The effects of extreme temperatures on CVD-related morbidity may be explained by behavioral patterns, as people are more likely to stay indoors on the coldest and hottest days.     

Surveillance of Heat-related Morbidity: Relation to Heat-related Excess Mortality

Objective

To describe the extent to which heat-illness indicators increase with extreme heat and to evaluate the association among daily weather, heat-related illness and natural cause mortality.

Introduction

The impact of heat on mortality is well documented [1–3] but deaths tend to lag extreme heat and mortality data is generally not available for timely surveillance during heat waves. Recently, systems for near-real time surveillance of heat illness have been reported [4] but have not been validated as predictors of heat related mortality. In this study, we examined the associations among weather, indicators of heat-related ambulance calls and emergency department visits and excess natural cause mortality in New York City (NYC).

Methods

We analyzed daily weather conditions, emergency medical system (EMS) calls flagged as heat-related by EMS dispatchers, emergency department (ED) visits classified as heat-related based on chief complaint text, and natural cause deaths. EMS and ED data were obtained from data reported daily to the city health department for syndromic surveillance. We fit generalized linear models to assess the relationships of daily counts of heat related EMS and ED visits to natural cause deaths after adjustment for weather conditions during the months of May–September between 1999 and 2008.

Results

We observed an increase in mean total calls to EMS and a decrease in mean total visits to EDs during 10 observed heat waves (maximum heat index ≥90° F (Fahrenheit) for four or more consecutive days with the first three days ≥95° F and at least one day ≥100°F) in NYC between 1999 and 2008. Both EMS and EDs experienced an increase in heat-related incidents during heat waves though the increase in heat-related EMS calls was much greater. A modest increase in mean natural cause deaths was also observed. Controlling for temporal trends, an 11% (95% confidence interval (CI): 5–18) and 7% (95% CI: 4–9) increase in natural cause mortality was associated with an increase from the 50th percentile to 99th percentile of same-day and one-day lagged heat-related EMS calls and ED visits, respectively. After controlling for both temporal trends and weather, we observed a 10% (95% CI: 4–16) increase in natural cause mortality associated with one-day lagged heat-related EMS calls and a 5% mortality increase with one-day lagged ED visits (95% CI: 2–8).

Conclusions

Heat-related EMS calls and ED visits lagged one day predicted natural cause mortality in our temporal and weather-adjusted model. In particular, risk of mortality rapidly increased as the number of heat-related EMS calls approached high levels (>100 heat-related calls/day). Heat-related illness can be tracked during heat waves using EMS and ED data which are indicators of heat associated excess natural cause mortality during the warm weather season.     

中国2004－2013年病毒性肝炎发病与死亡趋势分析

目的 探讨2004-2013年我国病毒性肝炎流行趋势及发病死亡规律。方法 对国家卫生和计划生育委员会2004-2013年发布的全国法定传染病疫情中的病毒性肝炎数据进行发病和死亡分析。结果 全国以贵州、云南、西藏、甘肃、青海、宁夏、新疆7个省份为高发区。病毒性肝炎的发病构成以乙型肝炎(80.63/10万)和丙型肝炎(9.68/10万)为主,分别占病毒性肝炎报告总发病例数的80.90%和9.25%.甲型、未分型肝炎报告发病数呈下降趋势,乙、丙、戊型肝炎的报告发病数均有一定程度的上升趋势。10年间,共报告病毒性肝炎死亡患者10 008例(年均死亡1 001例).甲、戊、未分型肝炎报告死亡数呈减少趋势;乙型肝炎报告死亡数波动减少,但所占构成比变化不大;丙型肝炎死亡报告数呈递增趋势。结论 2004-2013年我国病毒性肝炎发病率无下降趋势,乙型肝炎发病率仍维持在较高水平,丙型肝炎的发病率呈显着上升趋势;病毒性肝炎总体病死率和死亡率均呈下降趋势,乙型肝炎仍为病毒性肝炎死亡的主要构成,丙型肝炎死亡构成比呈明显上升趋势。因此,乙、丙型肝炎是我国病毒性肝炎的防治重点,西部7个高发病省份为防控的重点地区。     

