山东省1970-2013年恶性肿瘤死亡率变化趋势及差别分解

目的 探讨1970-2013年山东省恶性肿瘤死亡率的变化趋势和影响因素，为制定癌症防控规划和措施提供依据。方法 恶性肿瘤死亡率数据取自山东省死亡登记系统和3次全国死因回顾调查数据。利用死亡率和年龄标化死亡率等指标描述不同年代恶性肿瘤总死亡和主要肿瘤死亡水平的变化趋势，采用死亡率差别分解法计算死亡率变化中人口因素和非人口因素的贡献值。结果 1970-2013年山东省恶性肿瘤粗死亡率呈升高趋势，标化死亡率先升高后降低。恶性肿瘤死亡在全死因中的构成也是先升高后降低。人口因素和非人口因素共同导致粗死亡率的升高，人口因素所占的比重逐渐增加，甚至超过了非人口因素，导致2011-2013年恶性肿瘤年龄标化死亡率较2004-2005年降低。主要恶性肿瘤死因顺位变化较大，肺癌由第5位上升至第1位，2011-2013年较1970-1974年上升了6.81倍。胃癌死亡顺位从第1位降至第3位，食道癌从第2位降至第4位。经1964年中国标准人口调整后，肺癌死亡率仍呈快速升高趋势，而食管癌的调整率却逐渐下降。宫颈癌的粗死亡率和标化死亡率均呈快速下降趋势，2011-2013年较1970-1974年分别下降了87.00%和93.00%。结论 恶性肿瘤仍然是威胁山东省居民的重大疾病，不同恶性肿瘤的变化趋势不一致，应针对不同恶性肿瘤的病因和危险因素积极开展防控工作。

Trend of mortality and decomposition on malignant tumors in Shandong province, 1970-2013

Objective To describe the mortality trend of major malignant tumors in Shandong province, from 1970 to 2013. Methods Data related to cancer mortality were obtained from the Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. Trends of overall mortality and major causes of death were described using the indicators as:mortality rates and age-standardized mortality rates, through comparing the three large-scale mortality surveys in Shandong province. Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors for the change of mortality. Results From 1970 to 2013, the crude mortality rate of malignant tumors in Shandong was increasing. The age standard mortality rate was increasing and then decreasing. The composition of cancer deaths in the all-cause-deaths was seen increasing and then decreasing as well. Both demographic and non-demographic factors contributed to the increase of crude cancer mortality rate. With the gradual increase of the proportion of population, its role exceeded the non-demographic factors. The age-standardized mortality rate of malignant tumors in 2011-2013 was lower than that in 2004-2005. Lung cancer mortality rose from the fifth to the first place, with an increase of 6.81 times from 1970-1974 to 2011-2013. Ranking of gastric cancer mortality dropped from first to the third place, with esophageal cancer dropped from second to the fourth. After adjusted by China''s standard population in 1964, the mortality rate of lung cancer was still rapidly increasing, but the age-standardized mortality rates of esophageal cancer was gradually decreasing. The crude and age-standardized mortality rates of cervical cancer showed a rapid downward trend, reduced 87.00% and 93.00% respectively from 1970-1974 to 2011-2013. Conclusions Malignant tumors were still major threats to the residents of Shandong province. The changing trend of different malignant tumors presented an inconsistent nature which called for different intervention strategies be carried out, accordingly.