Zhentao Fu

Cancer incidence and mortality in Shandong province, 2012

Objective Population-based cancer registration data in 2012 from all available cancer registries in Shandong province were collected by Shandong Center for Disease Control and Prevention (SDCDC). SDCDC estimated the numbers of new cancer cases and cancer deaths in Shandong province with compiled cancer incidence and mortality rates. Methods In 2015, there were 21 cancer registries submitted data of cancer incidence and deaths occurred in 2012. All the data were checked and evaluated based on the National Central Cancer Registry (NCCR) criteria of data quality. Qualified data from 15 registries were used for cancer statistics analysis as provincial estimation. The pooled data were stratified by area (urban/rural), gender, age group (0, 1.4, 5.9, 10.14, …, 85+ years) and cancer type. New cancer cases and deaths were estimated using age-specific rates and corresponding provincial population in 2012. The Chinese census data in 2000 and Segi’s population were applied for age-standardized rates. All the rates were expressed per 100,000 person-year. Results Qualified 15 cancer registries (4 urban and 11 rural registries) covered 17,189,988 populations (7,486,039 in urban and 9,703,949 in rural areas). The percentage of cases morphologically verified (MV%) and death certificate-only cases (DCO%) were 66.12% and 2.93%, respectively, and the mortality to incidence rate ratio (M/I) was 0.60. A total of 253,060 new cancer cases and 157,750 cancer deaths were estimated in Shandong province in 2012. The incidence rate was 263.86/100,000 (303.29/100,000 in males, 223.23/100,000 in females), the age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 192.42/100,000 and 189.50/100,000 with the cumulative incidence rate (0.74 years old) of 22.07%. The cancer incidence, ASIRC and ASIRW in urban areas were 267.64/100,000, 195.27/100,000 and 192.02/100,000 compared to 262.32/100,000, 191.26/100,000 and 188.48/100,000 in rural areas, respectively. The cancer mortality was 164.47/100,000 (207.42/100,000 in males, 120.23/100,000 in females), the age-standardized incidence rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 117.54/100,000 and 116.90/100,000, and the cumulative mortality rate (0.74 years old) was 13.53%. The cancer mortality, ASMRC and ASMRW were 141.59/100,000, 101.17/100,000 and 100.33/100,000 in urban areas, and 173.79/100,000, 124.20/100,000 and 123.64/100,000 in rural areas, respectively. Cancers of the lung, stomach, liver, esophagus, colorectum, female breast, brain, leukemia, bladder and pancreas were the most common cancers, accounting for about 82.12% of all cancer new cases. Lung cancer, stomach cancer, liver cancer, esophageal cancer, colorectal cancer, female breast cancer, pancreatic cancer, brain tumor, leukemia and lymphoma were the leading causes of cancer death, accounting for about 89.01% of all cancer deaths. The cancer spectrum showed difference between urban and rural, males and females both in incidence and mortality rates. Conclusions Cancer surveillance information in Shandong province is making great progress with the increasing number of cancer registries, population coverage and the improving data quality. Cancer registration plays a fundamental role in cancer control by providing basic information on population-based cancer incidence, mortality, survival and time trend. The disease burden of cancer is serious in Shandong province, and so cancer prevention and control in Shandong province should be enhanced including health education, health promotion, cancer screening and cancer care services.

Incidence and mortality of stomach cancer in Shandong Province in 2012

Stomach cancer is common in the Chinese population. The present study aimed to analyze the incidence and mortality as a result of stomach cancer in Shandong Province, in order to provide a reference for cancer prevention and control. We analyzed the incidence and mortality data of stomach cancer collected from 15 cancer registries in 2012. We calculated the crude, age‐standardized, and truncated incidence and mortality rates for the registered population, and estimated the numbers of new cases and deaths that might have occurred in the total provincial population by applying the age‐specific rates to the corresponding populations. The estimated numbers of new cases and deaths of stomach cancer were 36 796 and 25 343, respectively, among the total Shandong population in 2012. Both the incidence and mortality rates were higher in men than in women. The incidence in rural areas was similar with that in urban areas, whereas mortality was markedly higher in rural than in urban areas. Age‐specific incidence and mortality of stomach cancer increased with age, particularly after 40 years‐of‐age and peaked at 80–84 or ≥85 years‐of‐age. Stomach cancer is common in Shandong province, particularly among men and residents in rural areas. Targeted prevention, early detection, and treatment programs should be carried out.

