The study was conducted to estimate the effects of age, year of diagnosis (period) and year of birth (cohort) on the time trend of female lung cancer incidence between 1976 and 2000 in Hong Kong. Data were obtained from a populationbased cancer registry and the Census and Statistics Department. Using the Hong Kong general population of 1990 as the reference, age-adjusted incidence rates were computed by using direct standardization. We also analyzed secular trends in 2 consecutive periods, 1976 -1990 and 1991-2000, using a Poisson regression model to estimate the annual percentage change in incidence rate. Age, period and cohort effects were assessed employing the method proposed by Clayton and Schifflers with 3 Poisson regression models fitted separately for age alone, age and period, and age and cohort. The age-adjusted incidence rate increased steadily up to 1990, when a peak of 40.1 per 100,000 was reached. Thereafter, a downward trend was observed. The overall annual increase
Key words: female lung cancer; incidence, age-period-cohort models; time trend; annual percentage change; epidemiologyLung cancer among females has progressed from being a rare disease in the early 1900s to becoming one of the most common cancers worldwide today. 1 In Hong Kong, a special administrative region of China with a resident population of 6.8 million, lung cancer is currently the second most commonly diagnosed cancer among females, accounting for around 13% of all forms of cancers. 2 The age standardized incidence rate of Hong Kong females used to be the highest around the world in the early 1990s. 3 In 2000, Hong Kong women still had a very high incidence rate (32.1/100,000), only slighted lower than the highest one (34.0/ 100,000 for American females) in the world. 4 Different patterns in the time trend of female lung cancer during the past 50 years were observed in various countries. A number of epidemiological studies in European countries showed upward trends in the incidence rate. [5][6][7][8] Other studies showed a less sharp rise or a plateau or even a decline in incidence rate in the past 2 decades. 9 -13 These heterogeneous patterns of trends reflect various effects of age, birth cohort and calendar period on incidence. For lung cancer, there is usually about several decades between the first exposure to a carcinogen and the clinical appearance of the disease. 14 Consequently, recent trends in incidence are strongly influenced by changes in exposure to carcinogens several decades ago, when the cohorts now experiencing the highest rates were young. By contrast, other factors may affect lung cancer incidence in a short period of time for population of all age groups, independent of the cohort of birth. For instance, improved diagnostic technology, with better detection of asymptomatic cases, could theoretically lead to a general increase in the number of new cases over a few years for all age groups.Thus, using appropriate statistical models to disentangle the effect of birth cohort from that of calendar period of ...