Objective: To describe the 40-years trend for the mortality of colorectal cancer (CRC) in Shanghai and to estimate the effect of age, period, and birth cohort with Age-Period-Cohort (APC) model. Methods: Data on tumor-releated death from 1975 Janurary 1 to 2014 December 31 was derived from the Yangpu District of Shanghai Center for Diseases Prevention and Control tumor registration system. Colonrectal cancer cases (C18.2-C18.9 and C20 in ICD10) were selected for analyses. Crude mortality, age-adjusted mortality, and Average Annual Percent Changes (AAPCs) were calculated for colon cancer and rectal cancer. The difference of AAPCs between male/female and different age groups were tested. An APC model (reference cohort and period were 1900 and 1975, respectively) was constructed to estimate the age-effect, period-effect, and cohort-effect on the colorectal cancer death. Results: During 1975-2014, 6 725 cases died of colorectal cancer (the cased of colon and rectal cancer were 3 684 and 3 041, respectively). The crude mortality and age-adjusted mortality of colon cancer was 8.83/100 000 and 6.76/100 000, respectively. The crude mortality and age-adjusted mortality of rectal cancer were 7.32/100 000 and 5.67/100 000, respectively. For population in Yangpu District, the crude mortality and age-adjusted mortality of colon cancer increased with time, and the crude mortality of rectal cancer increased with time (P<0.001). AAPC of the crude mortality rate (5.6%) and age-adjusted mortality rate (2.3%) of colon cancer were higher than those in rectal cancer (3.0% and -0.3%), respectively (both P values <0.001). AAPC of the crude mortality rate (males vs. females was 6.2% vs. 5.0%, P<0.05) and age-adjusted mortality rate (males vs. females was 2.7% vs. 1.7%, P<0.05) of colon cancer were higher in males than in females. APC model indicted that CRC-related death increased with age. During 1901 to 1941, the RR values of cohort effects for colon and rectal cancer death were 1.09-5.57 and from 1.04-2.28, respectively; During 1946 to 1991, the RR values of cohort effects for colon cancer and rectal cancer were 5.51-4.32 and 2.16-0.89. Conclusion: From 1975 to 2014, the mortality of CRC in Yangpu District increased gradually, and colon cancer mortality in males increased faster than that in females. The risk of death from colorectal cancer in the 1946-1991 birth cohort declined.
目的： 了解1975—2014年上海市杨浦区结直肠癌（CRC）的死亡率变化趋势，并采用年龄-时期-队列模型评估结直肠癌死亡的年龄效应、出生队列和时期效应。 方法： 收集1975年1月1日至2014年12月31日间的上海市疾病预防控制中心肿瘤登记系统的杨浦区户籍病例资料，纳入《国际疾病分类》第十版编码为C18.2~C18.9和C20的病例资料。计算结直肠癌的死亡率、年龄标化死亡率和平均年均变化百分比（AAPC），检验比较不同性别和年龄组居民结直肠癌AAPC值的差异；分别将1975年和1900年作为时期效应和队列效应的参照水平，建立年龄-时期-效应（APC）模型，分别评估年龄因素、出生队列因素对结直肠癌死亡的影响。 结果： 1975—2014年上海市杨浦区居民CRC死亡病例6 725例（结、直肠癌分别为3 684和3 041例）。结肠癌的死亡率为8.83/10万人年，年龄标化死亡率为6.76/10万人年；直肠癌的死亡率为7.32/10万人年，年龄标化死亡率为5.67/10万人年。1975—2014年，上海市杨浦区居民结肠癌的死亡率和标化死亡率、直肠癌的标化死亡率均呈逐年上升的趋势（P<0.001），结肠癌死亡率、标化死亡率的AAPC值（百分比为5.6%和2.3%）均大于直肠癌（分别为3.0%和-0.3%）（P值均<0.001）；男、女性居民结肠癌的死亡率和标化死亡率均呈上升趋势（P值均<0.001），男性结、直肠癌死亡率和标化死亡率的AAPC值均（分别为6.2%和2.7%）大于女性（分别为5.0%和1.7%）（P值均<0.05）。APC模型分析结果表明，结肠癌、直肠癌的死亡风险均随年龄而增加，与1900年出生相比，1901—1941年出生队列的结肠癌、直肠癌死亡风险RR值分别为1.09~5.57和1.04~2.28；1946—1991年出生队列的结肠癌、直肠癌死亡风险RR值为5.51~4.32和2.16~0.89。 结论： 1975—2014年上海市杨浦区结直肠癌的死亡率呈上升趋势，男性结肠癌的增长速度高于女性，1946—1991年出生队列的结直肠癌死亡风险有下降趋势。.
Keywords: Age-period-cohort model; Colorectal cancer; Mortality.