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. 2021 Oct 4;193(39):E1516-E1524.
doi: 10.1503/cmaj.210595.

Incidence and mortality rates of keratinocyte carcinoma from 1998-2017: a population-based study of sex differences in Ontario, Canada

Evan Tang  1 , Kinwah Fung  1 , An-Wen Chan  2
Affiliations

Incidence and mortality rates of keratinocyte carcinoma from 1998-2017: a population-based study of sex differences in Ontario, Canada

Evan Tang et al. CMAJ. .

Abstract

Background: Keratinocyte carcinoma is the most common malignant disease, but it is not captured in major registries. We aimed to describe differences by sex in the incidence and mortality rates of keratinocyte carcinoma in Ontario, Canada.

Methods: We conducted a population-based retrospective study of adults residing in Ontario between Jan. 1, 1998, and Dec. 31, 2017, using linked health administrative databases. We identified the first diagnosis of keratinocyte carcinoma using a validated algorithm of health insurance claims, and deaths related to keratinocyte carcinoma from death certificates. We calculated the incidence and mortality rates of keratinocyte carcinoma, stratified by sex, age and income quintile. We evaluated trends using the average annual percentage change (AAPC) based on joinpoint regression.

Results: After decreasing from 1998 to 2003, the incidence rate of keratinocyte carcinoma increased by 30% to 369 per 100 000 males and 345 per 100 000 females in 2017 (AAPC 1.9%, 95% confidence interval [CI] 1.7 to 2.1 from 2003 to 2017). The incidence rate was higher in females younger than 55 years, but higher in males aged 55 years or older. Between 2008 and 2017, the incidence rate rose faster in females than males aged 45-54 years (AAPC 1.2% v. 0.5%, p = 0.01) and 55-64 years (1.2% v. 0.1%, p < 0.01). The incidence was higher in males than females in the higher income quintiles. Between 1998 and 2017, the mortality rate of keratinocyte carcinoma was 1.8 times higher in males than females, on average, and rose 4.8-fold overall (AAPC 8.9%, 95% CI 6.4 to 11.4 in males; 8.0%, 95% CI 5.3-10.8 in females).

Interpretation: The population burden of keratinocyte carcinoma is growing, and the incidence and mortality rates rose disproportionately among certain sex- and age-specific groups. This warrants further investigation into causal factors and renewed preventive public health measures.

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Conflict of interest statement

Competing interests: An-Wen Chan reports funding from Pellepharm to his institution to support participation as a clinical trial site, outside the submitted work. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Annual crude incidence rates of first diagnosis of keratinocyte carcinoma (solid lines) and Ontario adult population size (vertical bars) from 1998 to 2017. Note: CI = confidence interval.
Figure 2:
Figure 2:
Annual crude incidence rates of first diagnosis of keratinocyte carcinoma by age and sex among Ontario adults (1998–2017). Note: CI = confidence interval.
Figure 3:
Figure 3:
Average annual percent change in incidence rates of keratinocyte carcinoma by age and sex among Ontario adults from 2008 to 2017. The p value represents the pairwise comparison between males and females. Note: CI = confidence interval.
Figure 4:
Figure 4:
Annual age-standardized incidence rates of first diagnosis of keratinocyte carcinoma by income quintile (Q1–Q5) and sex among Ontario adults (1998–2017). Incidence rates were age-standardized using the 1991 Canadian population. Note: CI = confidence interval.
Figure 5:
Figure 5:
Annual crude mortality rates of keratinocyte carcinoma by sex among Ontario adults (1998–2017). Note: CI = confidence interval.
See this image and copyright information in PMC

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