• gastric cancer
• incidence
• mortality
• multiple management
• stratified analysis

• Humans
• Aged
• Incidence
• Quality-Adjusted Life Years
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/therapy
• Morbidity
• Chronic Disease

• Chinese
• cancer
• incidence

Cancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators.

Cancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1 – (ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS.

Substantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412–$9361).

Similar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity.

The online version of this article (10.1186/s12889-019-7384-y) contains supplementary material, which is available to authorized users.

• Cancer outcomes
• Cancer site-standardized relative survival
• Global health
• Health economics

• age-period-cohort analysis
• gastrointestinal cancers
• incidence
• mortality
• trends

• age-period-cohort model
• all-cause mortality
• cancer mortality
• intrinsic estimator algorithm

• Accidental Falls/mortality
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cause of Death/trends
• China/epidemiology
• Cities
• Cohort Studies
• Female
• Forecasting
• Humans
• Life Tables
• Male
• Middle Aged
• Mortality/trends
• Neoplasms/mortality
• Young Adult

To investigate the incidence and mortality rates of upper gastrointestinal cancer (UGIC) in Hebei Province, China, and to identify high-risk populations to improve UGIC prevention and control.

Data for UGIC patients were collected from 21 population-based cancer registries covering 15.25% of the population in Hebei Province. Mortality data were extracted from three national retrospective death surveys (1973-1975, 1990-1992 and 2004-2005). The data were stratified by 5-year age groups, gender and area (high-risk/non-high-risk areas) for analysis. The age-period-cohort and grey system model were used.

The crude incidence rate of UGIC was 55.47/100000, and the adjusted rate (Segi’s population) was 44.90/100000. Males in rural areas had the highest incidence rate (world age-standardized rate = 87.89/100000). The crude mortality rate of UGIC displayed a decreasing trend in Hebei Province from the 1970s to 2013, and the adjusted rate decreased by 43.81% from the 1970s (58.07/100000) to 2013 (32.63/100000). The mortality rate declined more significantly in the high-risk areas (57.26%) than in the non-high-risk areas (55.02%) from the 1970s to 2013. The median age at diagnosis of UGIC was 65.06 years in 2013. There was a notable delay in the median age at death from the 1970s (66.15 years) to 2013 (70.39 years), especially in the high-risk areas. In Cixian, the total trend of the cohort effect declined, and people aged 65-69 years were a population at relatively high risk for UGIC. We predicted that the crude mortality rates of UGIC in Cixian and Shexian would decrease to 98.80 and 133.99 per 100000 in 2018, respectively.

UGIC was the major cause of cancer death in Hebei Province, and males in rural areas were a high-risk population. We should strengthen early detection and treatment of UGIC in this population.

• Upper gastrointestinal cancer
• Incidence
• Mortality
• Age-period-cohort
• Grey system model

• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Cause of Death
• China/epidemiology
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/mortality
• Female
• Humans
• Incidence
• Male
• Middle Aged
• Registries
• Retrospective Studies
• Rural Health
• Sex Distribution
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/mortality
• Time Factors
• Urban Health

• Age-period-cohort analysis
• Cancer prevalence
• Epidemiological transition
• Sardinia

Background: Esophageal cancer is one of the most common cancers in rural China. The aim of this study was to describe the time trends of esophageal cancer mortality in rural China and to better elucidate the causes of these trends. Methods: The mortality data were obtained from the World Health Organization Mortality Database and the China Health Statistical Yearbook Database. The mortality data were analyzed with age-period-cohort (APC) analysis. Results: Our study indicates that the Age-Standardized Mortality Rates (ASMRs) in rural China generally decreased from 1989 to 2003, and thereafter increased until the year 2008 in both sexes. After 2008, the ASMRs decreased again. The results of APC analysis suggest that the general decrease in esophageal cancer mortality in rural China from 1989 to 2003 might be caused by the downtrend of the cohort effects and period effects, while the general increase in mortality from 2004 to 2008 might be caused by the uptrend of the period effects. The decrease in mortality after 2008 may be relevant to the Four Trillion RMB Investment Plan launched by the Chinese Government. Conclusions: The declining cohort effects were probably related to the improvement of socioeconomic status in childhood and the decreasing consumptions of alcohol drinking and smoking, while the trends of the period effects were relevant to the changes in the dietary pattern. Our findings may help predict future changes in esophageal cancer mortality.

• APC
• esophageal cancer
• mortality
• rural China

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Asian People/statistics & numerical data
• China/epidemiology
• Cohort Studies
• Esophageal Neoplasms/epidemiology
• Esophageal Neoplasms/mortality
• Female
• Forecasting
• Humans
• Male
• Middle Aged
• Mortality/trends
• Rural Population/statistics & numerical data
• Rural Population/trends
• Sex Factors
• Time Factors

• Chinese
• Diabetes mellitus
• Economic development
• Mortality
• Secular trends

To delineate the temporal dynamics between alcohol tax policy changes and related health outcomes, this study examined the age, period and cohort effects on alcohol-related mortality in relation to changes in government alcohol policies. We used the age-period-cohort modeling to analyze retrospective mortality data over 30 years from 1981 to 2010 in a rapidly developed Chinese population, Hong Kong. Alcohol-related mortality from 1) chronic causes, 2) acute causes, 3) all (chronic+acute) causes and 4) causes 100% attributable to alcohol, as defined according to the Alcohol-Related Disease Impact (ARDI) criteria developed by the US Centers for Disease Control and Prevention, were examined. The findings illustrated the possible effects of alcohol policy changes on adult alcohol-related mortality. The age-standardized mortality trends were generally in decline, with fluctuations that coincided with the timing of the alcohol policy changes. The age-period-cohort analyses demonstrated possible temporal dynamics between alcohol policy changes and alcohol-related mortality through the period effects, and also generational impact of alcohol policy changes through the cohort effects. Based on the illustrated association between the dramatic increase of alcohol imports in the mid-1980s and the increased alcohol-related mortality risk of the generations coming of age of majority at that time, attention should be paid to generations coming of drinking age during the 2007–2008 duty reduction.

Hong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong’s unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching “first world” status over the last 60 years (i.e., in two or three generations), we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic transition affects infection-related mortality.

We used deaths from septicemia and pneumonia not specified as bacterial, and population figures in Hong Kong from 1976–2005. We fitted age-period-cohort models to decompose septicemia and non-bacterial pneumonia mortality rates into age, period and cohort effects.

Septicaemia-related deaths increased exponentially with age, with a downturn by period. The birth cohort curves had downward inflections in both sexes in the 1940s, with a steeper deceleration for women. Non-bacterial pneumonia-related deaths also increased exponentially with age, but the birth cohort patterns showed no downturns for those born in the 1940s.

The observed changes appeared to suggest that better early life conditions may enable better development of adaptive immunity, thus enhancing immunity against bacterial infections, with greater benefits for women than men. Given the interaction between the immune system and the gonadotropic axis, these observations are compatible with the hypothesis that upregulation of the gonadotropic axis underlies some of the changes in disease patterns with economic development.

• Age Factors
• Cohort Studies
• Female
• Hong Kong/epidemiology
• Humans
• Male
• Mortality/trends
• Pneumonia/mortality
• Sepsis/mortality

• U54 GM088558 NIGMS NIH HHS
• U54GM088558 NIGMS NIH HHS