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DOI:
https://doi.org/10.57187/4846

Original article

Vol. 156 No. 10 (2026)

Age-period-cohort analysis of Swiss lung cancer mortality trends since 1969, with prediction to 2041

Cite this as:
Swiss Med Wkly. 2026;156:4846
Published
07.10.2026

Summary

AIMS: Using more than five decades of national data, we examine how age, period and cohort factors influence lung cancer mortality in Switzerland, and forecast future death counts to the early 2040s.

METHODS: Lung cancer deaths were extracted from Swiss vital statistics. We applied age-period-cohort (APC) modelling to lung cancer mortality rates using substantiated assumptions about the age-mortality relationship as model constraints. To account for the uncertainty in the age-mortality relationship, boundary constraints were applied to the line of APC solutions, yielding a range of plausible results. In an alternative model, we replaced the cohort terms with smoking prevalence estimates from Swiss health surveys, enabling unconstrained modelling of age and period effects. Predictions are based on modelled age trends, and linearly extrapolated period and cohort trends.

RESULTS: Plausible age, period and cohort effects indicated that age-specific mortality risks decline at the oldest ages, that period effects were minimal, while cohort effects showed distinct peak risks for men born around 1909 and women born around 1954. Among women, birth cohorts with the highest mortality closely aligned with those exhibiting the highest smoking prevalence. The models predicted a decline in the number of lung cancer deaths among men beginning in the mid-2020s, and among women from the mid-2030s onwards.

CONCLUSIONS: This population-based analysis of lung cancer mortality not only highlights declining mortality rates in men of all ages, but reveals an emerging downward trend among younger women. We predict that the total number of lung cancer deaths in women will begin to decrease by the mid-2030s.

