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. 2020 Feb 20;17(4):1367.
doi: 10.3390/ijerph17041367.

A Hierarchical Age-Period-Cohort Analysis of Breast Cancer Mortality and Disability Adjusted Life Years (1990-2015) Attributable to Modified Risk Factors among Chinese Women

Sumaira Mubarik  1 , Fang Wang  1 , Saima Shakil Malik  2 , Fang Shi  1 , Yafeng Wang  1 , Nawsherwan  3 , Chuanhua Yu  1   4
Affiliations

A Hierarchical Age-Period-Cohort Analysis of Breast Cancer Mortality and Disability Adjusted Life Years (1990-2015) Attributable to Modified Risk Factors among Chinese Women

Sumaira Mubarik et al. Int J Environ Res Public Health. .

Abstract

Limited studies quantified the age, period, and cohort effects attributable to different risk factors on mortality rates (MRs) and disability-adjusted life years (DALYs) due to breast cancer among Chinese women. We used data from the Global Burden of Disease Study (GBD) in 2017. Mixed-effect and hierarchical age-period-cohort (HAPC) models were used to assess explicit and implicit fluctuations in MRs and DALYs attributable to different breast cancer associated risk factors. As the only risk factor, high body mass index (HBMI) showed continuously increasing trends in MRs and DALYs across ages, periods, and cohorts. Age, recent periods (2010-2015), and risk factor HBMI showed significant positive effect on MRs and DALYs (p < 0.05). Moreover, we reported significant interaction effects of older age and period in recent years in addition to the interplay of older age and risk factor HBMI on MRs and DALYs. Increased age and obesity contribute to substantially raised breast cancer MRs and DALYs in China and around the globe. These discoveries shed light on protective health policies and provision of healthy lifestyle for improving the subsequent breast cancer morbidity and mortality for China, as well as other related Asian regions that are presently facing the same public health challenges.

Keywords: China; age; breast cancer; cohort; high body mass index; mortality rates.

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Conflict of interest statement

The authors report no conflict of interest in this work.

Figures

Figure 1
Figure 1
Trends in breast cancer mortality (BCM) and disability-adjusted life years (DALYs) across ages within different risk factors (high body mass index (HBMI), alcohol use, low physical activity (PA), and smoking) in years 1990, 2000, 2010, and 2015. (A) The left panel indicate the BCM plots, and (B) the right panel indicate the breast cancer DALYs plots.
Figure 2
Figure 2
Random effects of (a) age, (b) period, and (c) cohort interaction with different risk factors on mortality rates (MRs) using hierarchical age–period–cohort (APC) model.
Figure 3
Figure 3
Random effects of (a) age, (b) period, and (c) cohort interaction with different risk factors on DALYs using hierarchical APC model.
Figure 4
Figure 4
Fixed and random effects of age, period, and cohort from hierarchical (APC) model of (a) MRs and (b) DALYs (per 100,000) from breast cancer.
See this image and copyright information in PMC

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