Time Trends In Incidence Research Articles

The Global Trends in Incidence of Different Oral Disorders: Results from the Global Burden of Disease Study 2017 and the Impact on the Prevention

Background: Oral disorders(OD) are the most common diseases in the world, ranking third in incidence. The etiology of OD is diverse, and there is little research on the incidence trend of different OD in different regions. Therefore, we aimed to determine the incidence pattern and time trend of OD. Methods: We collected detailed information on 4 OD between 1990 and 2017 from the Global Burden of Disease Study. Estimated annual percentage change (EAPC) in OD, age-standardized incidence rate (ASR), and estimates based on gender, region and etiology were calculated to quantify the temporal trends in OD. Findings: Globally, the incidence cases of OD increased 31.4%, from 2.74 billion in 1990 to 3.60 billion in 2017. The overall EAPC decreased 0.04% (95% CI -0.05% - -0.02%). The EAPC of Periodontal diseases (PD) increased 0.18 (95% CI 0.15-0.21). The EAPC of caries of permanent teeth remained stable, while the ASR of CDT and edentulism and severe tooth loss (EST) gradually decreased, with corresponding EAPC of -0.13 (95% CI -0.15 - -0.11) and -0.14 (95% CI -0.19- -0.09). OD have been observed to have the most significant growth in Belgium and Spain, while a most significant decline in Nigeria. PD showed a downward trend in the areas with high Socio-demographic Index (SDI) but an upward trend in the other four. EST have declined significantly in countries with a high SDI. Interpretation: OD are an important public health problem in the world. The rising incidence of PD cannot be ignored. We observed that the trend of OD incidence is closely related to the value of the national SDI. What is worth noting, Nigeria has the best control of OD incidence worldwide. More targeted and specific strategies should be developed in some countries to reduce the incidence of OD. Funding Statement: This study was supported by the National Social Science Foundation of China (No.16BGL183) and the Foundation of Health Commission of Hubei, China (No. WJ2017M072) Declaration of Interest: The author reports no conflicts of interest in this work.

A JOINPOINT REGRESSION ANALYSIS OF LONG-TERM TRENDS IN LEUKEMIA INCIDENCE AND MORTALITY IN CENTRAL SERBIA AND NIŠAVA DISTRICT (1999-2014)

Leukemia contributes 2.3% to the overall cancer incidence in Serbia and 2.9% in the total mortality, while the estimated incidence and mortality rate for males and females were 8.7 and 6.3 ‰, respectively and occupies 13th place among both sexes in Central Serbia. The objective of our study was to examine the time trends of leukemia in Central Serbia, with a focus on Nisava district, from 1999-2014, using a Joinpoint regression analysis and compare them with the trend in other populations, and identify possible changes. The standardised incidence and mortality were obtained from the Serbian Cancer Registry of Central Serbia. Time trends for incidence and mortality of leukemia were assessed using the annual percent change, estimated through Joinpoint regression analysis (age period cohort models - APC) using the Joinpoint Regression Software. Our results demonstrate a stable trend of the age-adjusted leukemia incidence rate both in males and females in Central Serbia during the observed 1999-2014 period. However, statistically significant decreasing trend of leukemia incidence rate was found in men from Nisava district, while non-significant slightly increasing pattern was present in women. Joinpoint analysis in our research demonstrated favorable mortality declines until the 2002, and than stabile trend in Central Serbia in both sexes to the end of the observed period. Conversely, mortality among males in Nisava district shows a positive trend, but not statistically significant. The results of the study suggest that leukemia profile in Central Serbia was stabile during the study period. It is particularly interesting that incidence is decreasing among male population from Nisava district.

Stagnation in Decreasing Gastric Cancer Incidence and Mortality in Quito: Time Trend Analysis, 1985-2013.

