摘要目的:分析2011—2023年浙江省象山县金七门核电站运行前周围居民恶性肿瘤死亡的基线数据及其变化趋势，为评价核电站运行对居民健康的影响提供科学依据。方法:利用宁波市死因监测系统和宁波市公安局人口数据，收集2011—2023年象山县居民的恶性肿瘤死亡资料，计算粗死亡率和年龄标准化死亡率(中标率)，采用Joinpoint回归模型分析年度变化百分比(APC)和平均年度变化百分比(AAPC)。结果:2011—2023年象山县年均恶性肿瘤死亡率为212.42/10万(中标率133.16/10万)，其中男性为287.41/10万，女性为135.40/10万。随着年份增加，粗死亡率呈上升趋势(AAPC＝1.264%, t＝5.07， P<0.05)，中标率则呈现明显下降趋势(AAPC＝－2.753%, t＝－10.50， P<0.05)。恶性肿瘤死亡率随年龄增长而上升( χ2＝23 903.91， P<0.05)，85岁以上组最高(1 693.11/10万)，男性( χ2＝16 982.46， P<0.05)和女性( χ2＝7 329.05， P<0.05)死亡率呈上升趋势。主要死因顺位为肺癌、肝癌、胃癌、结直肠癌和胰腺癌，其中肝癌、胃癌和食管癌的死亡率逐年呈现下降趋势，前列腺癌的死亡率逐年呈现上升趋势，辐射敏感性肿瘤如白血病、乳腺癌和甲状腺癌的死亡率未呈现明显上升或下降趋势变化。30岁以下各年龄组人群以白血病和脑及神经系统癌为主，30~79岁之间各年龄组主要以肺癌、肝癌和胃癌为主，≥80岁组主要以肺癌、胃癌和结直肠癌为主。随着距离核设施距离的增加，恶性肿瘤死亡率呈现上升趋势( χ2＝6.90， P<0.05)，男性呈现上升趋势( χ2＝10.42， P<0.05)，女性未呈现上升或下降趋势( P>0.05)，白血病、乳腺癌和甲状腺癌死亡率均未呈现明显的上升或下降趋势( P>0.05)。 结论:象山县恶性肿瘤中标死亡率总体呈下降趋势，部分癌种变化显著，白血病、乳腺癌和甲状腺癌死亡率相对稳定。该基线分析结果可为核电站健康影响评估及核能事业的可持续发展提供科学依据。

abstractsObjective:To analyze the 2011-to-2023 baseline data on, and the variations theirin, malignant tumor mortality for the surrounding residents prior to operation of the Jin-Qimen nuclear power plant at Xiangshan county, Zhejiang province, for pursose of providing scientific basis for evaluating the health impacts of nuclear power plant operation.Methods:Data on malignant tumor mortality and population in Xiangshan county from 2011 to 2023 were collected from the Ningzhou Cause of Death Monitoring System and the Ningzhou Public Security Bureau. Crude death rates and standardized rates (China standard population) were calculated. The Joinpoint regression model was used to analyze annual percentage change (APC) and average annual percentage change (AAPC).Results:The average annual malignant tumor mortality from 2011 to 2023 was 212.42 deaths per 100 000 population (age-standardized rate: 133.16 deaths per 100 000 population), with males at 287.41 deaths per 100 000 and females at 135.40 deaths per 100 000 population. The crude mortality exhibited an upward trend (AAPC=1.264%, t=5.07, P<0.05), while the age-standardized rate showed a significant downward trend (AAPC=-2.753%, t=-10.50, P<0.05). Mortality increased with age ( χ2=23 903.91, P<0.05), peaking in the ≥85 age group (1 693.11 per 100 000), and rising trends were observed in males ( χ2=16 982.46, P<0.05) and females ( χ2=7 329.05, P<0.05). Leading causes included lung cancer, liver cancer, gastric cancer, colorectal cancer, and pancreatic cancer. Liver cancer, gastric cancer, and esophageal cancer showed declining trends, whereas prostate cancer increased. Radiation-sensitive tumors (e.g., leukemia, breast cancer, thyroid cancer) displayed no significant trends. Among individuals under the age of 30, leukemia and brain/nervous system cancers predominated; for those aged 30-79, the lung, liver, and gastric cancers were dominant; and for the group aged 80 and above, the lung, gastric, and colorectal cancers were dominant. Malignant tumor mortality increased with distance from the nuclear facility ( χ2=6.90, P<0.05), significantly in males ( χ2=10.42, P<0.05) but not in females ( P>0.05). Leukemia, breast cancer, and thyroid cancer mortality showed no significant trends ( P>0.05). Conclusions:The age-standardized mortality rate for malignant tumors in Xiangshan county demonstrated an overall declining trend, with notable changes in specific cancers. Leukemia, breast cancer, and thyroid cancer mortality remained relatively stable. These baseline findings provide a scientific basis for health impact assessments of nuclear power plants and sustainable nuclear energy development.