Long-term Trends In Incidence Research Articles

Trends in Invasive Melanoma Thickness in Norway, 1983-2019.

Monitoring melanoma incidence time trends by tumour thickness is essential to understanding the evolution of melanoma occurrence and guiding prevention strategies. To assess long-term incidence trends, tumour thickness was extracted from pathology reports in the Cancer Registry of Norway (1983-2007) and the Norwegian Melanoma Registry (2008-2019), n = 45,635 patients. Across all anatomic sites, T1 (≤ 1 mm) incidence increased most (men annual percentage change [AAPC] = 4.6, 95% confidence interval [95% CI] 4.2-5.0; women AAPC = 3.2, 95% CI 2.8-3.6); the increase was steep until 1989/90, followed by a plateau, and a further steep increase from 2004/05. Increased incidence was also observed for T2 (>1.0-2.0) melanoma (men AAPC = 2.8, 95% CI 2.4-3.2; women AAPC = 1.5, 95% CI 1.1-1.9), and T3 (>2.0-4.0) in men (AAPC = 1.4, 95% CI 0.9-1.9). T4 (>4.0) melanoma followed a similar overall pattern (men AAPC = 1.3, 95% CI 0.9-1.7, head/neck, upper limbs, and trunk; women AAPC = 0.9, 95% CI 0.4-1.4, upper limbs and trunk). Men had the highest T3 and T4 incidence and the sex difference increased with age. Regarding birth cohorts, age-specific incidence increased in all T categories in the oldest age groups, while stabilizing in younger patients born after 1950. Overall, the steep increase in T1 melanoma was not accompanied by a decrease in thick melanoma.

Long-term trends in incidence and outcomes of rib fractures: A population-based data linkage study from New South Wales, Australia.

Determine long-term trends in population-based incidence and outcomes of rib fracture hospitalisations. This was a data linkage study of rib fracture cases identified between 2015 and 2022 in New South Wales, Australia. Routinely collected health data were linked between ED, admitted patient and death registry data collection. The primary outcomes were age-specific incidence of rib fracture hospitalisation cases and risk-adjusted 30 days mortality. Other outcomes of interest were hospital length of stay (LOS), admission rate and ICU admissions. A total of 70 609 cases were analysed. Overall, the number of rib fracture hospitalisations increased by 25% between 2015 and 2022. The highest proportion of cases was in the 45-65 years (28%) and 65-85 years (31%) age groups. On a per population basis, the incidence rate increased by 2% per annum. After adjusting for age, comorbidity and injury severity, there was no significant trend in 30 days mortality observed between 2015 and 2022. The median inpatient LOS was 4 days with 38% of patients staying 1-2 days. Regional and rural areas were associated with more severe chest injuries. Rib fracture hospitalisations have increased with older patients driving this trend.

Age-specific incidence trends of 32 cancers in China, 1983 to 2032: Evidence from Cancer Incidence in Five Continents.

The long-term incidence trends of 32 cancers in China remained unclear. Cancer statistics for young population were often presented in aggregate, masking important heterogeneity. We aimed to assess the incidence trends of 32 cancers in China from 1983 to 2032, stratified by sex and age groups. Data on cancer incidence from 1983 to 2017 were extracted from Cancer Incidence in Five Continents Volumes VI-XII. The age-period-cohort model was utilized to assess age and birth cohort effects on the temporal trends of 32 cancers in China, while the Bayesian age-period-cohort model was utilized to project future trends from 2018 to 2032. An increase in cohort effects is observed in some cancers such as thyroid and kidney cancers. Eight of the 12 obesity-related cancers may rise in the 0-14 age group, and nine in the 15-39 age group from 2013 to 2032. Liver and stomach cancers show an increasing trend among the younger population, contrasting with the observed declining trend in the middle-aged population. There has been a significant rise in the proportions of cervical cancer among females aged 40-64 (4.3%-19.1%), and prostate cancer among males aged 65+ (1.1%-11.8%) from 1983 to 2032. Cancer spectrum in China is shifting toward that in developed countries. Incidence rates of most cancers across different age groups may increase in recent cohorts. It is essential to insist effective preventive interventions, and promote healthier lifestyles, such as reducing obesity, especially among younger population.

