Cancer mortality in the older adults in China
Overall cancer mortality in the older adults in China
A total of 2,590,265 people aged ≥60 years died of cancer in China from 2005 to 2016, with a median crude mortality of 770.42 per 100,000 individuals (729.30/100,000–837.28/100,000), showing a decreasing trend over time (APC=-1.23%, P<0.001). Among them, cancer deaths in the group aged 60–64 years accounted for 17% (431,603 deaths), the groups aged 65–69, 70–74, 75–79, 80–84, and ≥85 years accounted for 17% (450,614 deaths), 19% (498,679 deaths), 21% (532,027 deaths), 16% (411,330 deaths), and 10% (266,012 deaths), respectively
( Table 1).
Table 1 Mortality of cancer in the older adults in China from 2005 to 2016
|
Year
|
The number of deaths
|
Mortality rate
|
Standardized mortality
|
per 100000
|
per 100000
|
2005
|
65604
|
810.37
|
776.47
|
2006
|
74337
|
837.28
|
801.80
|
2007
|
75518
|
832.73
|
795.07
|
2008
|
87912
|
828.91
|
782.14
|
2009
|
110316
|
831.21
|
793.15
|
2010
|
158251
|
827.43
|
794.13
|
2011
|
185860
|
812.70
|
786.20
|
2012
|
248439
|
786.93
|
765.30
|
2013
|
291170
|
778.37
|
761.14
|
2014
|
367025
|
747.87
|
732.10
|
2015
|
420164
|
738.32
|
723.81
|
2016
|
505669
|
729.30
|
717.66
|
APC(%)
|
-
|
-1.23
|
-0.91
|
95%CI(%)
|
-
|
(-1.69,-0.77)
|
(-1.31,-0.51)
|
t
|
-
|
-5.91
|
-5.04
|
P
|
-
|
<0.001
|
<0.001
|
Sex-specific cancer mortality in the older adults in China from 2005 to 2016
A total of 63% (1,633,188 deaths) of the all cancer deaths occurred in men and 37% (9,570,77 deaths) in women between 2005 and 2016. Cancer mortality showed a decreasing trend in the older men and women, but the decreasing trend was more obvious in the latter (APCmen=-1.19%, APCwomen=-1.53%, all P<0.05). In addition, from the perspective of different regions, cancer mortality in the older men and women in rural areas decreased significantly relative to that in urban areas (rural: APCmen=-3.10%; APCwomen=-2.80%, all P<0.05; urban: APCmen=-0.68%, APCwomen= -1.03%, all P<0.05). However, men in rural areas showed a faster decline, whereas women in urban areas showed a more significant decline, and the sex difference widened year by year (t=2.74, P<0.05)(Table 2 and Table 3).
Table 2 APC of cancer mortality in the older adults with different characteristics in China from 2005 to 2016 (%)
|
Age
|
Urban Areas
|
Rural Areas
|
All Areas
|
Men
|
Women
|
Both
|
Men
|
Women
|
Both
|
Men
|
Women
|
Both
|
60-64
|
1.27a
|
0.49
|
1.04a
|
-3.86a
|
-4.23a
|
-3.95a
|
0.05
|
-0.41
|
-0.05
|
65-69
|
0.75a
|
-1.33a
|
0.10
|
-2.49a
|
-2.31a
|
-2.39a
|
0.28
|
-1.10a
|
