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

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.