Long-term trends in incidence, characteristics and prognosis of screen-detected and interval cancers in women participating in the Dutch breast cancerscreening programme.

No studies are available in which changes over time in characteristics and prognosis of patients with interval breast cancers (ICs) and screen-detected breast cancers (SDCs) have been compared. The aim was to study these trends between 1995 and 2018. All women with invasive SDCs (N = 4290) and ICs (N = 1352), diagnosed in a southern mammography screening region in the Netherlands, were included and followed until date of death or 31 December 2022. The 5-year overall survival rate of women with SDCs increased from 91.4% for those diagnosed in 1995-1999 to 95.0% for those diagnosed in 2013-2018 (P < 0.001), and from 74.8 to 91.6% (P < 0.001) in the same periods for those with ICs. A similar trend was observed for the 10-year survival rates. After adjustment for changes in tumour characteristics, the hazard ratio (HR) for overall survival was 0.47 (95% confidence interval (CI): 0.38-0.59) for women with SDCs diagnosed in the period 2013-2018, compared to the women diagnosed in the period 1995-1999. For the women with ICs this HR was 0.27 (95% CI: 0.19-0.40). The prognosis of women with ICs has improved rapidly since 1995 and is now almost similar to that of women with SDCs.

Long-term trends in incidence, mortality and burden of liver cancer due to specific etiologies in Hubei Province

Liver cancer, a chronic non-communicable disease, represents a serious public health problem. Long-term trends in the burden of liver cancer disease are heterogeneous across regions. Incidence and mortality of liver cancer, based on the Global Burden of Disease, were collected from the Chinese Centre for Disease Control and Prevention. Age–period–cohort model was utilized to reveal the secular trends and estimate the age, period and cohort effects on primary liver cancer due to specific etiologies. Both the age-standardized incidence and mortality rate of liver cancer in Hubei province were on the rise, although there were discrepancies between gender groups. From age–period–cohort analysis, both incidence and mortality of liver cancer due to Hepatitis B virus were the highest in all age groups. The incidence of all liver cancer groups increased with time period in males, while this upward trend was observed in females only in liver cancer due to alcohol use group. Cohort effects indicated the disease burden of liver cancer decreased with birth cohorts. Local drifts showed that the incidence of liver cancer due to specific etiologies was increasing in the age group of males between 40 and 75 years old. The impact of an aging population will continue in Hubei Province. the disease burden of liver cancer will continue to increase, and personalized prevention policies must be adopted to address these changes.

Differences in femoral fracture localizations in men and women in Switzerland between 1998 and 2021-reversal of the secular trend?

Long-term incidence trends for femoral fractures by individual localizations are unknown. Annual absolute number of hospitalizations and median age at hospital admission between 1998 and 2021 were extracted from the medical database of the Swiss Federal Office of Statistics by sex and 10-year age groups for the following 10th International Classification of Diseases (ICD-10) codes: femoral neck (ICD-10 S72.0), pertrochanteric (S72.1), subtrochanteric (S72.2), and femoral shaft fractures (S72.3). Age-standardized incidence rates (ASI) and corresponding trends were calculated. Over 24years, the number of femoral neck fractures increased in men (+ 45%) but decreased in women (- 7%) with ASI significantly decreasing by 20% and 37% (p < 0.001 for trend for both), respectively. By contrast, the number of pertrochanteric fractures increased by 67% and 45% in men and women, respectively, corresponding to a horizontal ASI-trend in men (n.s.) and a modest significant decreasing ASI-trend in women (p < 0.001). The number of subtrochanteric fractures increased in both sexes with corresponding modest significant reductions in ASI-trends (p = 0.015 and 0.002, respectively). Femoral shaft fractures almost doubled in men (+ 71%) and doubled in women (+ 100%) with corresponding significant increases in ASI-trends (p = 0.001 and p < 0.001, respectively). Age at admission increased for all fracture localizations, more so in men than in women and more so for subtrochanteric and shaft fractures than for "typical" hip fractures. Incidence changes of pertrochanteric fractures and femoral shaft fractures deserve increased attention, especially in men. Pooling diagnostic codes for defining hip fractures may hide differing patterns by localization and sex.

