title: Spatiotemporal Variations in Lung Cancer Mortality in China between 2006 and 2012: A Multilevel Analysis.
abstract: We investigated temporal trends and geographical variations in lung cancer mortality in China from 2006 to 2012. Lung cancer mortality counts for people aged over 40 years were extracted from the China Mortality Surveillance System for 161 disease surveillance points. Negative binomial regression was used to investigate potential spatiotemporal variation and correlations with age, gender, urbanization, and region. Lung cancer mortality increased in China over the study period from 78.77 to 85.63 (1/100,000), with higher mortality rates evident in men compared to women. Median rate ratios (MRRs) indicated important geographical variation in lung cancer mortality between provinces (MRR = 1.622) and counties/districts (MRR = 1.447). On average, lung cancer mortality increased over time and was positively associated with county-level urbanization (relative risk (RR) = 1.15). Lung cancer mortality seemed to decrease in urban and increase in rural areas. Compared to the northwest, mortality was higher in the north (RR = 1.98), east (RR = 1.87), central (RR = 1.87), and northeast (RR = 2.44). Regional differences and county-level urbanization accounted for 49.4% and 8.7% of provincial and county variation, respectively. Reductions in lung cancer mortality in urban areas may reflect improvements in access to preventive healthcare and treatment services. Rising mortality in rural areas may reflect a clustering of risk factors associated with rapid urbanization.
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. liuyunning0723@163.com.
authors.forename: Yunning
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. thomasab@uow.edu.au.|School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. thomasab@uow.edu.au.|Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. thomasab@uow.edu.au.
authors.forename: Thomas
authors.initials: T
authors.lastname: Astell-Burt
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. jiangmei.liu@foxmail.com.
authors.forename: Jiangmei
authors.initials: J
authors.lastname: Liu
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. yinpengcdc@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.affiliation: Population Wellbeing and Environment Research Lab (PowerLab), Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. xfeng@uow.edu.au.|School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. xfeng@uow.edu.au.|Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia. xfeng@uow.edu.au.
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Feng
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. youjinling888@163.com.
authors.forename: Jinling
authors.initials: J
authors.lastname: You
authors.affiliation: School of Medicine, University of Western Sydney, Sydney, NSW 2006, Australia. A.Page@westernsydney.edu.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Page
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. maigengzhou@126.com.
authors.forename: Maigeng
authors.initials: M
authors.lastname: Zhou
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. wangli_19@aliyun.com.
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
mesh_terms: D000368:Aged; D016010:Binomial Distribution; D002681:China / Q000453:epidemiology; D003710:Demography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D011159:Population Surveillance; D011314:Preventive Health Services; D012044:Regression Analysis; D012307:Risk Factors; D062211:Spatio-Temporal Analysis; D014505:Urban Population; D014507:Urbanization
keywords: geographical variation; lung cancer; mortality; temporal trends; urbanization level