| 摘要: | 目的：探討台灣地區民眾罹患口腔癌與食道癌的發生率及死亡率之趨勢與地理分布差異；分析口腔癌與食道癌之年齡、年代及世代效應；以及各縣市民眾之嚼檳榔、吸菸、喝酒之盛行率與各縣市疾病的發生率與死亡率的相關性。
研究方法：以WHO 1976年世界標準人口標準，計算台灣地區23縣市1979-2003年各年度年齡標準化發生率與1982-2006年各年度年齡標準化死亡率，並繪製累積發生與死亡率之癌症三分法層次圖，探討其空間分佈。以年齡、年代和世代來繪製發生率圖與死亡率圖來探討疾病受年齡、年代及世代效應的影響，並且再以APC模式來進行分析。健康危險因子以2001年喝酒、2005年吸菸與2005年嚼檳榔各縣市盛行率為依據，並依照各別因子之第33、66百分位，分各縣市為高中低三類，再以波以松迴歸分析健康危險因子與發生率和死亡率兩者的相關性。
結果：比較1979與2003年的發生率顯示男性口腔癌發生率增加為6.19倍，女性增加為2.32倍，男性食道癌發生率增加為1.99倍，女性增加為1.01倍；比較1982與2006年的死亡率顯示男性口腔癌死亡率增加為4.72倍，女性減少為0.98倍，男性食道癌死亡率增加為1.19倍，女性減少為0.4倍。口腔癌增加趨勢較食道癌明顯，男性增加趨勢較女性明顯。
疾病地理分布，口腔癌以東部和中南部地區較為嚴重，食道癌則以東部和北部地區較為嚴重。
男性口腔癌與食道癌的發生率與死亡率有年輕化的趨勢，並且隨著年代¬而增加，在較新的世代亦呈現上升的趨勢；女性則隨著年齡層的增加而增加，隨年代改變的變化不大，而且於較新的世代均呈現下降的趨勢。
嚼食檳榔對於男性有顯著的影響(p<0.05)，與低盛行率的縣市相比，盛行率高的縣市之口腔癌與食道癌的發生率危險比分別為1.58、1.13，死亡率危險比分別為1.7、1.29。對於女性，菸、酒與檳榔大致都有顯著的影響。並且發現健康危險因子對於這兩種癌症均有交互作用關係存在。
結論：近年來男性口腔癌與食道癌的發生率與死亡率有增加的趨勢，女性口腔癌發生率亦有增加趨勢，並且這兩種癌症與菸、酒和檳榔等行為有相關性存在，未來在疾病的防治上，應不分性別，針對使用菸、酒和檳榔的高危險群來進行，以控制疾病上升的趨勢。
Aims: The objectives of this study are to, 1) evaluate the general trends and spatial-temporal patterns regarding incidence and mortality rates of oral and esophageal cancers in last twenty-five years in Taiwan; 2) to determine the age-, period- and cohort (APC)-specific effects for mortality rates and incidence rates of these two cancers; 3) to estimate whether the cancers are associated with smoking, drinking, and areca chewing.
Methods: We calculated the standard incidence rates from 1979-2003 and standard mortality rates from 1982-2006, using WHO 1976 world population as standard. In order to present the spatial-temporal patterns, we drew three-level cancer map of cumulative incidence and mortality rates. And we respectively used age, period, and cohort as horizontal axe to plot the observed rates to analysis the effects of age, period and cohort. We also used age-period-cohort model to assess those effects. The 23 counties in Taiwan in regarding to the use of tobacco, alcohol, and areca were classified into high, medium and low prevalence areas. Poisson regression was used to analyze the association between risk factors and the disease.
Results: Between 1979 and 2003, the oral cancer incidence rates had 6.19 times increase in males and 2.32 times in females, and the esophageal cancer had 1.99 times increase in males and 1.01 times in females. Compared with 1982, the oral cancer mortality rates in 2006 had 4.72 times increase in males and 0.98 times in females. The increasing trends were more precipitous in oral cancer than in esophageal cancer, and more precipitous among males than among females.
The oral cancer was more severe in counties of eastern and mid-southern Taiwan; esophageal cancer was more severe in eastern and northern Taiwan.
The incidence rates of oral and esophageal cancers were higher in younger male groups, but less in younger female groups. These diseases in male were in increasing trends in recent years, particularly in younger cohorts. However, the diseases in females were relatively stable and had a decreasing trend in younger cohorts.
The areca chewing behavior had a significant effect (p<0.05) on diseases among males. Compared with people of less areca use, rate ratios (RR) of incidence were 1.58 for the oral cancer and 1.13 for the esophageal cancer in males. The corresponding mortality ratios were 1.7 and 1.29. Among females, smoking, drinking and chewing areca were significant risks.
Conclusions: The incidence and mortality rates of oral and esophageal cancers are increasing among males, and incidence rates of oral cancer is also increasing among females. Both diseases have associations with using tobacco, alcohol, and areca. It is necessary to modify life styles (i.e. cigarette smoking, alcohol consumption and areca chewing) in order to prevent oral and esophageal cancers in our population. |