Background Despite the significant global decline in mortality and incidence, gastric cancer (GC) remains a very common cause of illness and death in the Latin American region. This article seeks to describe, in depth, the time trend of incidence and mortality of GC in the city of Quito, from 1985 to 2013. Methods Using data from the Quito Cancer Registry, annual sex-specific age-standardized incidence and mortality rates were calculated. The analysis included all types of GC together, as well as by histological subtype. Joinpoint regression analysis was performed to estimate the annual percentage change (EAPC). To evaluate cohort and period effects, Age-Period-Cohort (APC) modeling was performed. Results Over time, incidence rate decreased from 30.4 to 18.8 cases in men and from 20.1 to 12.9 cases in women. The mortality rate decreased from 17.5 to 14.4 deaths in men and from 14.2 to 10.9 deaths in women. The incidence trend was composed of a first period (1986-1999) of strong decline (EAPC Men= -2.6, 95% Confidence Interval [CI]: -4.2, -0.9; EAPC Women= -3.2, 95% CI: -4.6, -1.9), followed by a less important decrease in men (EAPC= -0.8, 95% CI:-2.5, 0.9) and a slight increase in women (EAPC= 0.7, 95% CI: -1.4; 2.8). Mortality rates were constantly decreasing in both men (EAPC= -0.5, 95% CI: -0.9, -0.1) and women (EAPC= -0.9, 95% CI: -1.7, -0.1) throughout the period of analysis. Conclusions The declines in incidence and mortality rates are stagnating. It is important to take measures to further reduce the high burden of GC.

A changing landscape: Temporal trends in incidence and characteristics of patients hospitalized with venous thromboembolism 2006–2015

BackgroundVenous thromboembolism (VTE) has major clinical and public health impact. However, only sparse data on calendar time trends in incidence from unselected populations reflecting current clinical practice are available. ObjectivesTo examine temporal trends in the incidence and characteristics of patients hospitalized with first-time VTE in Denmark between 2006 and 2015. Patients/MethodsUsing nationwide health care registries, we calculated yearly hospitalization rates for first-time VTE from 2006 to 2015. The rates were standardized to the age and sex distribution in 2006. Based on the hospitalization and prescription history of each patient, we assessed the risk profile and evaluated changes over time. ResultsWe identified 67,426 patients with a first-time VTE hospitalization. The age- and sex-standardized incidence rate increased from 12.6 (95% CI: 12.3–12.9) per 10,000 person years at risk in 2006 to 15.1 (95% CI: 14.7–15.4) in 2015, corresponding to an increase of 19.8%. The increase was due to a 73.9% increase in the standardized incidence rate of pulmonary embolism (PE), whereas no increase was observed for deep vein thrombosis. The risk profile changed with an increasing proportion of elderly patients and patients with comorbidity (proportion of patients with a Charlson's Comorbidity Index score of ≥1). ConclusionsThe hospitalization rate of first-time VTE, and particularly PE, has increased substantially within the last decade in Denmark. In addition, the risk profile of the VTE population has changed with more elderly and more patients with comorbidity being diagnosed. Further efforts are warranted to explore the changes in VTE epidemiology and the clinical implications.

P093 COMPARATIVE INCIDENCE OF INFLAMMATORY BOWEL DISEASE IN DIFFERENT AGE GROUPS: A COMMERCIALLY-INSURED, POPULATION-BASED US STUDY

Data on the incidence of inflammatory bowel disease (IBD) by age groups are available in countries outside of the United States (US) or localized populations within the US. We aimed to estimate the incidence rates (IRs) of IBD by age groups using a US multiregional dataset. We used the Optum® Research Database to identify incident IBD patients with a disease-free interval of 1.5 years between 2005-2015. Overall and age-specific IRs were calculated for 4 different age groups: pediatric (0-17 years), young adult (18-25 years), adult (26-59 years), elderly (>60 years). Time trends of incidence were evaluated in each age group. Disease extent and phenotype were also compared. The mean IR for the cohort (n=60,247) from 2005-2015 was 37.5/100,000. The IR was highest in adult and elderly cohorts (36.4 and 36.7/100,000 respectively), with predominance of ulcerative colitis (UC) over Crohn’s disease (CD). The IR increased over the 10-year study period for all age groups (time trends p-value <0.001). The elderly group had more colonic and more stricturing CD phenotype but less perianal disease. In pediatric and young adult cohorts, the incidence for CD (5.2 and 11.8/100,000 respectively) was higher than UC (2.4 and 9.6/100,000 respectively), with a higher rate of penetrating CD. In one of the most comprehensive evaluations of the incidence of IBD in the US, we found a similar incidence rate to other national populations. We also confirmed differences of IBD phenotypes based on age groups, with less aggressive and lower rates of perianal disease in the elderly. Figure 1. Distribution of IRs for IBD in four different age cohorts.

