Article Text


Long-term time trends in incidence, survival and mortality of lymphomas by subtype among adults in Manitoba, Canada: a population-based study using cancer registry data
  1. Xibiao Ye1,2,
  2. Salaheddin Mahmud1,2,
  3. Pamela Skrabek3,
  4. Lisa Lix1,2,
  5. James B Johnston3
  1. 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3 Department of Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Xibiao Ye;{at}


Objective To examine 30-year time trends in incidence, survival and mortality of lymphomas by subtype in Manitoba, Canada.

Methods Lymphoma cases diagnosed between 1984 and 2013 were classified according to the 2008 WHO classification system for lymphoid neoplasms. Death data (1984–2014) were obtained from the Manitoba Vital Statistics Agency. To examine time trends in incidence and mortality, we used joinpoint regression to estimate annual percentage change and average annual percentage change. Age–period–cohort modelling was conducted to measure the effects of age, period and cohort on incidence and mortality time trends. We estimated age-specific and standardised 5-year relative survival and used Poisson regression model to test time trends in relative survival.

Results Total Hodgkin lymphoma (HL) incidence in men and women was stable during the study period. Age-standardised total non-Hodgkin lymphoma (NHL) incidence increased by 4% annually until around 2000, and the trend varied by sex and NHL subtype. Total HL mortality continuously declined (by 2.5% annually in men and by 2.7% annually in women), while total NHL mortality increased (by 4.4% annually in men until 1998 and by 3.2% annually in women until 2001) and then declined (by 3.6% annually in men and by 2.5% annually in women). Age-standardised 5-year relative survival for HL improved from 72.6% in 1984–1993 to 85.8% in 2004–2013, and for NHL from 57.0% in 1984–1993 to 67.5% in 2004–2013. Survival improvement was also noted for NHL subtypes, although the extent varied, with the greatest improvement for follicular lymphoma (from 65.3% in 1984–1993 to 87.6% in 2004–2013).

Conclusions Time trends were generally consistent with those reported in other jurisdictions in total HL and NHL incidence, but were unique in incidence for HL and for NHL subtypes chronic/small lymphocytic leukaemia/lymphoma, diffuse large B cell lymphoma and follicular lymphoma. Survival improvements and mortality reductions were seen for HL and NHL in both sexes.

  • lymphoma
  • time trend
  • age-period-cohortmodel
  • incidence
  • mortality
  • relative survival

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from


  • Contributors XY designed the study, analysed the data and prepared the first draft of the manuscript. SM, JJ and PS participated in designing the study, data interpretation and manuscript preparation. LL contributed to analytical methods and reviewed the manuscript.

  • Competing interests SM has received unrestricted research grants from GlaxoSmithKline, Sanofi Pasteur and Pfizer for unrelated studies. SM is a Canada Research Chair in Pharmacoepidemiology and Vaccine Evaluation. PS has participated in Advisory Boards for Roche, Seattle Genetics, Lundbeck, Gilead and Celgene. Other authors have no conflict of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing is not applicable to this article as no data sets were generated or analysed during the current study. The data that support the findings of this study are available from the Manitoba Centre for Health Policy, but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission from the Manitoba Centre for Health Policy.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.