Trends in cancer incidence and mortality in the process of metropolitanization of Shanghai, 1973-2017

Jiejie Qin¹Mengyin Wu²Shulin Zhao¹Kai Gu²Renzhi Cai²Ziwei Tang³Defeng Zhu³Jingyan Tian¹Wei Yao³Shen Baiyong¹Yan Shi^2*

• ¹Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
• ²Shanghai Municipal Center for Disease Control and Prevention (SCDC), Shanghai, China
• ³Shanghai Institute of Microsystem and Information Technology, Chinese Academy of Sciences (CAS), Changning, Shanghai Municipality, China

Background: Shanghai has become a modern and international metropolis. A more comprehensive understanding of cancer incidence and mortality rates and socioenvironmental factors is explored for developing effective cancer control policies in Shanghai. Methods: Cancer registration data are currently collected in Shanghai from 1973 to 2017. And socioenvironmental factors were obtained from Shanghai statistical yearbook. Multivariate ridge regression analysis explored the contributions of socioenvironmental factors to cancer incidence and mortality, and the estimated annual percentage change (EAPC) were calculated for each cancer type by gender and district. Results: Multivariate ridge regression analysis indicated that numbers of divorces, total waste gas from industry, areas of buildings completed, and number of computers probably drived the increase in cancer incidence, and health expenditure and medical insurance cost probrably contributed to the decrease in cancer mortality in Shanghai.Age-standardized incidences of the lung in females, prostate, thyroid, and cervix, increased most, and incidence and mortality of esophagus, liver and stomach cancers decreased most in Shanghai from 2002 to 2017. The most common cancer sites diagnosed were lung, colorectal, female breast and male prostate in Shanghai in 2017, similar to the pattern in the high-income countries. Stricter air control strategies, lower divorce rates, healthier lifestyles, and more effective HPV vaccination campaigns may be useful actional measures of cancer prevention. Conclusions: The longitudinal cancer data span decades reported here from the real world and Shanghai's experience in cancer prevention and control can be a reference for government guidelines in preventing population-level cancer incidence during city development.