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1、IF:6.198Publication:June2017Globalpatternsandtrendsinstomachcancerincidence:Age,periodandbirthcohortanalysisGanfeng Luo,Yanting Zhang,Pi Guo,Li Wang,Yuanwei Huang and Ke LiDepartment of Public Health,Shantou University Medical College,Shantou,Guangdong 51504111.Purposeandbackgroud2.MaterialandMethod

2、s3.Results4.Discussion21.Purposeandbackgroud Purpose（目的）:The aim of this study was to provide a global geographical picture of SC incidence and temporal trends from1978 to 2007 for 38 countries providing data,with an emphasis on country-and sex-specific differences.3Backgroud（背景）:（1）SC is the third

3、leading cause of cancer death and the fifth most common cancer worldwide.The absolute number of new cases per year is still increasing,causing about 1 million new cases in 2012 and representing 7%of all cancers.（2）The SC incidence varies greatly by geography and sex（地理和性别）.Geographically,almost two-

4、thirds of all SC cases occur in Asia（specifically Japan and China）;Sex-specific analysis is also critical for viewing trends and associations in epidemiology,especially in SC,one of the most cancers in which the incidence is well known to differ between the sexes.4（3）H.pylori（幽门螺杆菌）infection is cons

5、idered the most important risk factor of SC.However,SC development cannot beexplained by infection with H.pylori alone,because SC develops in only a small proportion of people with the infection,between 2%and 5%.There also might exit some potential risk factors which we still could not recognize.（饮食

6、、腌制食品、蔬菜水果、冰箱普及率）（4）To evaluate the effects of age,period and birth cohort on temporal trends（时间趋势）,modern analysis methods are based on age-period-cohort models（年龄-时期-队列模型）,splitting the temporal variations into the three components of age,period and birth cohort.In particular,the effect of birth c

7、ohort may be significant for gaining further insight into underlying causal factors.5Datasources:（http:/ci5.iarc.fr）,the Cancer Incidence Five Continents;/invs.santepubliquefrance.fr）,（http:/ganjoho.jp）;19countries;The remaining 19 countries with more than one cancer registry;Cases and population da

8、ta of all registries were pooled to ensure the largest geographic coverage and obtain estimated national proportions.A total of 38 countries worldwide were included from Africa,Asia,Europe,the Americas and Oceania.These five continents were divided into 11 regions.（5大洲，11个区域，38个国家）2.MaterialandMetho

9、ds6Methods:Figures were plotted by using Sigma Plot v12.5.Producing the Joinpoint regression models involved use of the Joinpoint Regression Program v4.3.1.0.The ageperiodcohort model analyses and graphs involved use of APCfit in Stata v13（StataCorp LP,College Station,TX）.7 Sex disparities（M:F=1.53）

10、except for Uganda（M:F=1.3）Japan with highest rate France with greatest sex（M:F=2.7）3.Results8（1）In 20032007,SC incidence was highest in Eastern Asian and South American countries and lowest in South-Western Asia,Western European and Oce-ana countries.（2）Rates were heterogeneous within 11 regions,ran

11、ging from 6.1 in the United States to 26.5 in Costa Rica（哥斯达黎加）for males and from 3.0 in the United States to 15.0 in Costa Rica for females.9（3）For males,except for Ugan-da in Africa,all countries show-ed favorable decreasing trends（19782007）.Austria（奥地利）had largest decresing trends;Japan and Israe

12、l had only slight-ly decreasing trends,so did females.1011EuropecountriesIncidence rates for most age groups uniformly decreased insuccessive male and female birth cohorts in most countries.（出生队列：19001980年；年龄段：2584岁，5岁一组，12组；non-Europecountries）1213EuropecountriesCohort-specific IRRs rapidly decreas

13、ed with successive birth cohorts in most countries,whereas IRRs among recent generations plateaued in Australia,Canada,Costa Rica（哥斯达黎加）,Denmark,Germany,India,Israel and even increased in Brazil,Colombia,Iceland,New Zealand,Norway,Uganda and for US white people.14non-Europecountries4.DiscussionDispa

14、rities in the incidence and risk of SC persist across countries and regions worldwide.The highest rates occurred in Japan,Russia and Costa Rica for males and in Japan,Costa Rica and Ecuador for females.Except for Uganda in Africa,all countries showed favorable trends between 1978 and 2007 for both s

15、exes.在1978到2007年，全球各国家和地区的SC发病率和风险存在差异。男性最高比率发生在日本、俄罗斯和哥斯达黎加；女性为日本、哥斯达黎加和厄瓜多尔。除非洲的乌干达，所有国家两性之间胃癌发生率呈现出良好的下降趋势。15（1）Some meta-analysis indicated that the relative risk of SC developing due smoking was 1.62 for males and 1.2 for females.and heavy alcohol drinking（4 drinks per day:RR 1.2）.The lower SC

16、incidence for women than men may be due in part to their lower exposure to risk factors.However,for example,Ecuador,Finland,philippines,thailand and Uganda,the rates in females are close to those for males.The explanation for these similar rates in males and females is not clear but may suggest the presence of unidentified risk factors.Meta分析表明，胃癌发展的相对风险比，吸烟，男性为1.62和女性为1.2；酗酒（每天四杯以上：RR 1.2）。胃癌发病率女性比男性低部分原因是由于其较低的风险因素暴露。然而，在厄瓜多尔、芬兰、菲律