Temporal Trends in Geographical Variation in Breast Cancer Mortality in China, 1973-2005: An Analysis of Nationwide Surveys on Cause of Death.
To describe geographical variation in breast cancer mortality over time, we analysed breast cancer mortality data from three retrospective national surveys on causes of death in recent decades in China. We first calculated the age-standardized mortality rate (ASMR) for each of the 31 provinces in mainland China stratified by survey period (1973-1975, 1990-1992 and 2004-2005). To test whether the geographical variation in breast cancer mortality changed over time, we then estimated the rate ratio (RR) for the aggregated data for seven regions and three economic zones using generalized linear models. Finally, we examined the correlation between mortality rate and several macro-economic measures at the provincial level. We found that the overall ASMR increased from 2.98 per 100,000 in 1973-1975 to 3.08 per 100,000 in 1990-1992, and to 3.85 per 100,000 in 2004-2005. Geographical variation in breast cancer mortality also increased significantly over time at the regional level (p= 0.002) but not at the economic zone (p= 0.089) level, with RR being generally lower for Western China (Northwest and Southwest) and higher in Northeast China over the three survey periods. These temporal and spatial trends in breast cancer mortality were found to be correlated with per capita gross domestic product, number of hospitals and health centres' beds per 10,000 population and number of practicing doctors per 10,000 population, and average number of live births for women aged 15-64. It may be necessary to target public health policies in China to address the widening geographic variation in breast cancer mortality, and to take steps to ensure that the ease of access and the quality of cancer care across the country is improved for all residents.
National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. xiacfa@163.com.
Changfa
C
Xia
Cancer Council New South Wales, Sydney NSW 2011, Australia. clarek@nswcc.org.au.
Clare
C
Kahn
State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China. wangjf@lreis.ac.cn.
Jinfeng
J
Wang
State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China. liaoyl@lreis.ac.cn.
Yilan
Y
Liao
National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. chenwq@cicams.ac.cn.
Wanqing
W
Chen
Cancer Council New South Wales, Sydney NSW 2011, Australia. xueqiny@nswcc.org.au.|Sydney School of Public Health, University of Sydney, Sydney NSW 2006, Australia. xueqiny@nswcc.org.au.
Xue Qin
XQ
Yu
China; breast cancer; geographical; mortality; temporal
Int J Cancer. 2015 Mar 1;136(5):E359-86
25220842
J Natl Cancer Inst. 2008 Oct 1;100(19):1352-60
18812552
Lancet Oncol. 2014 Jun;15(7):e279-89
24872111
Zhonghua Yu Fang Yi Xue Za Zhi. 2010 Apr;44(4):303-8
20654141
Breast Cancer Res Treat. 2009 Sep;117(2):409-16
19153831
Br J Cancer. 2011 Nov 8;105 Suppl 1:S52-73
22048034
Breast Cancer Res Treat. 2011 Feb;126(1):231-4
21120600
Int J Equity Health. 2015 Sep 14;14:76
26369689
Zhonghua Zhong Liu Za Zhi. 2014 Sep;36(9):713-6
25564065
Int J Cancer. 2001 Nov 1;94(3):449-55
11745429
Soc Sci Med. 2014 Jan;100:54-61
24444839
Int J Cancer. 2015 Apr 15;136(8):1921-30
25242378
Med J Aust. 2014 Jun 2;200(10):586-90
24882490
CA Cancer J Clin. 2016 Mar-Apr;66(2):115-32
26808342
Cancer Causes Control. 2008 Dec;19(10):1383-90
18704715
Breast. 2015 Aug;24(4):524-7
25843905
Int J Environ Res Public Health. 2015 Dec 04;12(12):15409-18
26690183
Asian Pac J Cancer Prev. 2014;15(6):2785-91
24761901
Breast. 2013 Jun;22(3):344-50
22981738
BMC Cancer. 2009 Oct 14;9:364
19828016
Ann Oncol. 2016 Jun;27(6):1129-34
27013394
Zhonghua Yu Fang Yi Xue Za Zhi. 2011 Feb;45(2):150-4
21426796
PLoS One. 2014 Nov 05;9(11):e111729
25372837
BMC Cancer. 2011 Aug 22;11:364
21859480
Am J Prev Med. 2015 Nov;49(5):661-9
26275960
PLoS One. 2015 Feb 17;10(2):e0117572
25688556
Popul Health Metr. 2005 Mar 16;3(1):3
15769298