P093 COMPARATIVE INCIDENCE OF INFLAMMATORY BOWEL DISEASE IN DIFFERENT AGE GROUPS: A COMMERCIALLY-INSURED, POPULATION-BASED US STUDY

Data on the incidence of inflammatory bowel disease (IBD) by age groups are available in countries outside of the United States (US) or localized populations within the US. We aimed to estimate the incidence rates (IRs) of IBD by age groups using a US multiregional dataset. We used the Optum® Research Database to identify incident IBD patients with a disease-free interval of 1.5 years between 2005-2015. Overall and age-specific IRs were calculated for 4 different age groups: pediatric (0-17 years), young adult (18-25 years), adult (26-59 years), elderly (>60 years). Time trends of incidence were evaluated in each age group. Disease extent and phenotype were also compared. The mean IR for the cohort (n=60,247) from 2005-2015 was 37.5/100,000. The IR was highest in adult and elderly cohorts (36.4 and 36.7/100,000 respectively), with predominance of ulcerative colitis (UC) over Crohn’s disease (CD). The IR increased over the 10-year study period for all age groups (time trends p-value <0.001). The elderly group had more colonic and more stricturing CD phenotype but less perianal disease. In pediatric and young adult cohorts, the incidence for CD (5.2 and 11.8/100,000 respectively) was higher than UC (2.4 and 9.6/100,000 respectively), with a higher rate of penetrating CD. In one of the most comprehensive evaluations of the incidence of IBD in the US, we found a similar incidence rate to other national populations. We also confirmed differences of IBD phenotypes based on age groups, with less aggressive and lower rates of perianal disease in the elderly.Figure 1Distribution of IRs for IBD in four different age cohorts.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Biliary tract cancer incidence and trends in the United States by demographic group, 1999-2013.

Biliary tract cancers (BTCs) are rare but deadly cancers (gallbladder cancer [GBC], intrahepatic cholangiocarcinoma [ICC], extrahepatic cholangiocarcinoma [ECC], and ampulla of Vater cancer [AVC]). A recent US study reported increasing GBC incidence among people younger than 45 years and blacks; however, it did not examine trends for other biliary tract sites. This study characterized demographic differences in BTC incidence rates and time trends by anatomic site. Population-based North American Association of Central Cancer Registries data were used to calculate age-adjusted incidence rates, incidence rate ratios (IRRs), and estimated annual percent changes (eAPCs) for 1999-2013 by site and demographic group. For sites with significant differences in eAPC by age group, IRRs were compared by age group. GBC incidence rates declined among women (eAPC, -0.5%/y; P=.01) and all racial/ethnic groups except for non-Hispanic blacks, among whom rates increased (1.8%/y; P<.0001). Although GBC rates increased among 18- to 44-year-olds (eAPC, 1.8%/y; P=.01), they decreased among people 45 years old or older (-0.4%/y; P=.009). Sex (P<.0001) and racial/ethnic differences (P=.003 to .02) in GBC incidence were larger for younger people than older people. During this period, ICC (eAPC, 3.2%/y; P<.0001) and ECC rates (1.8%/y; P=.001) steadily increased across sex and racial/ethnic groups. Although AVC incidence rates increased among younger adults (eAPC, 1.8%/y; P=.03) but not older adults (-0.20%/y; P=.30), sex and racial/ethnic IRRs did not differ by age. Differential patterns of BTC rates and temporal trends have been identified by anatomic site and demographic groups. These findings highlight the need for large pooling projects to evaluate BTC risk factors by anatomic site.

Brain and Salivary Gland Tumors and Mobile Phone Use: Evaluating the Evidence from Various Epidemiological Study Designs.

Mobile phones (MPs) are the most relevant source of radiofrequency electromagnetic field (RF-EMF) exposure to the brain and the salivary gland. Whether this exposure implies a cancer risk has been addressed in several case-control and few cohort studies. A meta-analysis of these studies does not show increased risks for meningioma, pituitary, and salivary gland tumors. For glioma and acoustic neuroma, the results are heterogeneous, with few case-control studies reporting substantially increased risks. However, these elevated risks are not coherent with observed incidence time trends, which are considered informative for this specific topic owing to the steep increase in MP use, the availability of virtually complete cancer registry data from many countries, and the limited number of known competing environmental risk factors. In conclusion, epidemiological studies do not suggest increased brain or salivary gland tumor risk with MP use, although some uncertainty remains regarding long latency periods (>15 years), rare brain tumor subtypes, and MP usage during childhood.

Respiratory tuberculosis incidence and mortality in Estonia: 30-year trends and sociodemographic determinants.

