| Objective: To analyze the long-term trend of esophageal cancer mortality in China from 1990 to 2019 and the long-term trend of mortality attributable to smoking,alcohol consumption,and high BMI,providing reference opinions for the prevention and control of esophageal cancer in China.Methods: Collect and collate national esophageal cancer mortality data from 1990 to 2019 and mortality data attributed to smoking,alcohol consumption,and high BMI in the Global Burden of Disease Research(GBD)database,analyze the trend of esophageal cancer mortality using a Joinpoint regression model,and calculate esophageal cancer mortality rates,esophageal cancer mortality due to smoking,and esophageal cancer mortality due to alcohol consumption,respectively,The average annual percentage change(APC)value and the average annual percentage change(AAPC)value of esophageal cancer mortality attributable to high BMI;The age period cohort model(APC model)was used to analyze the impact of age,period,and cohort effects on various mortality changes.Results: From 1990 to 2019,the age standardized mortality rate of esophageal cancer in the country generally showed a downward trend,from22.08/100000 in 1990 to 13.15/100000 in 2019,with an AAPC value of-1.82%(P<0.001);In 2004,it reached a maximum of 23.91/100000,and in 2018,it reached a minimum of13.11/100000.From 1990 to 2019,the age standardized mortality rate of esophageal cancer due to smoking nationwide showed a downward trend,from 9.24/100000 in 1990 to 6.16/100000 in 2019,with an AAPC value of-1.44%(P<0.001);In 2004,the maximum was 10.20/100000,and in 2018,the minimum was 6.11/100000.From 1990 to 2019,the age standardized mortality rate of esophageal cancer due to alcohol consumption nationwide showed a downward trend,from 3.95/100000 in 1990 to 3.04/100000 in 2019,with an AAPC value of-0.97%(P<0.001);In 2004,the maximum was 4.41/100000,and in 2017,the minimum was 2.98/100000.From 1990 to 2019,the age standardized mortality rate of esophageal cancer due to high BMI increased nationwide,from1.44/100000 in 1990 to 1.80/100000 in 2019,with an AAPC value of 0.76%(P<0.001);In2004,it reached a maximum of 2.20/100000,and in 1990,it reached a minimum of1.44/100000.The results of the Joinpoint regression model for the mortality rate of esophageal cancer in various age groups from 1990 to 2019 showed that the mortality rate in all age groups was decreasing,and there were significant differences(P<0.001);The mortality rate of esophageal cancer due to smoking in all age groups increased in the85+year old age group,but there was no statistically significant difference(P=0.824).The mortality rate of other age groups showed a downward trend,and there was a significant difference(P<0.001);The mortality rate due to alcohol consumption in various age groups of esophageal cancer increased in the 85+year old age group(AAPC=0.80%),and there was no statistically significant change in the 80-84 year old age group(P=0.313).The other age groups showed a downward trend(P<0.05).The mortality rate of esophageal cancer due to high BMI in all age groups was increasing in the age groups of 30-34,35-39,60-64,70-74,75-79,80-84,and 85+years(P<0.05),while the trend of change in other age groups was not statistically significant.Results of the age period cohort model: From 1990 to 2019,the mortality rate of esophageal cancer in the population aged 30-85+increased with age,with the highest RR=4.088 for the 85+year old group(3.888,4.298);The period effect did not change significantly with the different period groups,with the highest risk of death from 2005 to 2009,RR=1.119(1.101,1.138);Cohort effect The later the birth cohort,the lower the risk of death,with the highest RR of 2.258(2.09,2.439)in 1905-1910.Results of the age period cohort model for esophageal cancer mortality attributable to smoking: The age effect mortality risk increases with age,with the highest RR=3.004 for the 75 to 79 year old age group(2.916,3.095);The period effect slightly increases with the increase of years,with the highest mortality risk from 2015 to 2019,RR=1.102(1.07,1.134);Cohort effect The later the birth cohort,the lower the risk of death,with the highest RR=1.947(1.837,2.064)in 1910-1914.Results of the age period cohort model for esophageal cancer mortality attributable to alcohol consumption: The age effect mortality risk increases with age,with the highest RR=3.728(3.58,3.882)for the 75 to 79 year old age group;The period effect does not change significantly with the increase of years,with the highest mortality risk from 2005 to 2009,RR=1.102(1.082,1.123);Cohort effect The later the birth cohort,the lower the risk of death,with the highest RR of 2.264(2.085,2.457)in 1910-1914.Age period cohort model results of esophageal cancer mortality due to high BMI: The age effect mortality risk increases with age,with the highest RR=3.403(3.301,3.508)for the 75 to 79 year old age group;The period effect significantly increases with the increase of years,with the highest mortality risk from2015 to 2019,RR=1.330(1.289,1.372);Cohort effect The later the birth cohort,the lower the risk of death,with the highest RR=2.312(2.147,2.49)in 1910-1914.Conclusion: From1990 to 2019,the mortality rate of esophageal cancer in the country showed a downward trend.The mortality rate due to smoking and alcohol consumption showed the same trend,while the mortality rate due to high BMI showed an upward trend;Overall,the mortality rate due to smoking and alcohol consumption in all age groups has an upward trend,while the mortality rate due to high BMI in all age groups has an upward trend;The total mortality rate in the age period cohort model is attributed to smoking and alcohol consumption.The age effect increases with age,the period effect does not change much,and the cohort effect decreases with the passage of the birth cohort.The period effect attributed to high BMI increases with age,and the age and cohort effects are the same as the total mortality rate. |
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