Trends in Incidence, Survival and Mortality of Gastric Cancer in the United States: A Population-Based Study, 2001-2015.

Gastric cancer remains one of the leading causes of death, and a burden of public health in the United States (US). The aim of the study was to provide updates to gastric cancer estimates, and analyzed the long-term trends in incidence, survival, and mortality of gastric cancer in the US, which was helpful for the monitoring of the screening program and the prevention strategy. The incidence, and long-term trends in incidence, survival, and mortality of gastric cancer in the US from 2001 to 2015 were analyzed. The data were obtained from the Surveillance, Epidemiology, and End Results (SEER) Database. Age-adjusted incidence rates were calculated, joinpoint regression and age-period-cohort analyses were conducted. All statistical tests were 2-sided. The overall age-adjusted incidence of gastric cancer decreased over the study period, with an annual percentage change (APC) of -1.4% (95% confidence interval [CI] = -1.1 to 13.3; P < 0.001). The incidence rates leveled off at an earlier age (< 45 years) and creased obviously with age. The age rate deviations increased sharply before the age of 47.5 years (age rate deviation = 0.92; 95% CI = 0.71 to 1.13). The 5-year mortality attributed to gastric cancer declined from 65.98% to 56.29% over the study period. The trend of 5-year mortality attributed to gastric cancer showed no significant fluctuation. The hazard ratio for 5-year all-cause death increased with cancer stage from 1.22 (95% CI = 1.13 to 1.33; P < 0.001) to 4.71 (95% CI = 4.40 to 5.06; P < 0.001). During the study period, the incidence decreased, while the survival rate increased slightly. Specially, the trend of 5-year mortality attributed to gastric cancer did not vary significantly. The data demonstrated that the prognosis of gastric cancer in the US remained challenging.

Future trends in incidence and long-term survival of metastatic cancer in the United States

BackgroundPrevious studies have demonstrated epidemiological trends in individual metastatic cancer subtypes; however, research forecasting long-term incidence trends and projected survivorship of metastatic cancers is lacking. We assess the burden of metastatic cancer to 2040 by (1) characterizing past, current, and forecasted incidence trends, and (2) estimating odds of long-term (5-year) survivorship.MethodsThis retrospective, serial cross-sectional, population-based study used registry data from the Surveillance, Epidemiology, and End Results (SEER 9) database. Average annual percentage change (AAPC) was calculated to describe cancer incidence trends from 1988 to 2018. Autoregressive integrating moving average (ARIMA) models were used to forecast the distribution of primary metastatic cancer and metastatic cancer to specific sites from 2019 to 2040 and JoinPoint models were fitted to estimate mean projected annual percentage change (APC).ResultsThe average annual percent change (AAPC) in incidence of metastatic cancer decreased by 0.80 per 100,000 individuals (1988–2018) and we forecast an APC decrease by 0.70 per 100,000 individuals (2018–2040). Analyses predict a decrease in metastases to liver (APC = −3.40, 95% CI [−3.50, −3.30]), lung (APC (2019–2030) = −1.90, 95% CI [−2.90, −1.00]); (2030–2040) = −3.70, 95% CI [−4.60, −2.80]), bone (APC = −4.00, 95% CI [−4.30, −3.70]), and brain (APC = −2.30, 95% CI [−2.60, −2.00]). By 2040, patients with metastatic cancer are predicted to have 46.7% greater odds of long-term survivorship, driven by increasing plurality of patients with more indolent forms of metastatic disease.ConclusionsBy 2040, the distribution of metastatic cancer patients is predicted to shift in predominance from invariably fatal to indolent cancers subtypes. Continued research on metastatic cancers is important to guide health policy and clinical intervention efforts, and direct allocations of healthcare resources.

