| Objectives:Breast cancer is the most common female malignant tumor.The incidence and death of breast cancer carry a heavy burden on women's health.According to the China Cancer Report,breast cancer is the highest incidence of cancer in Chinese women,it accounts for 6.9%of all cancer deaths in our country.Through analysis and prediction,this study aims to grasp the trend of the incidence and death of female breast cancer in china and provides data support for the health authorities to formulate relevant policies and measures.Methods:The research object of this study is the Chinese female population.The study included the long-term trends in the incidence and mortality of breast cancer from 1990 to 2016 and future morbidity and mortality prediction in the Chinese women.The statistical methods used mainly for conducting this study include:(1)Descriptive research.We described the standardized incidence and mortality rate of breast cancer among Chinese women from 1990 to 2016,and to understand their development trendency.The age trends,time trends,and cohort changes of breast cancer incidence and mortality in Chinese women during the observation period are described separately.(2)The Joinpoint regression model was used to subsection describe women's breast cancer incidence and mortality trends from 1990 to 2016 in China,and found out the junctions of different segments and assessed whether the changes within the segments had statistically significant.At the same time,the annual percentage change rate and the average annual percent change rate and their 95%confidence interval for age-specific morbidity and age-specific mortality were calculated by age group.(3)Using the Poisson regression model and the negative binomial regression model to analyze the incidence mortality of breast cancer in Chinese women from 1990 to 2016,to explore the possible impact of the epidemic characteristics of breast cancer incidence and death on the subjects during the observation period,and to compare the fitting effect of these two models.(4)Using the Age-Period-Cohort model to analyze the trends of breast morbidity and mortality in Chinese women from 1990 to 2016,and to further calculate the age,time,and cohort effects.(5)Forecasting the incidence and mortality of breast cancer in Chinese women in the next decade.Firstly,a time series model was constructed for the Chinese women's breast cancer morbidity and mortality data from 1990 to 2016.After the model was identified,the ARIMA model was used to predict the morbidity and mortality of Chinese women's breast cancer from 2017 to 2026.Results:(1)From 1990 to 2016,the incidence of female breast cancer in China showed an overall rising trend.The Joint-point regression model showed that the trend of the incidence can be divided for five periods:1990-1993,1993-2000,2000-2005,2005-2010 and 2010-2016.The annual percentage change rate for each period were 2.92%,3.23%,2.71%,2.35%,and 1.64%.The analysis of the age trends,time trends,and cohort trends of the incidence of breast cancer in Chinese women during the observation period showed that:with the increase of women's age,the incidence increased first and then decreased slightly.Before the age of 65,the incidence of the disease increased with age,and it increased significantly before the age of 45.It began to decline slightly after age 65;the trend of the period appeared throughout the observation period.The period trend was gradual increase and the high age group was the most obvious.The cohort trend showed that the smaller the birth cohort had,the smaller the impact on the risk of incidence,and the trend of the cohort trend of the women over 45 years old was the largest.The age-specific morbidity study results indicated that the trend of incidence changes in different age groups with observation time can be divided into rising-falling-rising group and continuous rising situation.(2)From 1990 to 2016,the overall incidence of breast cancer mortality in Chinese women showed a trend of first rise and then decline.The Joinpoint regression model results showed that during the observation period Chinese female breast cancer mortality trends could be divided into five sections:1990-1998,1998-2002,2002-2005,2005-2014 and 2014-2016,the annual percentage rate were 0.24%,1.20%,1.81%,1.03%and 1.86%,respectively.The analysis of the age trends,time trends,and cohort trends of the mortality of breast cancer in Chinese women during the observation period showed that:The trend of age showed that the mortality rates rising as the growth of the age;before the age of 59,mortality rate rising significantly but the change of 60-69 age group was smaller;During the observation period,the trend of breast cancer mortality in Chinese women showed that there was little change in the mortality rate of women aged 20-29 years,while mortality decreased slowly with the change of time in women aged 30-49 years,and the mortality trend was more complicated in women aged 50 and over.The mortality rate of females in the 60-64 age groups showed an upward-descending-rising-declining trend over time.The overall trend of the period showed that the fluctuation range of breast cancer mortality rate with birth cohort gets smaller as the female gets younger.For women aged 29 years and younger,the cohort trends were not obvious;for age 30 to 39,the trends went down;the others were complex.The results of the study on the trend of age-specific death rate showed that the mortality rate of the different age groups increased first and then decreased or no discipline.