-0.10
|
60-69
|
0.68a
|
-0.88a
|
0.21
|
-3.30a
|
-3.32a
|
-3.31a
|
-0.09
|
-1.08a
|
-0.35a
|
70-74
|
-0.93a
|
-2.16a
|
-1.39a
|
-4.18a
|
-3.68a
|
-3.76a
|
-1.32a
|
-2.30a
|
-1.59a
|
75-79
|
1.63a
|
-1.33a
|
1.53a
|
-3.22a
|
-2.43a
|
-2.53a
|
-1.78a
|
-1.72a
|
-1.69a
|
70-79
|
-1.08a
|
-1.48a
|
-1.24a
|
-3.65a
|
-3.00a
|
-3.12a
|
-1.41a
|
-1.85a
|
-1.50a
|
80-84
|
-1.25a
|
-0.27
|
-0.71
|
-2.09a
|
-1.10a
|
-1.22a
|
-1.59a
|
-0.83a
|
-1.09a
|
≥80
|
-1.02a
|
0.09
|
-0.35
|
-1.53a
|
-0.61
|
-0.67
|
-1.43a
|
-0.53
|
-0.83
|
≧85
|
-0.72
|
0.58
|
0.15
|
-0.19
|
0.20
|
0.11
|
-1.56
|
-0.12
|
-0.39
|
≥60
|
-0.68a
|
-1.03a
|
-0.76a
|
-3.10a
|
-2.80a
|
-2.84a
|
-1.19a
|
-1.53a
|
-1.23a
|
a:P<0.05
|
Table 3 Sex-specific cancer mortality in the older adults in China from 2005 to 2016*
|
Year
|
Urban Areas
|
Rural Areas
|
All Areas
|
Ratio
|
95%CI
|
Ratio
|
95%CI
|
Ratio
|
95%CI
|
2005
|
1.74
|
(1.70,1.77)
|
1.96
|
(1.90,2.02)
|
1.79
|
(1.76,1.82)
|
2006
|
1.79
|
(1.76,1.82)
|
1.96
|
(1.88,2.02)
|
1.82
|
(1.79,1.85)
|
2007
|
1.75
|
(1.72,1.78)
|
1.95
|
(1.89,2.00)
|
1.79
|
(1.77,1.82)
|
2008
|
1.76
|
(1.73,1.78)
|
1.94
|
(1.88,1.99)
|
1.79
|
(1.77,1.82)
|
2009
|
1.74
|
(1.72,1.77)
|
1.91
|
(1.86,1.95)
|
1.78
|
(1.76,1.81)
|
2010
|
1.76
|
(1.74,1.79)
|
1.47
|
(1.45,1.50)
|
1.81
|
(1.79,1.83)
|
2011
|
1.79
|
(1.77,1.82)
|
1.92
|
(1.89,1.95)
|
1.84
|
(1.82,1.86)
|
2012
|
1.76
|
(1.74,1.78)
|
1.89
|
(1.87,1.91)
|
1.82
|
(1.80,1.83)
|
2013
|
1.76
|
(1.74,1.78)
|
1.9
|
(1.87,1.92)
|
1.83
|
(1.82,1.85)
|
2014
|
1.79
|
(1.78,1.81)
|
1.88
|
(1.86,1.90)
|
1.83
|
(1.82,1.84)
|
2015
|
1.81
|
(1.79,1.83)
|
1.91
|
(1.89,1.93)
|
1.86
|
(1.85,1.87)
|
2016
|
1.84
|
(1.83,1.85)
|
1.92
|
(1.90,1.93)
|
1.88
|
(1.87,1.89)
|
t
|
2.74
|
-0.42
|
4.03
|
P
|
0.02
|
0.68
|
<0.01
|
* ratio=men: women
|
Regional distribution of the older adults with cancer
Urban-rural distribution of the older adults with cancer in China from 2005 to 2016
A total of 57% (1,483,037 deaths) and 43% (1,107, 228 deaths) of cancer deaths among the older individuals occurred in urban and rural areas, respectively, from 2005 to 2016. Over time, cancer mortality decreased in both urban and rural areas, but it decreased more significantly in rural areas (urban: APC =-0.76%; rural: APC =-2.84%, all P<0.05). In addition, the ratio of mortality between urban and rural areas also increased with time, gradually approaching 1, and the difference between urban and rural areas decreased (t=4.32, P<0.01). The urban-rural mortality difference was also narrowed by sex, especially for men (t=6.16, P<0.01)(Table 2 and Table 4).
