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Int. J. Environ. Res. Public Health 2016, 13(10), 963; doi:10.3390/ijerph13100963

Temporal Trends in Geographical Variation in Breast Cancer Mortality in China, 1973–2005: An Analysis of Nationwide Surveys on Cause of Death

National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Cancer Council New South Wales, Sydney NSW 2011, Australia
State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, China
Sydney School of Public Health, University of Sydney, Sydney NSW 2006, Australia
Authors to whom correspondence should be addressed.
Academic Editor: Peter Baade
Received: 17 August 2016 / Revised: 21 September 2016 / Accepted: 23 September 2016 / Published: 28 September 2016
(This article belongs to the Special Issue Geographical Variation in Breast Cancer Outcomes)
View Full-Text   |   Download PDF [4104 KB, uploaded 28 September 2016]   |  


To describe geographical variation in breast cancer mortality over time, we analysed breast cancer mortality data from three retrospective national surveys on causes of death in recent decades in China. We first calculated the age-standardized mortality rate (ASMR) for each of the 31 provinces in mainland China stratified by survey period (1973–1975, 1990–1992 and 2004–2005). To test whether the geographical variation in breast cancer mortality changed over time, we then estimated the rate ratio (RR) for the aggregated data for seven regions and three economic zones using generalized linear models. Finally, we examined the correlation between mortality rate and several macro-economic measures at the provincial level. We found that the overall ASMR increased from 2.98 per 100,000 in 1973–1975 to 3.08 per 100,000 in 1990–1992, and to 3.85 per 100,000 in 2004–2005. Geographical variation in breast cancer mortality also increased significantly over time at the regional level (p = 0.002) but not at the economic zone (p = 0.089) level, with RR being generally lower for Western China (Northwest and Southwest) and higher in Northeast China over the three survey periods. These temporal and spatial trends in breast cancer mortality were found to be correlated with per capita gross domestic product, number of hospitals and health centres’ beds per 10,000 population and number of practicing doctors per 10,000 population, and average number of live births for women aged 15–64. It may be necessary to target public health policies in China to address the widening geographic variation in breast cancer mortality, and to take steps to ensure that the ease of access and the quality of cancer care across the country is improved for all residents. View Full-Text
Keywords: breast cancer; mortality; temporal; geographical; China breast cancer; mortality; temporal; geographical; China

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Xia, C.; Kahn, C.; Wang, J.; Liao, Y.; Chen, W.; Yu, X.Q. Temporal Trends in Geographical Variation in Breast Cancer Mortality in China, 1973–2005: An Analysis of Nationwide Surveys on Cause of Death. Int. J. Environ. Res. Public Health 2016, 13, 963.

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