Diverging trends in cardiovascular morbidity and mortality in a low risk population

Cardiovascular (CVD) disease morbidity and mortality are changing over the years, following changes in socioeconomic conditions and underlying risk factors. However, the trends of these changes differ among various populations. There is little data regarding these trends in low CVD risk populations. Tables of deaths by cause and age for the period 1956–2007 and tables of hospitalizations for the period 1979–2003 published by the National Statistical Service of Greece were used. Trends over time were determined using log-linear regression models. Age-adjusted all-cause mortality has declined steadily since 1964 in both sexes. CVD mortality initially increased until the late 1980s and subsequently decreased. An increase in mortality from stroke was seen until 1978, especially in men, followed by a decline. Mortality from coronary heart disease (CHD) increased initially, continued to increase for one decade more than stroke and started to decrease in 1989. However, only in women has CHD mortality returned below 1956 levels. As a result, deaths from CHD have surpassed those from stroke. Although the in-hospital fatality of acute myocardial infarction (AMI) has decreased by half between 1979 and 2003, deaths from AMI have decreased only slightly, as hospitalization and morbidity rates have increased during the same period. Although the various types of CVD share common risk factors, the trends of their respective mortality rates have differed significantly over the past five decades in the Greek population. This could partly be explained by the fact that risk factors do not equally contribute to CHD and stroke, and they might have not all been equally well controlled.     

中国甲状腺癌发病和死亡趋势分析与预测

目的 分析1990-2019年中国甲状腺癌发病和死亡趋势,探讨趋势变化原因,并对未来发病和死亡情况进行预测。方法 收集2019全球疾病负担数据库中1990-2019年中国甲状腺癌发病和死亡数据。利用Joinpoint连接点回归模型描述变化趋势。基于2012-2019年发病和死亡数据,构建灰色模型GM（1,1）预测未来10年情况,根据后验误差法、残差检验法对模型进行检验。结果 全国、男性、女性粗发病率的平均年度变化百分比（AAPC）值分别为4.15%（95%CI：3.86%~4.44%,P<0.001）、5.98%（95%CI：5.65%~6.31%,P<0.001）、3.23%（95%CI：2.94%~3.53%,P<0.001）,年龄标化发病率AAPC值分别为2.47%（95%CI：2.12%~2.83%,P<0.001）、3.98%（95%CI：3.68%~4.29%,P<0.001）、1.65%（95%CI：1.38%~1.93%,P<0.001）,粗死亡率AAPC值分别为2.09%（95%CI：1.92%~2.25%,P<0.001）、3.68%（95%CI：3.45%~3.90%,P<0.001）、0.60%（95%CI：0.50%~0.71%,P<0.001）。男性年龄标化死亡率呈先下降（1990-1994年）后上升（1994-2012年）再下降（2012-2019年）的波动趋势（AAPC=1.35%,95%CI：1.16%~1.53%,P<0.001）。女性年龄标化死亡率呈持续下降趋势（AAPC=-1.70%,95%CI：-1.82%~-1.58%,P<0.001）。建立的GM（1,1）模型均能够进行中长期预测,残差检验法结果显示,所有模型平均相对误差≤10.00%且预测精度>80.00%,预测效果优;后验误差法结果显示,除男性年龄标化发病率为合格外,其余均为好。预测2029年全国、男性、女性的粗发病率为3.57/10万、2.78/10万、4.40/10万,年龄标化发病率为2.38/10万、1.89/10万、2.88/10万,粗死亡率为0.57/10万、0.62/10万、0.53/10万,年龄标化死亡率为0.33/10万、0.42/10万、0.27/10万。结论 全国、男性、女性年龄标化死亡率近10年呈下降趋势,预测结果显示未来可能进一步下降,但粗发病率、年龄标化发病率和粗死亡率一直处于上升状态,且中国人口老龄化程度日益加剧,需要密切关注并实施有针对性的防控措施。     

