Disparities of birth cohort effects on pancreatic cancer incidence between the United States and urban China

• Published in: ESMO open 2021-10, Vol.6 (5), p.100240-100240, Article 100240
• Main Authors: Yang, S., Yeoh, K.W., Wong, M.C.-S., Mang, O.W.-K., Tse, L.A.
• Format: Article
• Language: English
• Subjects: age–period–cohort modeling; cohort effects; incidence; lifestyle factors; Original Research; pancreatic cancer
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2021.100240

Pancreatic cancer has been associated with lifestyle factors, but few comparative studies were conducted among countries of different culture and lifestyle habits. This study compared the trends of pancreatic cancer incidence and birth cohort effects in the United States and urban China and explored the potential discrepancies of risk patterns. Age-standardized incidence rates (ASIRs) were calculated using data from national or regional cancer registries of the United States and two large cities of China (Shanghai, Hong Kong). The temporal trends of incidence were assessed by joinpoint regression. The effects of birth cohort and calendar period were identified through age–period–cohort modeling. The ASIR in the United States from 1976 to 2015 was 8.26/100 000, which was higher than that in Hong Kong (4.29/100 000) and Shanghai of China (6.63/100 000). Shanghai had lower incidence (4.41/100 000) in 1976-1980 but increased annually by 1.38% in males and 1.67% in females, with a sharper upward trend than the United States and Hong Kong. Males had higher risks than females, with a male-to-female ratio of 1.34, 1.44, and 1.37 in the United States, Hong Kong, and Shanghai, respectively. A significant and prominent increase in incidence rate was observed among successive generations in China particularly for Shanghai, but such a pattern was not apparent in the United States. The differences in pancreatic cancer incidence by sex may be multi-factorial involving known risk factors like tobacco smoking and alcohol consumption. The significant birth cohort effects among recent and early generations in the Shanghai population were in line with a society in socioeconomic transition and adoption of Western lifestyle mainly including consumption of calorie-rich foods and physical inactivity. Differences in these risk patterns will have implications on health care efforts and policies for cancer control. •The ASIR of pancreatic cancer in the U.S. is higher than that in urban China.•Higher risk of pancreatic cancer was observed in the youth of urban China, but this pattern was not prominent in the U.S.•The disparities of birth cohort effects are consistent with a society in socioeconomic transition.