1990-2019年中国人群癌症归因于超重肥胖的疾病负担分析与模型预测

目的:分析1990-2019年中国癌症归因于超重肥胖的疾病负担变化趋势并对其未来10年的变化进行预测,为我国癌症防控提供参考依据。方法:基于2019年全球疾病负担（global burden of disease,GBD）平台,采用伤残调整寿命年（disability adjusted life years,DALYs）描述疾病负担,利用Joinpoint回归模型分析中国人群癌症归因于超重肥胖的疾病负担的时间变化趋势;通过自回归滑动平均混合(autoregressive integrated moving average,ARIMA)模型预测未来10年的疾病负担情况。结果:1990-2019年中国癌症归因于超重肥胖的DALYs负担呈上升趋势,平均年度变化百分比（average annual percentage of change,AAPC）为3.87%。亚组分析,肝癌、食管癌及女性子宫癌的标化DALYs率在2016年以来均呈上升趋势;其余种类癌症均呈持续上升趋势。预测结果显示,不同种类癌症归因于超重肥胖的标化DALYs率均持续增加,其中男性DALYs负担顺位前5分别为食管癌、肝癌、结直肠癌、胰腺癌、肾癌,女性DALYs负担顺位前5分别为乳腺癌、食管癌、子宫癌、肝癌、结直肠癌。1990年和2019年,男性DALYs率峰值均在70~<75岁,女性DALYs率峰值则由65~<70岁后移至70~<75岁。结论:1990-2019年以及未来10年中国癌症归因于超重肥胖的疾病负担总体呈上升趋势,其中男性食管癌、肝癌、结直肠癌、胰腺癌、肾癌,以及女性乳腺癌、食管癌、子宫癌、肝癌、结直肠癌的疾病负担最重。中老年和男性是重点关注人群,建议采取综合干预措施以降低肥胖导致的癌症疾病负担。     

1990-2019年中国归因于高BMI的肾癌疾病负担

目的:描述和分析1990-2019年中国人群归因于高体质量指数（body mass index,BMI）的肾癌疾病负担变化趋势。方法:基于2019年全球疾病负担研究(GBD2019)部分数据,按照性别、年龄、年份对近三十年归因于高BMI的肾癌人群死亡数、伤残调整寿命年(disability adjusted life year,DALY)、过早死亡损失寿命年（years of life lost,YLL）和伤残损失寿命年（years lived with disability,YLD）及其年龄标化率等指标分类记录。并采用Joinpoint回归模型计算平均年度变化百分比（AAPC）反映中国与全球以及不同社会人口学指数（socio-demographic index,SDI）地区归因于高BMI的肾癌疾病负担及其变化趋势。结果:从1990到2019年,中国归因于高BMI的肾癌疾病的标化死亡率由0.03/10万上升至0.13/10万,标化DALY率从0.86/10万增加到3.45/10万,增长率分别为333%和301%。伴随年龄增加,死亡率、DALY率、YLL率和YLD率均明显上升,在DALY率的占比中,YLD率值虽低于YLL率,但增速较YLL率快。中国归因标化死亡率和标化DALY率的增长趋势显著高于全球及不同SDI地区,AAPC分别高达4.8%和4.9%（P均＜0.05),且男性的增长速率较女性更显著。结论:1990-2019年我国归因于高BMI的肾癌负担进行性加重并呈持续上升状态,早死导致疾病负担比重大,伤残疾病负担增速快,尤其是在男性和老年人群中更为显著。对此,积极控制肥胖/超重、加强肾癌早期筛查、注重康复指导和健康干预成为减轻疾病负担的重要措施。     

Burden Assessment of Thyroid cancer in Iran from 1990 to 2010: Lessons Obtained from Global Burden of Disease Report 2010

Background: Thyroid tumors are generally regarded as rare malignancies. Nowadays, however, their global incidence is growing continuously partially due to western life style and utilization of more sensitive methods of early detection. It is approximately three times more prevalent in females than in males. Most cases of thyroid cancer are asymptomatic nodules or just have local cervical symptoms or adenopathy in early stages. Materials and Methods: The Global Burden of Diseases report 2010 study (released 3/2013) profited from 100 collaborators worldwide and used a vast network of data on health outcomes, vital registries, and population surveys. It shared many of the Global Burden of Diseases 1990 principal databases such as all available data on injuries, diseases, risk factors, as well as comparable metrics, and used different scientific approved methods to estimate important health status data like: death rate, life expectancy, healthy adjusted life expectancy, disability–adjusted life years (DALY), years of living lost due to premature death and years of life with disabilities. Results: DALY as thyroid cancer burden per 100,000 Iranian populations had increased by about 14% during 1990 to 2010 in all ages; from 6.1 (95% UI 4.2-9.74) years in 1990 to 6.95 (95% UI 5.06-9.18) years in 2010 in both sex. The 2010 peak age-group was estimated at 45-49 years in males and 40-45 years in females.     