P829 The Burden of Colorectal Cancer in Patients with Ulcerative Colitis – Incidence and Risk factors from a Population-based Inception Cohort from Veszprem county, Western Hungary, from 1977–2020

Abstract Background Limited data are available on the incidence and risk of colorectal cancer (CRC) in ulcerative colitis (UC) from population-based studies in Eastern Europe. We aimed to identify the long-term incidence trends and predictors of CRC in a prospective population-based inception cohort from Veszprem, Western Hungary. Methods Patient inclusion for the inception cohort was between January 1,1977 and December 31,2018, and follow-up ended December 31,2020. The risk of CRC was estimated using standardized incidence ratios (SIRs). Age-and gender-specific CRC rates of the background population were derived from the National Cancer Registry. Results A total of 1,370 incident UC patients were included [male:51.2%, median age at diagnosis:37years). During a median follow-up of 17 years(IQR9-24), CRC was diagnosed in 41 UC patients(2.99%), equaling 1.76/1000 person-year(py).Median age at CRC diagnosis was 59(IQR:50.0-67.5) years. Overall SIR of CRC was 2.02(CI95%:10.1-12.1). SIRs were higher in extensive colitis (SIR:3.77, CI95%:2.41-5.91). The cumulative probability of CRC at 10-,20 and 30 years was 0.9% (95%CI0.6-1.2), 3.5%(95%CI2.8-4.2), and 6.5%(95%CI5.4-7.6), and there was no difference in the risk of CRC over different decades of UC diagnosis in a Kaplan Meier analysis(Log-rank=0.693). In multivariate analyses, co-existing PSC(HR4.19;95%CI1.72-10.20), colonic dysplasia(3.42;95%CI1.04-11.26), and extensive colitis (HR2.15;95%CI1.29-3.60) were identified as a significant predictor for CRC. Conclusion We report an increased CRC risk in UC patients with a standardized incidence ratio of approximately 2 folds, with a stable CRC risk over four decades. Disease extent, co-existing PSC and dysplasia were identified as predictors of CRC.

Incidence of in Situ vs Invasive Melanoma: Testing the "Obligate Precursor" Hypothesis.

BackgroundMelanoma incidence has been rising in populations with predominantly European ancestry (White), speculated to be partly driven by heightened detection of indolent tumors. If in situ melanomas are destined to evolve to invasive cancers, detecting and removing them should deplete the pool of invasive lesions, and people with in situ melanoma should, on average, be younger than those with invasive melanoma.MethodsWe analyzed long-term incidence trends (1982-2018) for in situ and invasive melanomas in 3 predominantly White populations with high, medium, and low melanoma rates: Queensland (Australia), United States White, and Scotland. We calculated the incidence rate ratio (IRR) of in situ to invasive melanomas and estimated the contributions of age, period, and cohort effects. We compared age at diagnosis of in situ vs invasive melanomas overall and stratified by sex and anatomic site.ResultsIn all 3 populations, the in situ to invasive incidence rate ratio increased statistically significantly from less than 0.3 in 1982 to 1.95 (95% confidence interval [CI] = 1.88 to 2.02) in Queensland, 0.93 (95% CI = 0.90 to 0.96) in the US White population, and 0.58 (95% CI = 0.54 to 0.63) in Scotland in 2018. The mean age at diagnosis of in situ melanomas was the same or higher than invasive melanomas for almost all time periods among men and women and on all body sites except the lower limbs.ConclusionsThe increasing ratio of in situ to invasive melanoma incidence over time, together with the high (and increasing) mean age at diagnosis of in situ melanomas, is consistent with more indolent lesions coming to clinical attention than in previous eras.

