| BackgroundThe major digestive tract cancers include esophageal cancer,stomach cancer,and colorectal cancer.The total number of deaths in digestive tract cancers accounts for 31.0%of all cancer deaths in Suzhou.Studies have shown that period and age play important roles in the trend of the digestive tract cancer mortality.However,there was no study on the prediction of future mortality in digestive tract cancers.PurposesIn order to understand the death characteristics of esophageal cancer,stomach cancer and colorectal cancer in Suzhou from 2002 to 2016.A Lee-Carter model was used to analyze the trend of mortality and the age-specific mortality rate of digestive tract cancer in the next 10 years,and will further provide a scientific basis for the government and its related departments in order to formulate prevention policies and allocate rational health resources for people.MethodsData of major digestive tract cancer mortality were abstracted from Suzhou chronic disease surveillance system from 2002 to 2016 and were coded by ICD-10.Our study included a total of 60,689 patients aged 45 years and older who died of esophageal cancer(C15),stomach cancer(C16),colon cancer(C18),rectal cancer(C19-20),and anal cancer(C21).The crude,standardized,and age-specific mortality rates were calculated based on deaths of digestive tract cancer by sexes and cancer sites.Furthermore,we establish Lee-Carter model to predict the mortality of digestive tract cancer,and used the mean absolute percentage error to estimate the effectiveness of result.Results1.In 2002-2016,60,689 deaths were caused by cancer in the digestive tract in Suzhou,including 40,975(68%)males and 19,714(32%)females.The crude mortality rate was 150.60/105,and the average age of death was 71.33±10.39 years old.The crude mortality rates of male and female with digestive tract cancer are 207.31/105 and 96.15/105 respectively,and the difference between male and female mortality rates was statistically significant(P<0.001).The crude mortality rate was on the downtrend in overall digestive tract cancer(P<0.001)from 2002 to 2016,among which the crude mortality rate of male(P<0.001)and female(P<0.001)were decreased.There were 14,464 died due to esophageal cancer and 34,478 people died due to gastric cancer,respectively.They both showed a downward trend in mortality(P<0.001).In addition,there were 11,747 people died of colorectal cancer and the mortality was on up trend(P<0.001).2.The mortality index(kt)was in overall digestive tract cancer decreased from 2002 to 2016,among which the mortality index(Kt)was decreased in male and female.Meanwhile,there was a fluctuation around 2006.The mortality index(Kt)in esophageal cancer and gastric cancer was on the downtrend,while in colorectal cancer was on up trend,and it will continue in the next 10 years.3.The mortality rate of digestive tract cancer in Suzhou increases with age.With the development of period,the mortality rate of all age groups gradually decreased except people over 85 years old.From the curve of age-specific mortality rate in digestive tract cancer in Suzhou,there is a phenomenon that with the development of the age the mortality of people over 85 years old appears to shift backward in esophageal cancer and gastric cancer,and gradually replace 80-84 years old becoming the new death peak.4.We used Lee-Carter model to analysis the mortality of digestive tract cancer in Suzhou from 2002 to 2016.It has been verified that the dynamic trend of the predicted mortality of digestive tract cancer in Suzhou is basically consistent with the actual value when the parameter of the time series model was set to ARIMA(0,1,0).It also implies that the effectiveness of Lee-Carter model is good in our study.At the same time,the mean absolute percentage error is greater than 20%at the period and age level.It indicates that the Lee-Carter model is fit for predicting the mortality rate of digestive tract cancer in Suzhou.Furthermore,the predicting effectiveness of male is better than that of female.Conclusions1.The mortality of digestive tract cancer in Suzhou residents from 2002 to 2016 has shown a downtrend,among which the mortality of esophageal cancer and gastric cancer decreased by year.The mortality of colorectal cancer showed an upward trend.2.Period effect:The mortality rate of digestive tract cancer in Suzhou fluctuated in 2006.The death was relatively stable before 2006,while the mortality rate of esophageal cancer and gastric cancer was significantly decreased after it.It indicates that previous Health policies have produced significant results such as Gastrointestinal Screening.3.Age effect:The mortality rate of digestive tract cancers in Suzhou has increased among the people over 85 years old,while the mortality rate of other age groups has decreased by year.It makes the mortality rate of people over 85 years old gradually becoming the peak of death by age.This phenomenon indicates that Suzhou is experiencing a rapid population aging.4.The effectiveness of Lee-Carter model was validated in the data of digestive tract cancer mortality from 2012 to 2016 in Suzhou and can further expand the death prediction applied to other chronic diseases.The Lee-Carter model can also reflect the impact of the significant improvements in medical and health level with cancer mortality,since China has entered the well-off society.It is also used to evaluate the effects of population aging and cancer prevention. |
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