Colorectal cancer burden and trends: Comparison between China and major burden countries in the world

Objective:To summarize the colorectal cancer(CRC)burden and trend in the world,and compare the difference of CRC burden between other countries and China.Methods:Incidence and mortality data were extracted from the GLOBOCAN2018 and Cancer Incidence in Five Continents.Age-specific incidence trend was conducted by Joinpoint analysis and average annual percent changes were calculated.Results:About 1.85 million new cases and 0.88 million deaths were expected in 2018 worldwide,including 0.52 million(28.20%)new cases and 0.25 million(28.11%)deaths in China.Hungary had the highest age-standardized incidence and mortality rates in the world,while for China,the incidence and mortality rates were only half of that.CRC incidence and mortality were highly correlated with human development index(HDI).Unlike the rapid increase in Republic of Korea and the downward trend in Canada and Australia,the age-standardized incidence rates by world standard population in China and Norway were rising gradually.The age-specific incidence rate in the age group of 50-59 years in China was increasing rapidly,while in Republic of Korea and Canada,the fastest growing age group was 30-39 years.Conclusions:The variations of CRC burden reflect the difference of risk factors,as well as levels of HDI and screening(early detection activities).The burden of CRC in China is high,and the incidence of CRC continues to increase,which may lead to a sustained increase in the burden of CRC in China in the future.Screening should be expanded to control CRC,and focused on young people in China.     

1990—2019年江苏省男性前列腺癌疾病负担分析

目的 分析1990—2019年江苏省前列腺癌疾病负担的变化趋势。方法 采用2019年全球疾病负担研究中关于江苏省前列腺癌的发病率、死亡率、伤残调整寿命年(DALY)率、伤残损失寿命年(YLD)率以及过早死亡损失寿命年(YLL)率,分析1990—2019年江苏省前列腺癌疾病负担情况。利用Joinpoint软件计算前列腺癌标化发病率、标化死亡率、标化DALY率、标化YLD率和标化YLL率的年度变化百分比(Annual percentage change,APC)和平均年度变化百分比(Average annual percentage change,AAPC)。结果 1990—2019年江苏省前列腺癌标化发病率、标化YLD率均呈整体上升趋势(AAPC分别为2.10%、3.20%,P＜0.05),标化死亡率、标化DALY率和标化YLL率则呈现出下降的趋势(AAPC分别为-0.42%、-0.48%、-0.69%,P＜0.05)。1990年和2019年江苏省前列腺癌发病率和死亡率均随着年龄增长而上升,≥85岁组发病率和死亡率最高。1990年和2019年,≥85岁组前列腺癌DALY率、YLD率和YLL率均达到最高值。结论 1990—2019年,江苏省前列腺癌的整体疾病负担趋于下降,但发病水平持续上升,且前列腺癌导致的伤残负担持续升高,需加强前列腺癌的防治工作。     

Global incidence,risk factors and trends of vulvar cancer: A country-based analysis of cancer registries

Vulvar cancer is an uncommon malignancy. Vulvar cancer alarmed the public health problem in terms of the cost of diagnostic and medical treatments and psychical health of females. Our study aims to provide a thorough analysis of the global disease burden, related risk factors and temporal incidence trends of vulvar cancer in population subgroups. Data from Global Cancer Observatory and the Cancer Incidence in Five Continents Plus were used for the vulvar cancer incidence. Age-standardized rates (ASR) were used to depict the incidence of vulvar cancer. The 10-year trend of incidence was assessed using joinpoint regression with average annual percentage change and 95% confidence intervals in various age groups, while its correlations with risk factors were investigated using linear regression. Higher ASR were found in Western Europe (2.4), Northern America (1.9), Northern Europe (1.9), Australia and New Zealand (1.8) and Eastern Africa (1.4). The associated risk factors of higher vulvar cancer incidence were gross domestic product per capita, Human Development Index, higher prevalence of smoking, alcohol drinking, unsafe sex and human immunodeficiency virus infection. The overall trend of vulvar cancer incidence was increasing. An increasing trend was found in older females while a mixed trend was observed in younger females. The disease burden of vulvar cancer follows a bimodal pattern according to its two histologic pathways, affecting women in both developed and developing regions. Smoking cessation, sex education and human papillomavirus vaccination programs should be promoted among the general population. Subsequent studies can be done to explore the reasons behind the increasing trend of vulvar cancer.     

