Effects of population aging on the mortality burden of related cancers in urban and rural areas of China, 2004-2017: a population-based study

Objective: China is a developing country with urban-rural disparities and accelerating population aging. Therefore, quantifying the effects of population aging on the cancer mortality burden is urgently needed. Methods: Using data from China's death surveillance datasets (2004-2017), we decomposed and quantified the effects of population aging and factor variations on cancer mortality rates in urban and rural China during 2004-2017 through a decomposition method. R ratios were used to assess the extent of the mortality decreases attributable to factor variations offsetting the increases attributable to population aging for 4 aging-related cancers (lung, colorectal, esophageal, and stomach cancer). Results: Overall, population aging has led to continued increases in cancer mortality rates in China during 2004-2017 (mortality rates attributable to population aging: 8.63/100,000 for urban men, 4.21/100,000 for urban women, 11.95/100,000 for rural men, and 5.66/100,000 for rural women). The 4 cancers displayed 3 patterns. The mortality rates from lung cancer in rural China and from colorectal cancer nationwide increased because of both population aging and factor variations. Population aging was primarily responsible for the growing mortality due to lung cancer in urban areas. However, for esophageal and stomach cancer, the effect of population aging was not dominant, thus resulting in decreases in mortality rates. Conclusions: Health resource allocation should prioritize areas or cancers more adversely affected by population aging. The burden of cancer will continue to increase in the future, because of rapid population aging, but can still be offset or even reversed with enhanced cancer control and prevention.