中国2013年报告法定传染病发病及死亡特征分析

目的 了解2013年全国报告法定传染病的发病与死亡特征。方法 采用描述性分析方法对2013年全国报告的法定传染病发病、死亡数据进行分析,采用Microsoft Excel 2010和 ArcGIS 10.0软件制作图表。结果 2013年全国法定传染病总发病率为473.87/10万,较近3年平均值下降3%;总死亡率为1.23/10万,较近3年平均值上升2%。报告病例的实验室诊断率为38.4%。其中,报告发病率居前5位的病种为手足口病、其他感染性腹泻病、乙型肝炎、肺结核和梅毒,报告死亡的病种主要为艾滋病、肺结核和狂犬病。按传播途径分析,肠道传染病占本年度报告发病总数的49%,其次分别是经血与性传播传染病、呼吸道传染病和动物源性及虫媒传染病;按病原分析,病毒类传染病占发病总数的68%,高于细菌类和寄生虫类传染病。上海、浙江和江苏等地新发人感染H7N9禽流感疫情,麻疹、登革热、布鲁氏菌病等疫情上升明显,肺结核、乙型肝炎等传染病发病水平呈现下降。海南、广西、广东、新疆和浙江等地报告的法定传染病发病率排在全国前5位。结论 2013年我国法定传染病报告病例的实验室诊断率仍较低。西部省份和部分东南部省份的传染病发病水平较高,死亡水平较高的为西部省份。新发人感染H7N9禽流感疫情及局部地区的麻疹、登革热、布鲁氏菌病的高发与流行受到社会关注。     

Mortality and cancer morbidity in a cohort of Swedish glassworkers

Summary A cohort of 625 male, art glassworkers with employment of more than one month for some time between 1964 and 1985 was studied with regard to causes of death and cancer incidence. The number of total deaths was 97 versus 98.9 expected from national death rates and 82.9 expected from county death rates. A moderate increase in total cancer deaths was seen (26 observed cases vs 22.3 and 18.9 expected from national and county death rates, respectively) as also associated with duration of exposure. The excess number of cases was particularly noted for lung cancer, (6 observed cases vs 4.2 and 2.5 expected, respectively), colon cancer (4 observed cases vs 1.6 expected from both national and county death rates), cancer of the pharynx (2 observed cases vs 0.2 and 0.1 expected, respectively), and prostate (4 observed cases vs 3.0 and 2.4 expected, respectively). Most of these excesses occurred among men working in the foundry producing either heavy crystal glass or semicrystal glass, except for cancer of the prostate which occurred in the context of glass refinement. Excess risks for deaths from ischemic heart disease (39 observed cases vs 32.1 and 30.9 expected, respectively) and cerebrovascular disease (11 observed cases vs 7.3 and 6.5 expected, respectively) were also found, although with no clear relationship to duration of exposure. These latter risks occurred particularly among men working with the refinement of glass. Approximative correction for smoking habits resulted in increased risk estimates for lung cancer and ischemic heart disease, indicating a negative confounding effect from smoking in this material.     

