Trends and age-period-cohort effect on incidence and mortality of prostate cancer from 1990 to 2017 in China

Abstract

OBJECTIVES The incidence and mortality trends of prostate cancer remain unknown in China. We examined secular trends in prostate cancer incidence and mortality rates and the net age, period, and cohort effects on them. STUDY DESIGN Trends were estimated using joinpoint regression, and the net age, period, and cohort effects were estimated by an age-period-cohort (APC) model with an intrinsic estimator (IE) algorithm. METHODS Age-specific mortality rates of prostate cancer (1990-2017) were collected from the Global Burden of Disease (GBD) 2017 study, and the average annual percent change (AAPC) and relative risks (RRs) analyzed by joinpoint regression and APC model. RESULTS Age-standardized rates significantly rose by 2.75% (95% confidence interval [CI]: 2.6, 2.9) for incidence but declined by 0.26% (95% CI: -0.4, -0.2) for mortality from 1990 to 2017. The joinpoint regression analysis showed that incidence rates significantly rose in all age groups, but mortality rates decreased in these age groups over the past three decades. In addition, compared to the younger age groups (15-19, 20-24, 25-29, 30-34, 35-39 and 40-44 age group), the older age groups (50-54, 55-59, 60-64 and 75-79 age group) showed more substantial increases in incidence and slighter declines in mortality. The age effect on incidence and mortality showed sharp increasing trends from 40 to 79 years, and period effect showed both of them continuously increased with advancing period, but cohort effect showed substantial decreasing trends from 1917-1921 to 2002-2006 birth cohort. CONCLUSIONS Age effect on incidence and mortality presented an increasing trend in older people, and period effect showed increasing trends. The incidence rate of prostate cancer is increasing at an alarming rate in all age groups, which may adversely impact the mortality rates. Mortality began to increase since 2005; thus, timely intervention should be conducted, especially for earlier birth cohorts at high risk.