Trends in cancer mortality in China from 2004 to 2018: A nationwide longitudinal study

Abstract

Background: The long-term trend in cancer death in a rapidly developing country provides information for cancer prophylaxis. Here, we aimed to identify the trends in cancer mortality in China during the 2004-2018 period.

Methods: Using raw data from the national mortality surveillance system of China, we assessed the mortalities of all cancer and site-specific cancers during the 2004-2018 period. The participants were divided into three age groups: ≥65 years, 40-64 years, and ≤39 years. Changing trends in cancer death by gender, residency, and tumor location were estimated using fitting joinpoint models to log-transformed crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs).

Results: Cancer death accounted for 24% of all-cause of death in China during 2014-2018. The CMR of all cancer was 150.0 per 100,000 persons. Cancer was the leading cause of death in the population <65 years. The six major cancer types (lung/bronchus cancer, liver cancer, stomach cancer, esophagus cancer, colorectal cancer, and pancreas cancer) accounted for 75.85% of all cancer deaths. The CMR of all cancer increased while the ASMR decreased during 2014-2018 (P < 0.001). Lung/bronchus cancer and liver cancer were the leading causes of cancer death in the population <65 years, accounting for 45.31% (CMR) and 44.35% (ASMR) of all cancer death, respectively. The ASMR of liver cancer was higher in the 40-64 years population than in the ≥65 years population, in contrast to the other five major cancers. The ASMRs of liver cancer, stomach cancer, and esophagus cancer decreased although they were higher in rural residents than in urban residents; the ASMRs of lung/bronchus cancer, colorectal cancer, and pancreas cancer increased in rural residents although they were higher in urban residents than in rural residents during 2014-2018.

Conclusion: Although the ASMR of all cancer decreased in China during 2004-2018, lung/bronchus cancer and liver cancer remained the leading causes of cancer-related premature death. Lung/bronchus cancer, colorectal cancer, and pancreas cancer increased in rural residents.

Keywords: age-standardized mortality rate; breast cancer; colorectal cancer; crude mortality rate; demographic distribution; liver cancer; national mortality surveillance system; premature death; site-specific cancer; stomach cancer; trend.

FIGURE 1

Crude and age‐standardized mortality rates for six major diseases in mainland China among the whole population and the population younger than 65 during 2004‐2018; (A) crude mortality rates for six major diseases among the whole population; (B) age‐standardized mortality rates for six major diseases among the whole population; (C) crude mortality rates for six major diseases among the population younger than 65 years; and (D) age‐standardized mortality rates for six major diseases that lead to death in China among the population younger than 65 years. * P < 0.05, ** P < 0.01, *** P < 0.001; ⁺ increased, ^–decreased from 2004 to 2018

FIGURE 2

Crude and age‐standardized mortality rates for cancers of women and men in mainland China during 2004‐2018; (A) trend in the crude mortality rate of all cancer of females and males; (B) trend in the age‐standardized mortality rates of all cancer of females and males; (C) the crude mortality rate of each cancer type in females <65 years; (D) the age‐standardized mortality rate of each cancer type in females <65 years; (E) the crude mortality rate of each cancer type in males <65 years; and (F) the age‐standardized mortality rate of each cancer type in males <65 years. *** P< 0.001; ⁺ increased, ^–decreased from 2004 to 2018

FIGURE 3

Trends in the age‐standardized mortality rates per 100,000 of six major cancer types in three age groups (younger than 39 years, 40‐64 years, 65 years or older) in mainland China during 2004‐2018; (A) trends in the age‐standardized mortality rate of esophagus cancer; (B) trends in the age‐standardized mortality rate of stomach cancer; (C) trends in the age‐standardized mortality rate of liver cancer; (D) trends in the age‐standardized mortality rate of lung/bronchus cancer; (E) trends in the age‐standardized mortality rate of colorectal cancer; and (F) trends in the age‐standardized mortality rate of pancreas cancer. *P < 0.05, ***P < 0.001; ⁺increased, ^–decreased from 2004 to 2018

FIGURE 4

The age‐standardized mortality rates per 100,000 for six major cancer types in urban and rural populations in mainland China during 2004‐2018; (A) comparison of the age‐standardized mortality rates per 100,000 of the six major cancer types in urban and rural populations; (B) trends in the age‐standardized mortality rates of six major cancer types in urban population, 2004‐2018; (C) trends in the age‐standardized mortality rates of six major cancer types in rural population, 2004‐2018. ** P < 0.01, *** P < 0.001; ⁺ increased, ^–decreased from 2004 to 2018

FIGURE 5

Trends in the age‐standardized mortality rates per 100,000 of six major cancer types in the eastern, central, and western regions of mainland China during 2004‐2018; (A) trends in the age‐standardized mortality rates of six major cancer types in eastern urban population; (B) trends in the age‐standardized mortality rates of six major cancer types in eastern rural population; (C) trends in the age‐standardized mortality rates of six major cancer types in central urban population; (D) trends in the age‐standardized mortality rates of six major cancer types in central rural population; (E) trends in the age‐standardized mortality rates of six major cancer types in western urban population; and (F) trends in the age‐standardized mortality rates of six major cancer types in western rural population. *P < 0.05, **P < 0.01, ***P < 0.001; ⁺increased, ^–decreased from 2004 to 2018