2012—2018年重庆市急性心肌梗死发病死亡趋势分析

目的了解重庆市急性心肌梗死(AMI)发病与死亡流行趋势,为开展AMI防治提供建议。方法2012—2018年重庆市AMI个案资料来源于重庆市心脑血管疾病监测数据库。根据国际疾病分类编码(ICD-10)进行疾病分类,AMI编码为I21-I22。采用SPSS 25.0软件计算发病率、标化发病率、死亡率和标化死亡率。率的比较采用χ²检验,率的趋势变化分析采用年度变化百分比(APC)。结果重庆市AMI发病率与标化发病率分别由2012年的29.86/10万、24.52/10万上升至2018年的52.67/10万、39.56/10万,APC分别为12.41%与11.18%,变化趋势均有统计学意义(P<0.01)。2012—2018年AMI发病率男性均高于女性(P<0.01)。2014年AMI发病率城市高于农村,2015—2018年AMI发病率农村高于城市(P<0.01)。农村地区AMI发病率与标化发病率分别以年均15.37%与14.34%的比例上升,变化趋势均有统计学意义(P<0.01)。2012年重庆市AMI死亡率与标化死亡率分别为20.05/10万、16.37/10万,2018年AMI死亡率与标化死亡率分别为37.49/10万、27.73/10万,变化趋势均无统计学意义(P>0.05)。2012年、2013年与2018年AMI死亡率男性高于女性(P<0.05,P<0.01)。2012年与2013年AMI死亡率城市高于农村,2015年后农村高于城市,差异均有统计学意义(P<0.01)。农村地区AMI死亡率与标化死亡率分别以14.34%、12.41%的比例上升,变化趋势均有统计学意义(P<0.05,P<0.01)。结论重庆市AMI发病率与死亡率较高,并呈快速上升的趋势,男性与农村居民是AMI防治的重点人群。     

The completeness of brain tumour registration in Devon and Cornwall

Objectives: To determine ascertainment rates for primary brain tumours and examine factors influencing those rates. Design: Comparison of a clinical database with official figures from the Regional Cancer Intelligence Unit. Results: Of 1480 potential cases 52% appeared in the registry. Only two-thirds of patients operated upon were registered and less than one-third of those who were not operated appeared in the registry. Independent predictors of registration were having had an operation, 5.47 (4.19–7.17) (odds ratio (95% CI)), being over 60 years of age, 1.62 (1.26–2.07), and having a tumour requiring radiotherapy, 2.52 (1.74–3.66). Conclusions: There is asymmetric registration of primary brain tumours in Devon and Cornwall with under registration of more benign tumours in younger patients. If similar problems exist across the United Kingdom, this could have a negative influence on survival rates, and international comparisons of such rates should be performed with caution.     

2012年南通市居民恶性肿瘤发病和死亡情况

目的探讨南通市恶性肿瘤的流行特征,并对该地区肿瘤登记工作质量作以简要评估。方法收集南通市恶性肿瘤的发病和死亡数据,采用Canreg4软件录人,通过Excel和SPSS软件进行整理,分析该地区恶性肿瘤的发病率、死亡率,标化发病（死亡）率、年龄别发病率（死亡率）等指标。对死亡／发病比（M／I）、病理组织学诊断所占比例（MV％）、只有死亡医学证明书比例（DCO％）、未指明部位和原发部位不明的恶性肿瘤新发病例所占的百分比（O＆U％）进行评估。结果2012年南通市恶性肿瘤发病为23736人,死亡为17464人,恶性肿瘤发病率为312．84／10万,恶性肿瘤死亡率为234．00／10万,经年龄构成调整后,发病的中标率为167．03／10万,死亡的中标率为113．38／10万。前6位高发恶性肿瘤分别为肺癌、肝癌、胃癌、食管癌、结／直肠癌、乳腺癌。肺癌在男性和女性中均居发病率的首位,全人口发病率为60．66／10万。前6位高死亡率的恶性肿瘤分别为肺癌、肝癌、食管癌、胃癌、结直肠癌、胰腺癌。肿瘤登记工作质量指标,M／I为0．74、MV％为54．86％、DCO％为0．41％、0＆u％为3．70％。结论恶性肿瘤是南通市居民的第1位死因,肺癌居恶性肿瘤发病率和死亡率之首,消化系统肿瘤占比例最高。南通市肿瘤登记数据基本反映了全市恶性肿瘤的发病和死亡情况,但仍需完善。     

Modeling of air pollution and its relationship with mortality and morbidity in Madrid, Spain

