Demographic and Epidemiological Contributions to Recent Trends in Cancer Incidence in Hong Kong

SIMPLE SUMMARY: Hong Kong has an ageing Chinese population with high life expectancy and a rising number of new cancer cases (156.5% increase for women and a 96% increase for men during the period 1983–2017). While both population growth and population ageing could contribute to this trend, it is unknown whether change in disease risk contributes to or inhibits this trend. In this study, we quantify the demographic and epidemiological contributions to this trend by disentangling the effect of these factors, finding that this increasing trend is mostly due to population growth (66.1% for women, 25.4% for men) and population ageing (95% for women, 119.4% for men), with changes in disease risk inhibiting this increasing trend (−4.5% for women, −48.8% for men). ABSTRACT: Background: Hong Kong has an ageing Chinese population with high life expectancy and a rising number of cancer cases. While population ageing could lead to higher incidence, we aim to quantify the demographic and epidemiological contributions to this trend by disentangling the effect of these factors. Methods: We analysed secular trends of cancer incidences of all cancer sites combined, including the five top cancers in men and women in Hong Kong in 1983–2017, by disentangling effects of demographics (ageing population and population growth) and cancer risk/rate change using the RiskDiff methodology. Results: Overall, age-standardised incidences of all cancers combined in women and in men declined over the study period (−5.3% for women, −30.2% for men), but total incident cancer case counts increased dramatically (156.5% for women, 96% for men). This increase was primarily due to ageing and increasing population (95% age, 66.1% growth for women, and 119.4% age, 25.4% growth for men), while disease risk for all cancers combined has a decreasing trend (−4.5% for women and −48.8% for men). For the site-specific risk changes among the most five common cancer types, there were increases in risks of prostate and colorectal cancers in men, and breast, endometrial, and thyroid cancers in women. Conclusion: Demographic changes and ageing in our Chinese population resulted in a marked increase in the number of cancer diagnoses in Hong Kong in past decades. The surge in incident case counts overall is expected to stress the healthcare system in terms of the increased demand of healthcare professionals. Cancer surveillance should be enhanced in view of the growing demand from older patients and the cancer types with fast-increasing incidence rates in our population.