To explore time trends in the incidence and mortality of respiratory tuberculosis (TB) over a 30-year period in Estonia, and to evaluate disease disparities according to sex, age, ethnicity and education. Data from the TB Register and the Causes of Death Register were used to assess time trends in age-standardised incidence and mortality rates. The effect of sociodemographic characteristics on TB risk was modelled using Poisson regression around three population censuses. Respiratory TB incidence and mortality decreased in males and were stable in females in 1987-1991, after which the rates increased sharply in both sexes until 1998 and decreased steadily afterwards. Multidrug-resistant TB (MDR-TB) incidence rose in males until 1998 and in females until 2002, and then started to fall. The incidence of TB and human immunodeficiency virus (HIV) coinfection in males increased until 2007 and decreased thereafter. Less educated people and non-Estonians had a significantly higher relative risk of respiratory TB. Estonia, one of the countries most affected by TB in the World Health Organization European Region, has made considerable progress in reducing the risk of respiratory TB, TB-HIV and MDR-TB. Continuing education- and ethnicity-related disparities in TB risk remain a concern.

Decline in the Incidence of All-Cause and Alzheimer's Disease Dementia: a 12-Year-Later Rural Cohort Study in Korea.

BackgroundThere has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimer's disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area.MethodsA total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence.ResultsThe incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia.ConclusionUpon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.

A forecasting model of disease prevalence based on the McKendrick–von Foerster equation

A new model for disease prevalence based on the analytical solutions of McKendric–von Foerster's partial differential equations is developed. Derivation of the model and methods to cross check obtained results are explicitly demonstrated. Obtained equations describe the time evolution of the healthy and unhealthy age-structured sub-populations and age patterns of disease prevalence. The projection of disease prevalence into the future requires estimates of time trends of age-specific disease incidence, relative survival functions, and prevalence at the initial age and year available in the data. The computational scheme for parameter estimations using Medicare data, analytical properties of the model, application for diabetes prevalence, and relationship with partitioning models are described and discussed. The model allows natural generalization for the case of several diseases as well as for modeling time trends in cause-specific mortality rates.

Incidence of testicular tumor subtypes according to the updatedWHO classification, North Rhine-Westphalia, Germany, 2008-2013.

In 2016, the WHO introduced an updated classification for testicular tumors. The application of this updated classification to cancer registry data requires some recoding of tumors. The aim of this study was to provide up-to-date population-based incidence estimates of subtypes of testicular germ cell tumors (TGCT) according to the updated classification. We reviewed 2251 pathology reports (42.9%) out of 5252 testicular tumors at the cancer registry of North Rhine-Westphalia for the years 2008-2013. We used population counts to estimate age-standardized incidence rates per million person-years (EUROSTAT revised European Standard Population). The application of the updated WHO classification resulted in a recoding of 8.9% of all testicular tumors. While the recodings have no influence on the incidence of seminomatous and non-seminomatous TGCTs that include mixed TGCTs, they influence the incidence of individual histological types of seminomatous and non-seminomatous TGCTs. Among the 4935 testicular germ cell tumors (TGCT), 23.7% were mixed TGCTs. Overall, 46.9% of all mixed TGCTs included seminoma and age-standardized incidence rates were highest for the combination seminoma plus embryonal carcinoma (5.9 per million person-years) and embryonal carcinoma plus teratoma (4.9 per million person-years). The median age at diagnosis was higher for mixed TGCTs including seminoma (31years) than those that did not include seminoma (28years). Population-based incidence time trends for seminomatous and non-seminomatous TGCTs that include mixed TGCTs are not distorted by the introduction of the WHO update. Trend distortions can only be expected if time trends of individual histological subtypes of the seminomatous and non-seminomatous TGCTs are examined.

Time Trends of Gastrointestinal Cancers Incidence and Mortality in Yangzhong From 1991 to 2015: An Updated Age-Period-Cohort Analysis.