Objective: Evaluation of the association between air pollution and mortality and morbidity is becoming ever more complex owing to changes in inner-city air pollution, marked by decreasing values for all main pollutants save those associated with traffic. This has led to the need for the study of new epidemiological scenarios in which most pollutants are below guideline values. Nonetheless, the health effects are significant. Methods: This report presents the results of a statistically based model for real-time forecasting of mortality and morbidity in Madrid, with meteorological and pollution series serving as inputs. Results and conclusions: Not only did the models perform well with correlation coefficients between predicted and observed values (r = 0.683 for mortality, r = 0.681 for morbidity), but they enabled quantification of the impact of air pollution on mortality and morbidity (with increases ranging from 1.8% to 12% for mortality and from 2.3% to 18% for morbidity for a 25-μg/m³ increase in pollutants). Moreover, attention should be drawn to the observation that the model proved to be easy to implement and operate on a routine basis. Received: 31 August 1998 / Accepted: 3 March 1999     

Mortality and cancer morbidity among cement workers.

OBJECTIVE--To explore associations between exposure to cement dust and cause specific mortality and tumour morbidity, especially gastrointestinal tumours. DESIGN--A retrospective cohort study. SUBJECTS AND SETTING--2400 men, employed for at least 12 months in two Swedish cement factories. MAIN OUTCOME MEASURES--Cause specific morality from death certificates (1952-86). Cancer morbidity from tumour registry information (1958-86). Standardised mortality rates (SMRs; national reference rates) and standardised morbidity incidence rates (SIRs; regional reference rates) were calculated. RESULTS--An increased risk of colorectal cancer was found > or = 15 years since the start of employment (SIR 1.6, 95% confidence interval (95% CI) 1.1-2.3), mainly due to an increased risk for tumours in the right part of the colon (SIR 2.7, 95% CI 1.4-4.8), but not in the left part (SIR 1.0, 95% CI 0.3-2.5). There was a numerical increase of rectal cancer (SIR 1.5, 95% CI 0.8-2.5). Exposure (duration of blue collar employment)-response relations were found for right sided colon cancer. After > or = 25 years of cement work, the risk was fourfold (SIR 4.3, 95% CI 1.7-8.9). There was no excess of stomach cancer or respiratory cancer. Neither total mortality nor cause specific mortality were significantly increased. CONCLUSIONS--Diverging risk patterns for tumours with different localisations within the large bowel were found in the morbidity study. Long term exposure to cement dust was a risk factor for right sided colon cancer. The mortality study did not show this risk.     

2006—2011年杭州市下城区恶性肿瘤发病与死亡情况分析

[目的]分析杭州市下城区恶性肿瘤发病与死亡情况及流行趋势,为制定预防控制措施提供科学依据。[方法]根据下城区公共卫生监测系统2006-2011年恶性肿瘤发病和死因监测数据,采用国际疾病分类法(ICD-10)进行编码,对发病率、死亡率及潜在寿命损失年数(YPLL)等进行分析。[结果]2006-2011年下城区恶性肿瘤发病率为423.75/10万,标化发病率为244.98/10万;死亡率为208.74/10万,标化死亡率为100.93/10万;男性高于女性,恶性肿瘤发病率和死亡率均随着年龄的升高而上升。肿瘤发病前5位依次是肺癌、结直肠癌、胃癌、乳腺癌和肝癌,死亡前5位依次为肺癌、结直肠癌、肝癌、胃癌和胰腺癌;恶性肿瘤YPLL前5位顺位与死因顺位有所不同。[结论]恶性肿瘤已严重影响下城区居民的健康,应制定相应的预防控制措施,开展有针对性的健康教育及做好早期筛查,是降低恶性肿瘤发病率和死亡率的重要方法。     

Mortality and incidence of cancer among Swedish gas workers

The mortality and incidence of cancer was studied among 295 workers at a Swedish gas production company. All men employed for at least one year between 1965 and 1972 were included in the study. The follow up period for mortality was 1966 to 1986, and the incidence of cancer was followed up from 1966 to 1983. Expected numbers of deaths were based on local death rates among occupationally active men, the expected numbers of cancer were based on national statistics. The total mortality was increased, mainly due to an excess of deaths from circulatory diseases. The excess was larger after long follow up and after long employment periods. Two cases of cancer in the nose and nasal sinuses were found; there was no excess of lung cancer. Smoking habits were investigated for a subset of the cohort and did not differ from the average for men in large cities. The findings are discussed in relation to other studies of soot and combustion exposed workers.     