Table 4 Urban-rural cancer mortality in the older adults in China from 2005 to 2016*
|
Year
|
Men
|
Women
|
Both
|
Ratio
|
95%CI
|
Ratio
|
95%CI
|
Ratio
|
95%CI
|
2005
|
0.78
|
(0.76,0.80)
|
0.88
|
(0.86,0.91)
|
0.79
|
(0.78,0.80)
|
2006
|
0.8
|
(0.78,0.82)
|
0.88
|
(0.85,0.90)
|
0.83
|
(0.82,0.85)
|
2007
|
0.78
|
(0.76,0.79)
|
0.87
|
(0.84,0.89)
|
0.81
|
(0.80,0.83)
|
2008
|
0.83
|
(0.81,0.85)
|
0.91
|
(0.89,0.94)
|
0.86
|
(0.85,0.87)
|
2009
|
0.95
|
(0.93,0.96)
|
1.04
|
(1.02,1.06)
|
0.98
|
(0.96,0.99)
|
2010
|
0.98
|
(0.97,0.10)
|
0.82
|
(0.81,0.83)
|
1.07
|
(1.06,1.08)
|
2011
|
0.94
|
(0.93,0.95)
|
1.01
|
(0.99,1.02)
|
0.96
|
(0.95,0.97)
|
2012
|
0.98
|
(0.97,0.99)
|
1.05
|
(1.04,1.06)
|
1
|
(0.99,1.01)
|
2013
|
0.96
|
(0.95,0.96)
|
0.8
|
(0.80,0.81)
|
0.98
|
(0.97,0.99)
|
2014
|
0.99
|
(0.98,0.10)
|
1.04
|
(1.02,1.05)
|
1
|
(0.99,1.01)
|
2015
|
0.98
|
(0.98,0.99)
|
1.04
|
(1.03,1.05)
|
1
|
(0.99,1.01)
|
2016
|
1
|
(1.00,1.01)
|
1.04
|
(1.03,1.05)
|
1.01
|
(1.01,1.02)
|
t
|
6.16
|
1.95
|
4.32
|
P
|
<0.01
|
0.08
|
<0.01
|
* ratio=urban : rural
|
Global distribution of cancer mortality in the older adults in 2021
As shown in Fig. 1, countries with a high HDI had relatively high cancer mortality among the older adults. The standard cancer mortality in China was 822.5/100,000 higher than that in countries with high HDI, and generally higher than the countries with a very high average HDI worldwide (701.5/100,000).
Age-period-cohort analysis of cancer mortality in the older adults in China
From the perspective of age-specific mortality trends, cancer mortality in the older adult population in China showed an overall decreasing trend from 2005 to 2016. Specifically, that of the men group aged 60–64 and 65–69 years showed a relatively stable change, while that of the remaining groups showed a decline (APC70-74=-1.32%, APC75-79=-1.78%, APC80-84=-1.59%, all P<0.05; APC≥85=-1.56%, P>0.05) (Table 2 and Fig. 2a). Except for the group aged ≥85 years, all age groups in women showed a decreasing trend (APC60-69=-1.08%, APC70-79=-1.85%, APC80-84=-0.83%, all P<0.05) (Table 2 and Fig. 2b). The mortality of the group aged 60–64 and 65–69 years in urban areas showed an increasing trend (APC60-64=1.04%, P<0.05; APC65-69=0.10%, P>0.05), while that of the group aged 60–64 and 65–69 years in rural areas showed a decreasing trend (APC60-64=-3.95%, APC65-69=-2.39%, all P<0.05). (Table 2,Fig. 2c and Fig. 2d).
According to the results of the age-period-cohort model, the effect of age on cancer mortality risk in older adults increased with age. The cancer mortality of men and women from different age groups can be roughly divided into three categories. The first category was the group aged <70 years: the cancer mortality of older men maintained a stable tendency(APC60-69=-0.09%, P>0.05), while that of older women was significantly decreased with age (APC60-69= -1.08%, P<0.05). The second category was the group aged 70–79 years: cancer mortality was significantly decreased with increasing age (men: APC70-79=-1.41%; women: APC70-79=-1.85%, all P<0.05). The third category was the group aged >80 years: the cancer mortality was decreased with age in the group aged 80–84 years and then gradually remained stable in those aged ≥85 years (men: APC80-84=-1.59%, P<0.05; APC≥85=-1.56%, P>0.05; women: APC80-84=-0.83%, P<0.05; APC≥85=-0.12%, P>0.05) (Table 2 ,Fig. 3a and Fig. 3b).