(3)The Poisson Regression and Negative Binomial Regression results showed that age and period were independent risk factors for the incidence of Chinese female breast cancer.After comparing two regression model fitting effect,we chose the negative binomial distribution results evaluation of the influence of age and period factors and the results showed:Chinese women age increased every five years old,a 27%increased risk of breast cancer(OR=1.27,95%CI=1.24 1.29,P<0.05);During the observation period,the average morbidity risk increased by 2%(OR=1.02,95%CI=1.02-1.03,P<0.05)during each year of increase.The age was the independent risk factor for China's female breast cancer mortality by Poisson distribution and negative binomial regression results.After.choosing a better fitting effect,the negative binomial regression analysis results showed that the breast cancer risk of death increased 25%with women's age increased every five years(OR =1.25,95%CI = 1.24 1.26,P<0.05).(4)The Age-Period-Cohort model of breast cancer incidence data analysis results showed that the overall effect presented a downward trend after rising first,and the minimum age effect coefficient(2.74)and the maximum value(0.72)indicated the lowest and highest risk of breast cancer in women age group of 20 to 24 and 50 to 54,respectively.During the whole observation,the period effect of breast cancer was increasing over the time.The six observation point effect coefficients were 0.51,0.30,0.08,0.13,0.31 and 0.46.Cohort effect during the period of observation for the Chinese women presented a lowering overall risk of breast cancer;1916-1920 birth cohorts of women was the largest and the effect coefficient was 0.56,1991-1995 birth cohort of women was minimum and the effect coefficient was 0.54.(5)The Age-Period-Cohort model of breast cancer mortality data between 1990 to 2016 analysis results showed that the change of age effect in Chinese female breast cancer mortality risk was increased,the age effect of maximum and minimum value were 2.96 and 0.85 and the 75 to 79 years old and 20 to 24 years old age group were the highest and lowest respectively.During the observation period,the period effect showed the trend increasing with time,and the effect coefficient increased from-0.17 in 1991 to 0.12 in 2016.The effect of cohort was overall downward trend in the population during the observation period,and birth cohort of 1916-1920 years was the highest risk and the effect coefficient was 0.63.(6)The time series model of data from 1990 to 2016 Chinese female breast cancer incidence and mortality was set up,after repeated inspection,the final diagnosis and parameter were ARIMA(2,1,2)model and ARIMA(2,2,2)model for Chinese female breast cancer incidence and mortality of the next decade.The results showed that from 2017 to 2026,the breast cancer incidence of Chinese women is going to increase.It will get to 19.56 per 100,000 in 2026.But the death rate will gradually drop to about 4.32 per 100,000 in 2026.Conclusions:(1)Age is the influencing factor for the incidence and death of breast cancer in Chinese women.In most cases,older women get higher risk of morbidity.Therefore,we must pay more attention and input on the prevention and treatment of breast cancer in high-risk age groups.(2)The Joinpoint regression model is suitable for analyzing the long-term trends in the incidence and mortality.It is not only able to describe the trend of change,but also to analyze the statistical significance of changes in different segments,which is conducive to understand the development of the change.(3)Using the APC model to explore the age,period and cohort effect affecting the long-term trends in breast cancer incidence and mortality in Chinese women.The results of the study showed that the incidence of breast cancer in Chinese women continues to increase as the mortality rate has declined.(4)The Poisson distribution and the negative binomial distribution are appropriate for investigate the epidemiological investigation of cancer risk factors,and the negative binomial regression has a better fitting effect.The regression results indicate that age is a risk factor for the occurrence and death of breast cancer in Chinese women,and the influence of period factors need further study.(5)The result of using the ARIMA model to predict the incidence and death of breast cancer in Chinese women between 2017 and 2026 suggests that the incidence of breast cancer in Chinese women will continue to rise during the next decade,and the mortality rate will decline. |
PDF Full Text Request