1999 - 2018年黔南州女性乳腺癌发病和死亡趋势分析

目的 分析1999 - 2018年黔南州女性乳腺癌发病和死亡率变化趋势,为女性乳腺癌的防治提供依据。方法 利用黔南州肿瘤登记报告系统和居民全死因登记报告系统中1999 - 2018年女性乳腺癌发病和死亡登记资料,分别计算发病（死亡）率、中标化发病（死亡）率、年龄别发病（死亡）率和年均变化百分比等。结果 1999 - 2018年黔南州女性乳腺癌新发病例22 958例,发病率为33.41/10万,中标率为15.17/10万。20年中发病率APC3.75%,中标发病率APC 2.73%。城市女性发病率在35岁以后快速上升,50～54岁达到高峰（115.34/10万）。农村女性发病率在30岁以上快速上升,45～49岁达到高峰（86.42/10万）。城市女性乳腺癌发病率（43.31/10万）高于农村（19.39/10万）;1999 - 2018年黔南州女性乳腺癌死亡病例7 330例,死亡率为11.27/10万,中标率为4.65/10万。20年中死亡率APC 3.62%,中标化死亡率APC 2.51%。城市女性乳腺癌死亡率70岁以后快速上升,85岁～达到高峰（79.64/10万）;农村女性乳腺癌死亡率30岁以后快速上升,55～69岁变化趋于平稳,70岁以后又快速上升,85岁以后达到高峰（39.78/10万）。城市女性乳腺癌死亡率（18.67/10万）高于农村女性（9.28/10万）。结论 1999 - 2018年黔南州女性居民乳腺癌发病和死亡率呈明显上升趋势,应引起高度重视。     

广东省居民恶性肿瘤死亡趋势分析

目的了解广东省居民恶性肿瘤死亡水平及变化趋势。方法对广东省1970-1972、1990-1992以及2004-005年3次死因调查的恶性肿瘤死亡个案数据进行描述性流行病学分析,主要统计指标有死亡率、标化死亡率、死因构成及顺位。结果广东省1970-1972、1990—1992以及2004—2005年3次死因调查恶性肿瘤粗死亡率分别为52．23／10万、111．49／10万和135．93／10万,中标率分别为53．27／10万、95．70／10万和94．50／10万。3次调查恶性肿瘤在全省全死因顺位分别排第3位、第2位、第1位。3次调查恶性肿瘤前5位死因分别是1970-1972年为肝癌、食管癌、鼻咽癌、胃癌和肺癌,1990-1992年为肝癌、食管癌、肺癌、胃癌和鼻咽癌,2004-2005年为肝癌、肺癌、胃癌、食管癌和结直肠癌。在3次调查中,肝癌一直居第1位（3次调查粗死亡率分别是11．03／10万、23．22／10万和37．02／10万,中标率分别是11．17／10万、20．57／10万和26．95／10万）;肺癌、胃癌、结直肠癌位次逐渐前移,鼻咽癌位次逐渐后移。肝癌、肺癌、结直肠癌及女性乳腺癌死亡率呈逐渐上升趋势,宫颈癌呈下降趋势,鼻咽癌粗死亡率呈上升趋势,但标化率则呈下降趋势。死亡率差别分解法结果显示第2次调查恶性肿瘤死亡率较第1次升高有79．25％是由其他危险因素引起,20．75％是由人口老化引起的,第3次调查与第2次调查相比则98．61％是由人口老化引起的。结论广东省居民恶性肿瘤死亡率从绝对性上升趋势转变为相对上升趋势,需根据不同癌种变化趋势以及死亡模式变化采取针对性措施。