Cancer mortality among the older adults in urban and rural areas could be roughly divided into four categories. The first category was the group aged <70 years, and the cancer mortality of the older adults in urban areas was stable (APC60-69=0.21%, P>0.05), while that of those in rural areas significantly decreased with age (APC60-69=-3.31%, P<0.05). The second category was the group aged 70–74 years: the cancer mortality of the older adults in both urban and rural areas showed a significant decreasing trend with age (urban: APC70-74=-1.39%; rural: APC70-74= -3.76%, all P<0.05). The third category was the group aged 75–79 years: the cancer mortality of the older adults in urban areas showed an increasing trend, while that in rural areas showed a decreasing trend with age (urban: APC75-79=1.53%; rural: APC75-79=-2.53%, all P<0.05). The fourth category was the group aged >80 years: the cancer mortality of the older adults in urban areas did not change with age (APC80-84=-0.71%, APC≥85=0.15%, all P>0.05), while that of the older adults aged 80–84 years decreased in rural areas, then gradually remained stable in those ≥85 years old (APC80-84=-1.22%, P<0.05; APC≥85=0.45%, P>0.05).
(Table 2, Fig. 3c and Fig. 3d).
Cancer composition
Lung cancer ranked first in the number of cancer-related deaths in the older adults in China from 2005 to 2016, with approximately 743,922 deaths. As for the order of cancer deaths,liver, stomach, esophageal and colorectal cancers followed, and the top five cancer deaths accounted for about 73.0% of all cancer deaths(Fig. 4c).In men, lung cancer ranked first, with 506,578 deaths, followed by gastric, liver, esophageal and colorectal cancers. The top five cancers accounted for 77.0% of all cancer deaths(Fig.4a),with lung cancer ranking first in women, with about 237,340 deaths, followed by colorectal, stomach, liver, and breast cancers. The top five cancers accounted for 62.0% of all cancer-related deaths(Fig. 4b).
Trends of the top five cancer deaths in the older adults in China
For older men, lung cancer mortality ranked first in all age groups in China from 2005 to 2016. The lung cancer mortality in the groups aged 60–64 and 65–69 years showed an increasing trend (APC60-64=1.64%, APC65-69=0.98%, all P<0.05), while that in the groups aged 70–74, 75–79, 80–84 and ≥85 years showed a decreasing trend (APC70-74=-0.93%, APC75-79=-1.94%, APC80-84=-1.31%, all P<0.05; APC≥85=-0.23%, P>0.05). Liver cancer mortality showed an obscure change in men aged 60–64 and 65–69 years, while a decreasing trend was observed in the groups aged 70–74, 75–79, 80–84 and ≥85 years (APC70-74=-1.39%, APC75-79=-1.94%, APC80-84=-2.08%, APC≥85=-1.68%, all P<0.05). Colorectal cancer mortality presented an increasing trend in men aged 60–64 and 65–69 years (APC60-64=1.40%, APC65-69=0.65%, all P<0.05), while it decreased with increasing age in the group aged 70–74, 75–79, 80–84 and ≥85 years. Esophageal cancer mortality was stable in all men age groups ( P>0.05). Moreover, stomach cancer mortality in all men age groups showed a decreasing trend, and the decrease rate in the group aged 60–64 years was more obvious than in other age groups (APC60-64=-2.54%, P<0.05)(Fig. 5a).
Lung cancer mortality in older women showed an increasing trend in the groups aged 60–64, 80–84, and ≥85 years (APC60-64=0.98%, APC80-84=0.76%, APC≥85=2.04%, all P<0.05). Liver cancer mortality was relatively stable in the group aged ≥85 years (APC≥85=0.71%, P>0.05), while the other age groups showed a decreasing trend (APC60-64=-0.88%, P>0.05; APC65-69=-0.44%, APC70-74=-1.70%, APC75-79= -1.63%, APC80-84 = -0.92%, all P<0.05). Colorectal cancer in women of all age groups showed a downward trend. In addition, similar to men, stomach cancer mortality showed a decreasing trend in all age groups, and the decrease rate was more obvious in the group aged 60–64 years than the other age groups. However, the breast cancer mortality in the group aged 60–64 years showed an increasing trend (APC60-64=2.24%, P<0.05), while that in the group aged 80–84 years showed a decreasing trend (APC80-84=-1.86%, P<0.05), and the rest of the group presented a steady trend (APC65-69= -0.21%, APC70-74 = -0.96%, APC75-79 = -0.81%, APC≥85=-1.91%, all P>0.05)(Fig. 5b).