Cancer, a disease of aging (part 1) - Trends in older adult cancer mortality in Switzerland 1991-2008

Abstract

PRINCIPLES: It is crucial for aging societies to evaluate trends in cancer mortality rates of older adults. This study examined socio-demographic and regional characteristics specifically focused on the cancer mortality experience of older adults in Switzerland. METHODS: This study included all individuals ≥65 years based on 1990/2000 censuses linked to mortality records to end of 2008 in the Swiss National Cohort. Gender-age-specific (<65, 65-74, 75-84, 85+ years) mortality rates were calculated as observed (cancer deaths/person years) and expected from Poisson models adjusted for changes in death record coding over follow-up. RESULTS: Cancer mortality, except for lung cancer, increased with advancing age. Older men in all age groups had overall higher cancer mortality rates than older women and showed a consistent decline in all-cancer mortality (age 65-74 years 1991 rate ratio (RR) = 1.13 [95%CI 1.08, 1.19]; 2008 RR = 0.88 [95%CI 0.86, 0.90], compared to rates 2000). In contrast, older women in all age groups showed early declines with a levelling-off of all-cancer mortality beginning in 2000 (age 65-74 years 1991 RR = 1.20 [95%CI 1.14, 1.27]; 2008 RR = 0.96 [95%CI 0.93, 0.98], compared to rates 2000). For older men there appeared to be an education effect for all-cancer and lung cancer mortality; highest rates in older men with compulsory education. Younger old women living alone or in suburban areas had the most sharpest increase in lung cancer mortality rates. CONCLUSION: This comprehensive epidemiological analysis of cancer mortality trends in older adults provides further evidence that in Switzerland (like other developed countries) cancer is a disease of aging with important gender-age-specific variations representing major public health challenges for aging societies.