References

  1. 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018 Nov;68(6):394-424. doi:10.3322/caac.21492
  2. 2. Arndt V, Feller A, Hauri, Heusser R, Junker C, Kuehni C. Swiss Cancer Report 2015 - Current situation and developments 2016. 2016.
  3. 3. Time Period Compared to Birth Cohort in Connecticut Incidence Rates for Twenty-Five Malignant Neoplasms23. JNCI: Journal of the National Cancer Institute. 1985 Apr. doi:10.1093/jnci/74.4.779
  4. 4. Levi F, La Vecchia C, Decarli A, Randriamiharisoa A. Effects of age, birth cohort and period of death on Swiss cancer mortality, 1951–1984. International Journal of Cancer. 1987 Oct 15;40(4):439-449. doi:10.1002/ijc.2910400402
  5. 5. Bray FI, Weiderpass E. Lung cancer mortality trends in 36 European countries: secular trends and birth cohort patterns by sex and region 1970–2007. International Journal of Cancer. 2010 Mar 15;126(6):1454-1466. doi:10.1002/ijc.24855
  6. 6. Holford TR. The Estimation of Age, Period and Cohort Effects for Vital Rates. Biometrics. 1983 Jun;39(2):311. doi:10.2307/2531004
  7. 7. Kupper LL, Janis JM, Karmous A, Greenberg BG. Statistical age-period-cohort analysis: A review and critique. Journal of Chronic Diseases. 1985 Jan;38(10):811-830. doi:10.1016/0021-9681(85)90105-5
  8. 8. Clayton D, Schifflers E. Models for temporal variation in cancer rates. II: Age–period–cohort models. Statistics in Medicine. 1987 Jun;6(4):469-481. doi:10.1002/sim.4780060406
  9. 9. O’Brien RM. Estimable functions in age-period-cohort models: a unified approach. Quality & Quantity. 2014 Jan;48(1):457-474. doi:10.1007/s11135-012-9780-6
  10. 10. Rosenberg PS, Anderson WF. Age-Period-Cohort Models in Cancer Surveillance Research: Ready for Prime Time?. Cancer Epidemiology, Biomarkers & Prevention. 2011 Jul 1;20(7):1263-1268. doi:10.1158/1055-9965.EPI-11-0421
  11. 11. Kupper LL, Janis JM, Salama IA, Yoshizawa CN, Greenberg BG, Winsborough HH. Age-period-cohort analysis: an illustration of the problems in assessing interaction in one observation per cell data. Communications in Statistics - Theory and Methods. 1983 Jan;12(23):201-217. doi:10.1080/03610928308828640
  12. 12. Yang Y, Schulhofer‐Wohl S, Fu WJ, Land KC. The Intrinsic Estimator for Age‐Period‐Cohort Analysis: What It Is and How to Use It. American Journal of Sociology. 2008 May;113(6):1697-1736. doi:10.1086/587154
  13. 13. Osmond C, Gardner MJ. Age, period and cohort models applied to cancer mortality rates. Statistics in Medicine. 1982 Jan;1(3):245-259. doi:10.1002/sim.4780010306
  14. 14. O’Brien RM. Setting bounds on age, period, and cohort effects using observed data. Quality & Quantity. 2023 Jun;57(3):2841-2857. doi:10.1007/s11135-022-01503-9
  15. 15. Fosse E, Winship C. Bounding Analyses of Age-Period-Cohort Effects. Demography. 2019 Oct 1;56(5):1975-2004. doi:10.1007/s13524-019-00801-6
  16. 16. O’Brien RM. Using old results to produce new solutions in age–period–cohort multiple classification models. Quality & Quantity. 2020 Feb;54(1):111-124. doi:10.1007/s11135-019-00945-y
  17. 17. O'Brien RM. Age Period Cohort Characteristic Models. Social Science Research. 2000 Mar;29(1):123-139. doi:10.1006/ssre.1999.0656
  18. 18. FSO. Causes of death and stillbirth statistics (CoD).
  19. 19. Kohli R, Babel J, Deplazes J. Szenarien zur Bevölkerungsentwicklung der Schweiz und der Kantone 2020–2050. 2020.
  20. 20. Lutz JM, Pury P, Fioretta G, Raymond L. The impact of coding process on observed cancer mortality trends in Switzerland. European Journal of Cancer Prevention. 2004 Feb;13(1):77-81. doi:10.1097/00008469-200402000-00012
  21. 21. Swiss Health Survey. Tabakkonsum, 1992, 1997, 2002, 2007, 2012, 2017, 2022. 2023.
  22. 22. Abelin T, Müller R. Trend der Rauchgewohnheiten in der Schweiz 1975–1981. Sozial- und Präventivmedizin SPM. 1983 May;28(3-4):185-195. doi:10.1007/BF02094010
  23. 23. Gutzwiller F, Leu RE, Schulz HR, Schröter R, Zemp E. The Swiss health survey project (SOMIPOPS): An example of a data collection effort from various sources. Sozial- und Präventivmedizin SPM. 1985 Mar;30(2):76-79. doi:10.1007/BF02083049