Long-term trends in incidence and prevalence of severe sight impairment due to diabetes in South East Scotland before and after implementation of diabetic retinopathy screening

The study set out to examine the impact of the introduction of a national diabetic retinopathy screening programme in Scotland in 2006 on incidence and trends in severe sight impairment (SSI) certification due to diabetes over three decades. We analysed SSI certification due to diabetic eye disease in Fife, Scotland, between 2010 and 2019 and compared it to previously published estimates from 1990 onwards. Population estimates of the general population and those with diabetes were obtained from the National Records of Scotland and the National Diabetes Register, NHS SCI Diabetes, respectively. Mean annual incidence of SSI in the population with diabetes, 1990–2019, before and after the introduction of diabetic retinopathy screening was compared using a Mann–Whitney U Test. Mean incidence in 2007–2019 was 19.8/100,000 and was significantly less than the period before the systematic screening, 1990–2006 (57.5/100,000, p &lt; .001). Mean SSI incidence due to diabetes in Fife between 2010 and 2019 was significantly lower than in the previous decades ( p &lt; .001) at 16.4 per 100,000 for the population with diabetes, per year ( SD 10.0; 95% confidence interval: [9.2, 23.5]) compared to 42.7 per 100,000 in 2000–2009 and 64.3 per 100,000 in 1990–1999. This study demonstrates a significant reduction in the annual incidence of SSI due to diabetes before and after the introduction of the screening programme provides evidence for the benefit of systematic diabetic retinopathy screening programmes. Other factors including improved management of diabetes and risk factors will have also had an impact emphasizing the importance of a multidisciplinary approach to the prevention of sight loss in diabetes.

Long-term incidence in hepatocellular carcinoma and intrahepatic bile duct cancer in Denmark, Finland, Norway and Sweden, role of Thorotrast?

We analyzed long-term incidence trends in liver cancer (including hepatocellular carcinoma and intrahepatic cholangiocarcinoma) with an aim to interpret the changes in terms of known risk factors and hypothesize that historical exposure to Thorotrast, a radiographic contrast medium emitting alpha particles, has changed population rates. The NORDCAN database was used to collect cancer registry data from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), which we used from 1953 (DK, FI and NO) and 1960 (SE) through 2019. Thorotrast, which caused a 100-fold risk of liver cancer was used in DK and SE, and probably also in FI between 1930 and 1950, but not in NO. The incidence trend for liver cancer showed a broad maximum at around 1980, most prominent and statistically significant in SE and DK men and women, and in all countries, a steadily increasing trend towards the end of follow-up. Incidence for NO was lower than for the other countries and the rates showed no peaking at around 1980. Birth cohort analysis identified a transient risk which could be dated to a period between 1930 and 1950 in countries other than NO. Considering a lag time between Thorotrast use and liver cancer appearance, the large incidence peak around 1980 in DK and DE was probably contributed by Thorotrast but considering the ecological nature of the findings, the association should be considered cautiously as hypothesis generating. The late increase in liver cancer risk is most likely lifestyle related and largely preventable.

Socioeconomic status and risk of lung cancer by histological subtype in the Nordic countries.

BackgroundWhile the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype‐related long‐term incidence trends, are inconclusively reported.AimsWe explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark).Materials & MethodsWe have used data from the Nordic Occupational Cancer Study (NOCCA), computing age‐standardized incidence rates per 100,000 person‐years truncated at ages 50–69 years, by sex, histotype, country and SES, for the period 1971–2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated.ResultsA clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories.DiscussionThis prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women.ConclusionSmoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.

Long-Term Trends in Incidence, Mortality and Disease Burden of Liver Cancer Due to Specific Etiologies in Hubei Province, 1990-2019

Long-Term Trends in Incidence, Mortality and Disease Burden of Liver Cancer Due to Specific Etiologies in Hubei Province, 1990-2019

Incidence, Survival, and Mortality Trends of Cancers Diagnosed in Adolescents and Young Adults (15-39 Years): A Population-Based Study in The Netherlands 1990-2016.