2013—2020年重庆市北碚区胃癌疾病负担变化趋势及预测

目的 了解2013—2020年重庆市北碚区胃癌疾病负担变化趋势,预测2021—2023年胃癌死亡率,为开展胃癌防治工作提供建议。方法 2013—2020年重庆市北碚区胃癌死亡资料来源于“中国疾病预防控制系统人口死亡信息登记管理系统”,计算死亡率、标化死亡率、早逝生命损失年(YLL)、早逝生命损失年(YLL)率、平均减寿年数(AYLL)和期望寿命损失年数(YLEL)等指标,采用指数平滑的非季节性模型预测死亡率。率的标化采用2010年全国普查人口结构。率的比较采用卡方检验。率的趋势分析采用年度变化百分比(APC),并对APC进行t检验。结果 2013—2020年重庆市北碚区胃癌的死亡率和标化死亡率分别由2013年的15.26/10万和11.81/10万下降到2020年的10.66/10万和6.75/10万,APC分别为-6.29%和-8.79%,变化趋势有统计学意义(t值分别为-3.098和-4.690,P＜0.05)。胃癌死亡率随年龄的增加而上升,50岁以下年龄组最低(0.74/10万~2.13/10万),80岁以上年龄组最高(76.21/10万~169.81/10万)。YLL率、AYLL和YLEL分别由2013年的3.63‰、23.77年和0.25年下降到2020年的2.31‰、21.66年和0.16年,APC分别为-7.60%、-1.39%和-7.32%,变化趋势有统计学意义(t值分别为-3.211、-2.308和-4.930,P＜0.05)。指数平滑的简单非季节性模型为最优预测模型,预测2021—2023年胃癌死亡率均为10.66/10万。结论 北碚区胃癌死亡率呈下降趋势,胃癌早死造成的疾病负担较过去有所下降,但疾病负担仍较重,宜继续巩固胃癌的综合防控。     

Spatiotemporal trends of the global burden of melanoma in 204 countries and territories from 1990 to 2019: Results from the 2019 global burden of disease study

This study aimed to estimate the latest magnitudes and temporal trends of melanoma burden at the national, regional, and global levels. The data on melanoma incidence, deaths, and disability-adjusted life-years (DALYs) in 204 countries and territories between 1990 and 2019 came from the Global Burden of Disease 2019 Study. Estimated annual percentage change (EAPC) was calculated to depict the temporal trends and Spearman rank correlation was used to analyze the influential factors of EAPC. From 1990 to 2019, the incident cases of melanoma increased by 170% to 289,950, death increased by 90% to 62,840, and DALYs increased by 67% to 1,707,800 globally. The age-standardized incidence rate (ASIR) of melanoma increased globally by an average of 1.13 [95% confidence interval (CI): 0.93–1.32], while the age-standardized rates of death and DALYs both declined with the EAPC of −0.27 (95% CI: −0.36 to −0.19) and −0.49 (95% CI: −0.57 to −0.41). In 2019, the highest burden of melanoma was observed in Australasia, followed by high-income North America and Europe regions, which all presented an incremental growth in ASIR. The positive association between the EAPC in ASIR and socio-demographic index (SDI) in 2019 (ρ = 0.600, P < 0.001) suggested that countries with higher SDI have experienced a more rapid increase in ASIR of melanoma. In conclusion, the burden of melanoma is increasing globally but differed greatly across the world. Notably, the high burden areas are facing a continuing increase in incidence, which implies more targeted strategies should be taken for reducing the increasing melanoma burden.     

A comparative examination of colorectal cancer burden in European Union, 1990–2019: Estimates from Global Burden of Disease 2019 Study

International Journal of Clinical Oncology - This study examines the burden of colorectal cancer (CRC) in European Union (EU) countries in the last 3 decades. The data pertaining to CRC burden were...     

Cancer burden in China: trends,risk factors and prevention

As the most populous country in the world, China has made strides in health promotion in the past few decades. With the aging population, the burden of cancer in China continues to grow. Changes in risk factors for cancer, especially diet, obesity, diabetes, and air pollution, continue to fuel the shift of cancer transition in China. The burden of upper gastrointestinal cancer in China is decreasing, but still heavy. The rising burden of colorectal, prostate, and breast cancers is also significant. Lung cancer became the top cause of cancer-related deaths, together with smoking as the most important contributor to cancer deaths. The Chinese government has taken several approaches to control cancer and cancer-related risk factors. Many achievements have been made, but some challenges remain. Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China. The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments, public health organizations, and individuals. In this review, we describe the trends of cancer burden and discuss cancer-related risk factors in China, identifying strategies to reduce the burden of cancer in China.     