Background: Gastrointestinal (GI) cancers are the common cause of morbidity and mortality in China which seriously threaten people's health and lives. The aim of this study was to describe the temporal trend in the epidemiology of GI cancers from 1991 to 2015, with an emphasis on the effects of age, period and cohort in Yangzhong City, Jiangsu province, a high-risk area of GI cancers in China.Methods: Our study extracted cases of gastric cancer, esophageal cancer and colorectal cancer diagnosed from 1991 to 2015 from Yangzhong Cancer Registry. Age-standardized rates (ASRs) were calculated and joinpoint regression was used to compute the estimated annual percent changes. Age-period-cohort (APC) model was performed to investigate the independent effects of age, calendar period, and birth cohort.Results: Between 1991 and 2015, 18,006 new cases and 10,262 deaths were registered with GI cancers in Yangzhong. The age-standardized incidence rates (ASIRs) of gastric cancer decreased in both sexes during the study period. And the incidence rates of esophageal cancer stabilized at first then continued to decline, the turning point was in 2005 for men and 2001 for women. Changes in the mortality rates of gastric cancer and esophageal cancer showed significant declined trends around 2000–2010 in both genders. The incidence rates of colorectal cancer increased steadily during the entire study period, and the increase was more pronounced in the mortality rates of men. The results of APC analysis suggest that general decreases in incidence and mortality of esophageal cancer and gastric cancer might be caused by the downward trend of the period and cohort effects, while the increases in colorectal cancer might be caused by the uptrend of the period effects.Conclusions: The incidence and mortality rates of esophageal and gastric cancers showed a downward trend and colorectal cancer was on the rise as a whole in Yangzhong City. The different burden of gastrointestinal cancer indicating heterogeneous risk factors exist and may have contributed to these temporal variations.

Mobile phone use and incidence of brain tumour histological types, grading or anatomical location: a population-based ecological study

ObjectiveSome studies have reported increasing trends in certain brain tumours and a possible link with mobile phone use has been suggested. We examined the incidence time trends of brain tumour...

Overall survival and time trends in breast and cervical cancer incidence and mortality in the Regional Health District (RHD) of Barretos, S\xe3o Paulo, Brazil

BackgroundBreast and cervical cancers represent a significant cause of morbidity and mortality among women. The purpose of this study was to analyse the survival and time trends in two of the most common female cancers in the Regional Health District (RHD) of Barretos, São Paulo, Brazil.MethodsFrom 2000 through 2015, we calculated the breast and cervical cancer incidence and mortality rates per 100,000 women who were age-standardized to the world population. We obtained the time trends using the Joinpoint Regression software. We estimated the overall survival rates using the Kaplan-Meier methods.ResultsThe age-standardized rates (ASR) for incidence of breast cancer increased annually, with an average annual percentage change (AAPC) of 4.3 (95% Confidence Interval (CI): 2.4 to 6.3) for invasive breast cancer and 10.2 (95% CI: 6.1 to 14.5) for in situ breast cancer. The mortality rates for invasive breast cancer decreased with an AAPC of 0.2 (95% CI: -1.9 to 2.4). The ASR incidence of invasive cervical cancer showed an AAPC of − 1.9 (95% CI: -4.7 to 0.9). For in situ cases, the ASR showed an AAPC of 9.3 (95% CI: 3.3 to 15.7). The ASR mortality for cervical cancer showed an AAPC of − 5.3 (95% CI: -9.5 to − 0.8). The Kaplan-Meier analysis indicated 5-year overall survival rates of 74.3% for breast cancer and 70.7% for cervical cancer.ConclusionsThe incidence of in situ and invasive breast cancer is increasing, while the mortality rates remain stable. We observed an increase in the incidence of in situ cervical cancer and a decrease in invasive incidence rates during the study period, and we noted that the cervical cancer mortality significantly declined during the study period.

Time trends in statin use and incidence of recurrent cardiovascular events in secondary prevention between 1999 and 2013: a registry-based study

BackgroundThe current study evaluated time trends of statin use and incidence of recurrent CVD in secondary prevention from 1999 to 2013 and investigated which factors were associated with statin use in secondary prevention.MethodsIntego is a primary care registration network with 111 general practitioners working in 48 practices in Flanders, Belgium. This retrospective registry-based study included patients aged 50 years or older with a history of CVD. The time trends of statin use and incidence of recurrent CVD in secondary prevention were determined by using a joinpoint regression analysis. Multivariable mixed-effect logistic regression analysis was used to assess factors associated with statin use in patients in secondary prevention in 2013.ResultsThe overall prevalence of statin use increased and showed two trends: a sharp increase from 1999 to 2005 (annual percentage change (APC) 25.4%) and a weaker increase from 2005 to 2013 (APC 3.7%). The average increase in statin use was the highest in patients aged 80 and older. Patients aged 70–79 years received the most statins. Men used more statins than women did, but both genders showed similar time trends. The incidence of CVD decreased by an average APC of 3.9%. There were no differences between men and women and between different age groups. A significant decrease was only observed in older patients without statins prescribed. In 2013, 61% of the patients in secondary prevention did not receive a statin. The absence of other secondary preventive medication was strongly associated with less statin use. Gender, age and comorbidity were associated with statin use to a lesser degree.ConclusionsThe prevalence of statin use in secondary prevention increased strongly from 1999 to 2013. Less than 50% of patients with a history of CVD received a statin in 2013. Especially patients who did not receive other secondary preventive medication were more likely to not receive a statin. Despite the strong increase in statin use, there was only a small decrease in the incidence of recurrent CVD, and this occurred mainly in older patients without statins prescribed.

