[Study on behavioral risk factors and lagging effect analysis with liver cancer mortality in rural critical areas of 4 provinces of China from 2009 to 2019]

Objective: To analyze the trend of liver cancer mortality in rural key areas of Jiangsu Province, Anhui Province, Shandong Province, and Henan Province (4 provinces) from 2009 to 2019 and to explore the influence of behavioral risk factors on liver cancer mortality and its lagging effect, and provide a reference for the prevention and treatment of liver cancer in China. Methods: Based on the 2009-2019 National Cause of Death Surveillance Database of the Chinese Center for Disease Control and Prevention, and the survey data of tumor and risk factor behavior of residents in key areas of 4 provinces, Joinpoint 4.2 software was used to calculate the average annual percentage change (AAPC) for assessing the temporal trend of standardized mortality of liver cancer; Chi-square test and trend Chi-square test were used to analyze the regional distribution difference and temporal change trend of behavioral habit factors. Stata 16 was used to establish a panel model to analyze the correlation and lagging effect of behavioral risk factors with liver cancer. Results: The standardized mortality rate of liver cancer in Jinhu County, Sheyang County, Lingbi County, Shou County, Mengcheng County, Wenshang County, Juye County, Luoshan County, Shenqiu County, and Xiping County showed a downward trend (AAPC<0, P<0.05) from 2009 to 2019. The consumption frequency of pickles/salted fish, red meat, and aquatic products showed a downward trend. The consumption frequency of healthy foods such as fresh vegetables, fresh fruits, and dairy products in all counties and districts showed an upward trend, and the consumption frequency of fried foods, kimchi, smoked foods, moldy foods, coffee, and soy products remained at a low level (P<0.05); but the consumption frequency of soy products and dairy products was still <20.00%. Fried food, pickles/salted fish, current smoking rate, alcohol consumption rate, and unvaccinated hepatitis B vaccine rate were positively correlated with liver cancer death, and there was a lag effect, and the lag period was 4, 1, 6, 5, 4 years respectively. Conclusions: From 2009 to 2019, the mortality rate of liver cancer in rural key areas of 4 provinces shows a downward trend. There is a correlation and lagging effect between behavioral risk factors such as fried food, smoking, and alcohol consumption and liver cancer death.

[Distribution and risk factors of self-reported cancer cases in adults in China, 2015]

Objective: To analyze the prevalence and risk factors of self-reported cancer in adults in China in 2015. Methods: The data used in this study were from China Chronic Disease and Risk Factors Surveillance in 2015. The frequency and proportion of the classified variables were analyzed by descriptive statistics, the disordered classified variables were compared by χ² test, and the possible risk factors of cancer patients were screened by univariate and multivariate logistic regression analyses. Results: In 2015, there were 1 809 self-reported tumors patients in China, including 689 males (0.63%), 1 120 females (1.03%), 769 (0.71%) in the eastern region, 465 (0.43%) in the central region and 575 (0.53%) in the western region. The patients were mainly distributed in people aged 45- and 55- years old, being overweight or obese, living in eastern urban area, having low education level, being married, having low annual household income and being occupational population. The results of multivariate logistic regression showed that compared with the western region, the prevalence rate of cancer was higher in the eastern region (OR=1.05, 95%CI: 1.04-1.06), while lower in the central region (OR=0.94, 95%CI: 0.93-0.95); the risk for cancer in people with family history of malignancy was higher than that in people without family history of malignancy (OR=1.95, 95%CI:1.94-1.96) the risk for cancer in people with an annual household income of less than 10 000 yuan or between 10 000 and 50 000 yuan was higher than that in people with an annual household income of more than 50 000 yuan (<10 000 yuan: OR=1.59, 95%CI: 1.58-1.60; between 10 000 and 50 000 yuan: OR=1.27, 95%CI: 1.26-1.28); and the risk for cancer in people living urban areas was lower than that in people living in rural areas (OR=0.98, 95%CI: 0.97-0.99). In terms of personal behavior and diet, the risk for cancer in smokers was 1.25 times higher than that in non-smokers (OR=1.25, 95%CI: 1.24-1.26), and the risk for cancer in alcoholics was 1.16 times higher than that in non-alcoholics (OR=1.16, 95%CI: 1.15-1.17), the risk for cancer in people with insufficient vegetable and fruit intakes was 1.29 times and 1.03 times higher than those in people with sufficient intakes of vegetables and fruits, respectively (OR=1.29, 95%CI: 1.28-1.30;OR=1.03,95%CI: 1.02-1.04). People with low frequency of high-intensity exercise had a higher risk for cancer compared with those with high frequency of high-intensity exercise (OR=1.32, 95%CI: 1.31-1.33), the risk for cancer was higher in people with low frequency of moderate exercise than in people with high frequency of moderate exercise (OR=1.08, 95%CI: 1.07-1.09). The risk for cancer in people with sedentary time less than 2 hours was higher than that in those with sedentary time more than 2 hours (OR=1.69, 95%CI: 1.68-1.70), and the risk for cancer in people who ate moderate amount of red meat was lower than that in people who ate excessive amount of red meat (OR=0.86, 95%CI: 0.85-0.87). Conclusions: The number of female self-reported cancer was more than that in males, and the number of self-reported cancer in the eastern region was higher than that in the central and western regions. Living in eastern region, with family history of malignancy, having low annual household income, smoking, drinking, insufficient vegetable intake, insufficient fruit intake and low frequency of high-intensity exercise and low frequency of moderate intensity exercise were the main risk factors for cancer, while living in central region, living in urban area and low red meat intake were protective factors.