台灣1997年至2016年口腔癌發生率及死亡率之年齡－年代－世代分析

Abstract

背景. 台灣的口腔癌發生率高於世界平均，男性口腔癌發生率更居世界之冠。本研究透過長期趨勢分析，觀察口腔癌的發生率及死亡率在近年的改變，並探討檳榔嚼食防治以及口腔黏膜篩檢之成效。 方法. 資料範圍涵蓋1997至2016年，其中發生數資料取自台灣癌症登記中心，死亡數資料取自台灣衛生福利部，而人口數資料則取自台灣內政部統計處。資料以年齡－年代－世代模型進行分析。 結果. 男性的年齡標準化發生率以及死亡率雖在近20年持續升高，但在近年已逐漸趨緩。經調整後的世代相對風險發現，男性口腔癌發生率以及死亡率在1970-1974世代後開始下降，女性則是發生率部分在1975-1979世代後開始下降。當代年齡曲線發現，男性發生率隨年齡增加而增加並在60-64歲達到高峰後反轉下降，而死亡率隨年齡增加而增加，女性則皆隨年齡上升而上升。世代年齡曲線發現，無論男女，發生率及死亡率皆隨年齡增加而增加。 結論. 台灣口腔癌的發生率及死亡率，主要為世代效應所影響。隨近年檳榔嚼食防治的成效，檳榔在近幾個世代的消費量下降，口腔癌的發生率及死亡率亦隨之下降。

Background. The incidence rates of oral cancer in Taiwan exceed the worldwide average value, and that of males, the highest in the world. This study analyzes the long-term trends of incidence and mortality of oral cancer in Taiwan in relation to betel nut chewing control and oral cancer screening. Method. The incidence data were obtained from Taiwan Cancer Registry. The mortality data were obtained from the database provided by Ministry of Health and Welfare. The population data were obtained from the online database provided by the Department of Statistics of the Ministry of the Interior in Taiwan. We examine the incidence and mortality trends from 1997 to 2016 using age-period-cohort analysis. Result. The age-standardized incidence and mortality rate of males have been increasing continuously in the past 20 years, but have gradually slowed down in recent years. The adjusted cohort relative risk showed that the incidence and mortality rates of males start to decrease after the 1970-1974 cohort. The same decreasing trend was also found in the incidence of female after the 1975-1979 cohort. The cross-sectional age curve found that the incidence rate and mortality rates rose with age for both sexes, but the curve of male incidence rate starts to decline after the age of 60-64. In longitudinal age curve, the incidence and mortality rate rose with age for both sexes. Conclusion. The incidence and mortality trends of oral cancer in Taiwan were mainly influenced by the cohort effect. With success in betel nut chewing control in recent decades, the consumption of betel nut decreased in younger cohorts, and the incidence and mortality rate of oral cancer also decreased.