Incidence of notified Lyme borreliosis in Germany, 2013\u20132017

Lyme borreliosis (LB) is the most commonly reported tick-borne disease in Germany. In 9/16 states, notification of erythema migrans (EM), acute neuroborreliosis (NB) and Lyme arthritis (LA) is mandatory. We describe incidence measures, time trends, geographical distribution and frequencies of manifestations to better understand LB epidemiology and target prevention measures. We used cases notified in the 9 states and confirmed by local health offices, 2013–2017, to calculate incidences by time, place and person. Altogether, we observed 56,446 cases. Disease onset peaked yearly in July. Incidence ranged from 26/100,000 (2015) to 41/100,000 (2013) with mean annual incidences 2013–2017 on district level between 0.5/100,000 and 138/100,000. Median age was 54 years with peaks in boys (5–9 years, mean incidence 36/100,000) and women (50–69 years, mean incidence 57/100,000). 95% experienced EM only, 2.7% NB and 2.1% LA. 54% were female, but more men had NB (56%) and LA (53%, p < 0.001). Hospitalisation was recorded for 10% of LA and 71% of NB cases. LB remains an important public health concern in Germany with marked regional variation. To facilitate early diagnosis and treatment, health authorities should raise awareness among physicians and promote prevention strategies among the general population: tick-bite-protection, prompt tick removal and medical consultation.

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.

Time trends of incidence and mortality in colorectal cancer in Changning District, Shanghai, 1975-2013.

To evaluate the incidence and mortality of colorectal cancer (CRC) and the estimated patient's age, diagnostic duration and birth cohort effects in patients of Changning District, Shanghai. Age-standardized rates (ASRs) of CRC over eight intervals of 5 years from 1975 to 2013 were determined. Joinpoint regression analysis was used to determine the changes in annual incidence and mortality trends. Age-period-cohort analysis was performed to investigate their effects on the incidence and mortality trends of CRC. For incidence, the ASRs of 14.14 per 100 000 and 11.81 per 100 000 during 1975-1979 increased to 32.11 per 100 000 and 26.25 per 100 000 in men and women during 2008-2013. For mortality, ASRs of 9.40 per 100 000 and 8.76 per 100 000 increased to 14.80 per 100 000 and 11.92 per 100 000 in men and women, respectively, from 1975-1979 to 2010-2013. Joinpoint regression analysis found an increasing incidence (average annual percentage change [AAPC] 2.18% for men and 1.65% for women) and mortality (AAPC 1.47% for men and 0.97% for women) of CRC throughout the entire period. The incidence and mortality trends of CRC were significantly affected by birth cohorts. The increasing incidence and mortality of CRC are largely affected by the effects of birth cohorts. The increased incidence of CRC may be attributed to changes in lifestyle and diet, while that in mortality trends may be resulted from increasing incidence, an aging population and changing lifestyles.

Time trends in stroke incidence and in prevalence of risk factors in Southern Germany, 1989 to 2008/09

In prior studies, stroke incidence has mainly shown either declining time trends or stable rates in high-income countries. Changes could partially be linked to trends in classic cardiovascular disease (CVD) risk factors. In the present study, we analyzed the incidence of stroke in parallel with the prevalence of CVD risk factors over time in a German population. Data from three independent population-based MONICA/KORA Augsburg surveys conducted in 1989/90 (S2), 1994/95 (S3), and 1999/2001 (S4) were used to calculate age-standardized incidence rates (IR) of first-ever stroke over eight years from each baseline survey. Furthermore, the age-standardized prevalence rates of CVD risk factors were analyzed for these surveys. Changes in IR or prevalence were considered significantly different if their 95% confidence intervals (CI) did not overlap. The age-standardized IR of stroke showed no significant time trend (S2: IR = 203.4 per 100,000 person-years; CI 176.4–233.4, S3: IR = 225.6; 197.1–257.0, S4: IR = 209.9; CI 182.4–240.3). In agreement, the prevalence of the CVD risk factors was quite stable over time, showing divergent, but mostly non-significant changes. However, due to the aging Western societies and the longer survival time of stroke patients, the total number of stroke patients in the population will increase even with a stable IR.