Simple SummaryAdolescents and young adults (AYAs, aged 15–39 years) with cancer form a distinct patient population within the oncology care setting that is often overlooked in favour of paediatric and older adult patients. As such, specific knowledge on AYAs and their distinct spectrum of cancers is limited. Worldwide, cancer is increasing and it is among the major causes of death among AYAs. Cancer prognosis among AYAs has also been shown to lag behind that of younger and older patients suffering from similar diseases. To address these problems, better understanding of AYA cancers is needed. This study aims to provide an overview of the specific cancer trends among AYAs and the changes that have occurred in the Netherlands since 1990 in terms of incidence, survival, and mortality. This information will provide a solid foundation from which to guide future studies upon, aimed at acquiring more detailed cancer knowledge within the AYA domain.Adolescent and young adult (AYA) cancer patients, aged 15–39 years at primary cancer diagnosis, form a distinct, understudied, and underserved group in cancer care. This study aimed to assess long-term trends in incidence, survival, and mortality of AYA cancer patients within the Netherlands. Data on all malignant AYA tumours diagnosed between 1990–2016 (n = 95,228) were obtained from the Netherlands Cancer Registry. European age-standardised incidence and mortality rates with average annual percentage change (AAPC) statistics and five-year relative survival rates were calculated. The overall cancer incidence increased from 54.6 to 70.3 per 100,000 person-years (AAPC: +1.37%) between 1990–2016, and increased for both sexes individually and for most cancer types. Five-year relative survival overall improved from 73.7% in 1990–1999 to 86.4% in 2010–2016 and improved for both sexes and most cancer types. Survival remained poor (<60%) for rhabdomyosarcoma, lung, stomach, liver, bladder, and pancreatic carcinomas, among others. Mortality rates among male AYAs overall declined from 10.8 to 6.6 (AAPC: −1.64%) and from 14.4 to 10.1 per 100,000 person-years (AAPC: −1.81%) for female AYAs since 1990. Mortality rates remained unchanged for male AYAs aged 20–24 and 25–29 years. In conclusion, over the past three decades, there has been a considerable increase in cancer incidence among AYAs in the Netherlands. Meanwhile, the survival improved and the mortality overall declined. Survival at five-years now well exceeds above 80%, but did not do so for all cancer types.

Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States.

Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany.

Long-term Trends in Prostate Cancer Incidence by Stage at Diagnosis in Japan Using the Multiple Imputation Approach, 1993–2014

This study aimed to assess long-term trends in the incidence of prostate cancer by stage at diagnosis before and after the introduction of population-based PSA screening. We used data from three population-based cancer registries in Japan. A total of 29,458 malignant prostate cancer cases diagnosed between 1993 and 2014 were used for the analysis. Multiple imputation with chained equations was used to impute a specific stage at diagnosis for cases with "unknown" and missing status. We estimated the age-standardized incidence rates by stage at diagnosis from 1993 to 2014, and used joinpoint linear regression models to assess changes in trend. Joinpoint analyses after imputation showed that localized cancer was stable from 1993 to 2000, followed by a pronounced but insignificant increase through 2003 (from 12.1 per 100,000 in 2001 to 34.1 per 100,000 in 2003), and a significant increase thereafter [annual percentage change (APC), 4.1%]. For regional cancer, the imputed data showed that the increasing trend lasted from 1993 to 2006 (APC, 12.5%), then leveled off through 2014. For distant prostate cancer, the imputed data showed the increasing trend continued from 1993 to 2004 (APC, 2.4%), and started to marginally decline thereafter (APC, -2.2%). Our study confirmed a significantly rapid increase in localized prostate cancer after the spread of PSA screening in Japan, with a marginal decrease in distant prostate cancer after 2004. Evaluation of the effectiveness of PSA screening would require a comprehensive analysis of changes in mortality, survival, and treatment practices over time.

Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota.

Recent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors. The population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996-2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use. One hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16-94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011-2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006-2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018. A decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

Long-term trends in incidence and risk factors for ischaemic stroke subtypes: Prospective population study of the South London Stroke Register.

BackgroundAs the average life expectancy increases, more people are predicted to have strokes. Recent studies have shown an increasing incidence in certain types of cerebral infarction. We aimed to estimate time trends in incidence, prior risk factors, and use of preventive treatments for ischaemic stroke (IS) aetiological subtypes and to ascertain any demographic disparities.Methods and findingsPopulation-based data from the South London Stroke Register (SLSR) between 2000 and 2015 were studied. IS was classified, based on the underlying mechanism, into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). After calculation of age-, sex-, and ethnicity-specific incidence rates by subtype for the 16-year period, we analysed trends using Cochran-Armitage tests, Poisson regression models, and locally estimated scatterplot smoothers (loess). A total of 3,088 patients with first IS were registered. Between 2000–2003 and 2012–2015, the age-adjusted incidence of IS decreased by 43% from 137.3 to 78.4/100,000/year (incidence rate ratio [IRR] 0.57, 95% CI 0.5–0.64). Significant declines were observed in all subtypes, particularly in SVO (37.4–18; p < 0.0001) and less in CE (39.3–25; p < 0.0001). Reductions were recorded in males and females, younger (<55 years old) and older (≥55 years old) individuals, and white and black ethnic groups, though not significantly in the latter (144.6–116.2; p = 0.31 for IS). A 4-fold increase in prior-to-stroke use of statins was found (adjusted odds ratio [OR] 4.39, 95% CI 3.29–5.86), and despite the increasing prevalence of hypertension (OR 1.54, 95% CI 1.21–1.96) and atrial fibrillation (OR 1.7, 95% CI 1.22–2.36), preventive use of antihypertensive and antiplatelet drugs was declining. A smaller number of participants in certain subgroup-specific analyses (e.g., black ethnicity and LAA subtype) could have limited the power to identify significant trends.ConclusionsThe incidence of ISs has been declining since 2000 in all age groups but to a lesser extent in the black population. The reported changes in medication use are unlikely to fully explain the reduction in stroke incidence; however, innovative prevention strategies and better management of risk factors may contribute further reduction.

Measuring colorectal cancer incidence: the performance of an algorithm using administrative health data

BackgroundCertain cancer case ascertainment methods used in Quebec and elsewhere are known to underestimate the burden of cancer, particularly for some subgroups. Algorithms using claims data are a low-cost option to improve the quality of cancer surveillance, but have not frequently been implemented at the population-level. Our objectives were to 1) develop a colorectal cancer (CRC) case ascertainment algorithm using population-level hospitalization and physician billing data, 2) validate the algorithm, and 3) describe the characteristics of cases.MethodsWe linked physician billing, hospitalization, and tumor registry data for 2,013,430 Montreal residents age 20+ (2000–2010). We compared the performance of three algorithms based on diagnosis and treatment codes from different data sources. We described identified cases according to age, sex, socioeconomic status, treatment patterns, site distribution, and time trends. All statistical tests were two-sided.ResultsOur algorithm based on diagnosis and treatment codes identified 11,476 of the 12,933 incident CRC cases contained in the tumor registry as well as 2317 newly-captured cases. Our cases share similar overall time trends and site distributions to existing data, which increases our confidence in the algorithm. Our algorithm captured proportionally 35% more individuals age 50 and younger among CRC cases: 8.2% vs. 5.3%. The newly captured cases were also more likely to be living in socioeconomically advantaged areas.ConclusionsOur algorithm provides a more complete picture of population-wide CRC incidence than existing case ascertainment methods. It could be used to estimate long-term incidence trends, aid in timely surveillance, and to inform interventions, in both Quebec and other jurisdictions.