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Abstract：
BACKGROUND: Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021.
METHODS: Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China\'s National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.
RESULTS: From 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35-64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5-7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: - 0.7%, 95% CI - 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI - 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: - 2.7%, 95% CI - 4.6 to - 0.7%, P = 0.007) in urban areas. Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas, periods, and regions in China.
CONCLUSIONS: Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities. Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.
METHODS: Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China\'s National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups.
RESULTS: From 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35-64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5-7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: - 0.7%, 95% CI - 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI - 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: - 2.7%, 95% CI - 4.6 to - 0.7%, P = 0.007) in urban areas. Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas, periods, and regions in China.
CONCLUSIONS: Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities. Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.
摘要：
背景：宫颈癌和乳腺癌是女性癌症相关死亡率的前4个主要原因。这项研究旨在研究2009年至2021年中国城市和农村地区宫颈癌和乳腺癌死亡率的特定年龄时间趋势。
方法：20-84岁中国女性宫颈癌和乳腺癌的年龄特异性死亡率数据来自2009-2021年中国国家疾病监测点系统。负二项回归模型用于评估死亡率比率的城乡差异，同时采用具有估计年平均百分比变化（AAPC）和斜率的Joinpoint模型来比较不同年龄段的时间趋势和死亡率加速。
结果：从2009年到2021年，与城市地区相比，与农村地区观察到的两种癌症相关的年龄特异性死亡率相对增加。35-64岁的筛查年龄呈上升趋势[AAPC：4.0%，95%置信区间(CI)0.5-7.6%，P=0.026]在农村地区发现宫颈癌，虽然趋势稳定(AAPC：-0.7%，95%CI-5.8至4.6%，在城市地区观察到P=0.78）。至于乳腺癌，稳定趋势(AAPC：0.3%，95%CI-0.3%至0.9%，P=0.28)在农村地区观察到下降趋势(AAPC：-2.7%，95%CI-4.6至-0.7%，P=0.007）在城市地区。随着时间的推移，宫颈癌死亡率的城乡差异增加，但乳腺癌死亡率下降。宫颈癌和乳腺癌的死亡率趋势显示，随着年龄的增长，4个部分都有增加。在城市和农村地区的35-54岁年龄组中，死亡率上升幅度最大，perments,和中国的地区。
结论：由于死亡率趋势和城乡差距，应特别关注35-54岁的女性。在实施癌症控制计划时，关注弱势年龄组并解决城乡差异，可以提高资源效率并促进卫生公平。
方法：20-84岁中国女性宫颈癌和乳腺癌的年龄特异性死亡率数据来自2009-2021年中国国家疾病监测点系统。负二项回归模型用于评估死亡率比率的城乡差异，同时采用具有估计年平均百分比变化（AAPC）和斜率的Joinpoint模型来比较不同年龄段的时间趋势和死亡率加速。
结果：从2009年到2021年，与城市地区相比，与农村地区观察到的两种癌症相关的年龄特异性死亡率相对增加。35-64岁的筛查年龄呈上升趋势[AAPC：4.0%，95%置信区间(CI)0.5-7.6%，P=0.026]在农村地区发现宫颈癌，虽然趋势稳定(AAPC：-0.7%，95%CI-5.8至4.6%，在城市地区观察到P=0.78）。至于乳腺癌，稳定趋势(AAPC：0.3%，95%CI-0.3%至0.9%，P=0.28)在农村地区观察到下降趋势(AAPC：-2.7%，95%CI-4.6至-0.7%，P=0.007）在城市地区。随着时间的推移，宫颈癌死亡率的城乡差异增加，但乳腺癌死亡率下降。宫颈癌和乳腺癌的死亡率趋势显示，随着年龄的增长，4个部分都有增加。在城市和农村地区的35-54岁年龄组中，死亡率上升幅度最大，perments,和中国的地区。
结论：由于死亡率趋势和城乡差距，应特别关注35-54岁的女性。在实施癌症控制计划时，关注弱势年龄组并解决城乡差异，可以提高资源效率并促进卫生公平。