  24. 24. La Vecchia C, Levi F, Decarli A, Wietlisbach V, Negri E, Gutzwiller F. Trends in smoking and lung cancer mortality in Switzerland. Preventive Medicine. 1988 Nov;17(6):712-724. doi:10.1016/0091-7435(88)90090-4
  25. 25. Stata. 2023.
  26. 26. Armitage P, Doll R. The Age Distribution of Cancer and a Multi-stage Theory of Carcinogenesis. British Journal of Cancer. 1954 Mar;8(1):1-12. doi:10.1038/bjc.1954.1
  27. 27. Harding C, Pompei F, Wilson R. Peak and decline in cancer incidence, mortality, and prevalence at old ages. Cancer. 2012 Mar;118(5):1371-1386. doi:10.1002/cncr.26376
  28. 28. Li L, Tian T, Zhang X. Stochastic modelling of multistage carcinogenesis and progression of human lung cancer. Journal of Theoretical Biology. 2019 Oct;479:81-89. doi:10.1016/j.jtbi.2019.07.006
  29. 29. O'Brien RM. Age-period-cohort models: approaches and analyses with aggregate data. Boca Raton, Florida: CRC Press; 2015.
  30. 30. Preston SH, Wang H. Sex mortality differences in The United States: The role of cohort smoking patterns. Demography. 2006 Nov 1;43(4):631-646. doi:10.1353/dem.2006.0037
  31. 31. Freedman KS, Nelson NM, Feldman LL. Smoking Initiation Among Young Adults in the United States and Canada, 1998-2010: A Systematic Review. Preventing Chronic Disease. 2011 Dec;9:E05. doi:10.5888/pcd9.110037
  32. 32. Møller B, Fekjær H, Hakulinen T, Sigvaldason H, Storm HH, Talbäck M, et al. Prediction of cancer incidence in the Nordic countries: empirical comparison of different approaches. Statistics in Medicine. 2003 Sep 15;22(17):2751-2766. doi:10.1002/sim.1481
  33. 33. Bashir S, Estève J. Analysing the difference due to risk and demographic factors for incidence or mortality. International Journal of Epidemiology. 2000 Oct;29(5):878-884. doi:10.1093/ije/29.5.878
  34. 34. Nordling CO. A New Theory on the Cancer-inducing Mechanism. British Journal of Cancer. 1953 Mar;7(1):68-72. doi:10.1038/bjc.1953.8
  35. 35. Cook PJ, Doll R, Fellingham SA. A mathematical model for the age distribution of cancer in man. International Journal of Cancer. 1969 Jan 15;4(1):93-112. doi:10.1002/ijc.2910040113
  36. 36. Seo J, Ju YS, Lee W, Shin J, Lee JK, Bleazard T, et al. The transcriptional landscape and mutational profile of lung adenocarcinoma. Genome Research. 2012 Nov;22(11):2109-2119. doi:10.1101/gr.145144.112
  37. 37. Tomasetti C, Marchionni L, Nowak MA, Parmigiani G, Vogelstein B. Only three driver gene mutations are required for the development of lung and colorectal cancers. Proceedings of the National Academy of Sciences. 2015 Jan 6;112(1):118-123. doi:10.1073/pnas.1421839112
  38. 38. Nolen SC, Evans MA, Fischer A, Corrada MM, Kawas CH, Bota DA. Cancer—Incidence, prevalence and mortality in the oldest-old. A comprehensive review. Mechanisms of Ageing and Development. 2017 Jun;164:113-126. doi:10.1016/j.mad.2017.05.002
  39. 39. Pedersen JK, Rosholm J, Ewertz M, Engholm G, Lindahl-Jacobsen R, Christensen K. Declining cancer incidence at the oldest ages: Hallmark of aging or lower diagnostic activity?. Journal of Geriatric Oncology. 2019 Sep;10(5):792-798. doi:10.1016/j.jgo.2019.02.001
  40. 40. Anisimov VN, Ukraintseva SV, Yashin AI. Cancer in rodents: does it tell us about cancer in humans?. Nature Reviews Cancer. 2005 Oct;5(10):807-819. doi:10.1038/nrc1715
  41. 41. Collado M, Blasco MA, Serrano M. Cellular Senescence in Cancer and Aging. Cell. 2007 Jul;130(2):223-233. doi:10.1016/j.cell.2007.07.003
  42. 42. Weir HK, Sherman R, Yu M, Gershman S, Hofer BM, Wu M. Cancer Incidence in Older Adults in the United States: Characteristics, Specificity, and Completeness of the Data. J Regist Manag. 2020;47:150–60.
  43. 43. Zanetti R, Schmidtmann I, Sacchetto L, Binder-Foucard F, Bordoni A, Coza D, et al. Completeness and timeliness: Cancer registries could/should improve their performance. European Journal of Cancer. 2015 Jun;51(9):1091-1098. doi:10.1016/j.ejca.2013.11.040
  44. 44. Pavlidis N, Stanta G, Audisio RA. Cancer prevalence and mortality in centenarians: A systematic review. Critical Reviews in Oncology/Hematology. 2012 Jul;83(1):145-152. doi:10.1016/j.critrevonc.2011.09.007
  45. 45. Matter-Walstra KW, Achermann R, Rapold R, Klingbiel D, Bordoni A, Dehler S, et al. Delivery of health care at the end of life in cancer patients of four swiss cantons: a retrospective database study (SAKK 89/09). BMC Cancer. 2014 Dec;14(1):306. doi:10.1186/1471-2407-14-306