The gap between cause-of-death statistics and Household Registration reports in Shandong, China during 2011-2013: Evaluation and adjustment for underreporting in the mortality data for 262 subcounty level populations

Underreporting is a quality concern in mortality statistics. The purpose of this study was to assess and adjust underreporting in the population-based cause-of-death statistics. The total population (96 million) in Shandong, China was divided into 262 subcounty level populations geographically and by residence type (urban/rural). For each subpopulation, the total number of deaths during the years 2011–2013 was determined using data from the Household Registration System (HRS), and was used as a reference to assess the underreporting rate (UR) in the cause-of-death data from the Shandong Death Registration System (SDRS). It was estimated that 454,615 deaths, or 21.5% (95% CI: 21.4–21.5%) were unreported. Underreporting was more pronounced in rural (22.1%) versus urban communities (20.0%), in economically underdeveloped regions (32% versus 16% in least disadvantaged areas), and in newly included sites with no prior experience in cause-of-death reporting (24% versus 17%). Geographic variation was large with a UR at the prefectural level ranging from 11.2% to 43.7%. A stratified analysis showed that UR was higher in rural populations in high-income regions, but in middle- and low-income regions, was higher in urban communities. An adjustment factor (AF) was calculated for each of the 262 subpopulations (ranging from 0.9 to 2.5 with an average of 1.27). The total morality rate was adjusted from 6.03 to 7.67 deaths per 1000 persons. Underreporting in the SDRS varies greatly between areas and populations and is related to residence type, prior experience and local economy. Correcting underreporting at a local level is needed especially for comparative analyses across geographical areas or populations.

Female Breast Cancer Mortality Clusters in Shandong Province, China: A Spatial Analysis

This study aimed to detect the spatial distribution and high-risk clusters of female breast cancer mortality for the years 2011 to 2013 in Shandong Province, China. The urban-rural difference in the spatial distribution and clusters of disease mortality were also examined. Breast cancer mortality data were obtained from the Shandong Death Registration System (SDRS) during 2011 to 2013 and were adjusted for the underreporting rate. The purely spatial scan Statistics method was performed using Discrete Poisson model. Seven significant spatial clusters for high mortality of female breast cancer were detected in Shandong Province at the county level; these clusters were mainly located in the eastern, southern, southwestern, central and northern regions. The spatial distributions differed significantly between urban and rural populations. Population ageing influenced the distribution of breast cancer clusters for the urban eastern residents. This study provided evidence for the presence of clusters of breast cancer mortality in Shandong, China and found urban-rural difference in the clusters, which is helpful for developing effective strategies to control breast cancer in different areas.

Lung cancer mortality clusters in Shandong Province, China: how do they change over 40 years?

Lung cancer has long been a major health problem in China. This study aimed to examine the temporal trend and spatial pattern of lung cancer mortality in Shandong Province from 1970 to 2013. Lung cancer mortality data were obtained from Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. A Purely Spatial Scan Statistics method with Discrete Poisson models was used to detect possible high-risk spatial clusters. The results show that lung cancer mortality rate in Shandong Province increased markedly from 1970-1974 (7.22 per 100,000 person-years) to 2011-2013 (56.37/100, 000). This increase was associated with both demographic and non-demographic factors. Several significant spatial clusters with high lung cancer mortality were identified. The most likely cluster was located in the northern region of Shandong Province during both 1970-1974 and 2011-2013. It appears the spatial pattern remained largely consistent over the last 40 years despite the absolute increase in the mortality rates. These findings will help develop intervention strategies to reduce lung cancer mortality in this large Chinese population.