Mortality Trends in Colorectal Cancer in China During 2000–2015: A Joinpoint Regression and Age-Period-Cohort Analysis

Abstract

Introduction

As lifestyles have increasingly become westernized in China, public health strategies have increasingly focused on cancer prevention. The objective of this study was to describe trends in colorectal cancer (CRC) mortality and the age, period, and cohort effects of CRC mortality in urban and rural China from 2000 to 2015.

Methods

We collected CRC mortality data from the China Health Statistics Yearbook. We used joinpoint regression analysis to estimate the slope of mortality trends. We then used the age-period-cohort (APC) model with intrinsic estimator to estimate the age, period, and cohort effects of CRC mortality.

Results

CRC mortality was higher in urban areas than in rural areas, and the average annual percentage change was also larger in urban areas (4.1%) than in rural areas (3.7%). CRC mortality risk was higher among older adults than among adults aged 20 to 24: the relative risk among adults aged 60 to 64 was 31.09 times higher in urban China and 11.46 times higher in rural China. CRC mortality risk increased with period: compared with period 2000, the relative risk was 1.01 in period 2005, 1.36 in period 2010, and 1.42 in period 2015 in urban China and 1.12 in period 2005, 1.24 in period 2010, and 1.69 in period 2015 in rural China. More recent cohorts had lower CRC mortality risk: compared with the cohort born during 1920–1924, the relative risk of cohort 1950–1954 was 0.70 in urban China and 0.69 in rural China.

Conclusion

More interventions to reduce the burden of CRC should be conducted, and it is more necessary for older people and urban residents to adopt a healthy lifestyle in China.