  46. 46. Korteweg R. The Age Curve in Lung Cancer. British Journal of Cancer. 1951 Mar;5(1):21-27. doi:10.1038/bjc.1951.2
  47. 47. Eilstein D, Uhry Z, Lim T, Bloch J. Lung cancer mortality in France. Lung Cancer. 2008 Mar;59(3):282-290. doi:10.1016/j.lungcan.2007.10.012
  48. 48. Decarli A, La Vecchia C, Malvezzi M, Micciolo R. An R package for fitting age, period and cohort models. Epidemiology, Biostatistics, and Public Health. 2022 May 30;11(4). doi:10.2427/9977
  49. 49. Holford TR, Zhang Z, McKay LA. Estimating age, period and cohort effects using the multistage model for cancer. Statistics in Medicine. 1994 Jan 15;13(1):23-41. doi:10.1002/sim.4780130105
  50. 50. Moolgavkar SH, Knudson AG. Mutation and Cancer: A Model for Human Carcinogenesis2. JNCI: Journal of the National Cancer Institute. 1981 Jun 1;66(6):1037-1052. doi:10.1093/jnci/66.6.1037
  51. 51. Howlader N, Forjaz G, Mooradian MJ, Meza R, Kong CY, Cronin KA, et al. The Effect of Advances in Lung-Cancer Treatment on Population Mortality. New England Journal of Medicine. 2020 Aug 13;383(7):640-649. doi:10.1056/NEJMoa1916623
  52. 52. Frisone D, Sandoval J, Friedlaender A, Olivier T, Addeo A. Trends in incidence and mortality of lung cancer in Switzerland: Possible explanations and open questions. Cancer Epidemiology. 2022 Oct;80:102232. doi:10.1016/j.canep.2022.102232
  53. 53. Smith DR, Behzadnia A, Imawana RA, Solim MN, Goodson ML. Exposure–lag response of smoking prevalence on lung cancer incidence using a distributed lag non-linear model. Scientific Reports. 2021 Jul 14;11(1):14478. doi:10.1038/s41598-021-91644-y
  54. 54. Scherer G. Smoking behaviour and compensation: a review of the literature. Psychopharmacology. 1999 Jul 5;145(1):1-20. doi:10.1007/s002130051027
  55. 55. Joossens L, Raw M. The Tobacco Control Scale: a new scale to measure country activity. Tobacco Control. 2006 Jun;15(3):247-253. doi:10.1136/tc.2005.015347
  56. 56. Olefir L, Pelella S, Tao A. 2023 Europe Tobacco Industry Interference Index. 2023.
  57. 57. Lillard DR. The Evolution of Smoking in Switzerland. In: Life Course Research and Social Policies. Springer International Publishing; 2018. p. 3-16. doi:10.1007/978-3-319-89557-4_1
  58. 58. National Cancer Institute. Chapter 3. Smoking Prevalence and Lung Cancer Death Rates. In: Strategies to Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 1990's. 1991;1.
  59. 59. Funatogawa I, Funatogawa T, Yano E. Impacts of early smoking initiation: long-term trends of lung cancer mortality and smoking initiation from repeated cross-sectional surveys in Great Britain. BMJ Open. 2012;2(5):e001676. doi:10.1136/bmjopen-2012-001676
  60. 60. Doll R, Hill AB. Smoking and Carcinoma of the Lung. BMJ. 1950 Sep 30;2(4682):739-748. doi:10.1136/bmj.2.4682.739
  61. 61. Mackay J, Schluger N. Global Tobacco Epidemic. In: Progress in Respiratory Research. S. Karger AG; 2015. p. 19-26. doi:10.1159/000369320
  62. 62. Reitsma MB, Kendrick PJ, Ababneh E, Abbafati C, Abbasi-Kangevari M, Abdoli A, et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet. 2021 Jun;397(10292):2337-2360. doi:10.1016/S0140-6736(21)01169-7
  63. 63. Jakob J, Cornuz J, Diethelm P. Prevalence of tobacco smoking in Switzerland: do reported numbers underestimate reality?. Swiss Medical Weekly. 2017 May 11;147(1920):w14437. doi:10.4414/smw.2017.14437
  64. 64. Holford TR, Levy DT, McKay LA, Clarke L, Racine B, Meza R, et al. Patterns of Birth Cohort–Specific Smoking Histories, 1965–2009. American Journal of Preventive Medicine. 2014 Feb;46(2):e31-e37. doi:10.1016/j.amepre.2013.10.022
  65. 65. Storni M. Tabakkonsum in der Schweiz. BFS AKTUELL. 2020;2020:1–7.
  66. 66. Le TTT, Warner KE, Mendez D. The evolution of age-specific smoking cessation rates in the United States from 2009 to 2017: a Kalman filter based approach. BMC Public Health. 2023 Oct 24;23(1):2076. doi:10.1186/s12889-023-16986-w
  67. 67. Moller B, Fekjaer H, Hakulinen T, Sigvaldason H, Storm H, Talbäck M. nordpred: Cancer incidence prediction methods for the Nordic countries.

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