2012年至2020年重庆地区居民肝癌死亡率及疾病负担变化趋势

目的:了解2012年至2020年重庆地区居民肝癌死亡率及疾病负担变化趋势。方法:肝癌死亡个案病例资料（ICD-10:C22）来源于重庆市全人群死因监测报告数据库。采用SPSS 26.0统计分析死亡率、标化死亡率、早死所致的寿命损失年（years of life lost,YLL）和平均减寿年数（average years of life lost,AYLL）等指标,不同性别与地区间死亡率比较用χ2检验,趋势分析采用年度变化百分比（annual percentage change,APC）表示。结果:2012年重庆市肝癌死亡率与标化死亡率分别为29.87/10万与20.27/10万,2020年重庆市肝癌死亡率与标化死亡率分别为31.21/10万与18.16/10万,死亡率与标化死亡率APC分别为0.39%与-0.83%,变化趋势均无统计学差异（P＞0.05）。2012年至2020年男性历年肝癌死亡率均高于女性,差异均有统计学意义（P＜0.01）。2012年至2020年农村地区历年肝癌死亡率均高于城市,差异均有统计学意义（P＜0.01）。2012年重庆市肝癌导致的YLL率为8.72‰,2020年YLL率为8.02‰,APC为-1.28%,变化趋势无统计学差异（P＞0.05）,AYLL以年均1.66%的速度下降（P＜0.05）。男性AYLL高于女性,分别以年均1.55%（P＜0.05）和1.96%（P＜0.05）的速度下降,城市AYLL低于农村AYLL,城市和农村AYLL总体上分别以年均1.59%（P＜0.05）和1.72%（P＜0.05）的速度下降。结论:重庆市肝癌死亡率较高,早死导致的疾病负担重,男性与农村地区居民是肝癌发生的重点人群。     

Current cancer burden in China: epidemiology,etiology, and prevention

Cancer has become the most common cause of death in China. Owing to rapid economic development, improved livelihood, and shifts in risk factors, cancer epidemiology has experienced substantial changes during the past several decades. In this review, we aim to describe the current cancer epidemiology of the main types of cancer in China, report major risk factors associated with cancer development, and summarize the contributions of the Chinese government to controlling the cancer burden. A total of 4,064,000 new cases were diagnosed in China in 2016. The most frequent types are lung cancer (828,100; 20.4%), colorectal cancer (408,000; 10.0%), and gastric cancer (396,500; 9.8%). Lung (657,000; 27.2%), liver (336,400, 13.9%), and stomach (288,500; 12.0%) cancers are the 3 most deadly cancers in the general population. The 5-year survival rate for cancer has dramatically increased in recent decades. However, liver and particularly pancreatic cancers still have the poorest prognosis. The main modifiable risk factors associated with cancer development include infectious agents, smoking, alcohol consumption, obesity, unhealthful dietary habits, and inadequate physical activity. The Chinese government has made unremitting efforts to decrease the cancer burden, including cancer education and investment in cancer screening programs.     

Decreasing the cancer burden in developing countries: concerns and recommendations

Although the close of the 20th century witnessed advances in cancer detection and treatment, cancer morbidity and mortality rates steadily increase across the globe within the 21st century. The majority of this cancer burden can be found in underdeveloped and developing countries. A growing concern can be seen regarding this issue, with the research community as well as governmental and non-governmental organizations considering efforts that need to be developed and implemented. In this article, we propose several strategies to reduce cancer burden in developing countries that involve not only governmental and non-governmental organizations in such developing countries but also the research community. Such measures may prove helpful in gaining a better understanding of cancer burden and assist in clinical decision making and the design of prevention strategies for developing countries.     

疾病负担研究的发展与应用

疾病负担是指由于疾病、伤残以及早逝带来的生命健康、社会经济方面的损失和影响,包括研究疾病的流行病学负担和经济负担两个方面.疾病负担研究对了解疾病对人群的危害程度和发展规律,确定卫生工作重点,制订有效的卫生发展策略具有十分重要的意义.全文在参阅文献的基础上,对疾病负担的概念、研究发展过程、运用方法、恶性肿瘤等主要疾病负担状况和研究注意事项进行了综述.     

Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030

Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015. The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.Methods:The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry. Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015. A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.Results:Approximately 303,600 new cases of breast cancer (205,100 from urban areas and 98,500 from rural areas) and 70,400 breast cancer deaths (45,100 from urban areas and 24,500 from rural areas) occurred in China in 2015. Urban regions of China had the highest incidence and mortality rates. The most common histological subtype of breast cancer was invasive ductal carcinoma, followed by invasive lobular carcinoma. The age-standardized incidence and mortality rates increased by 3.3% and 1.0% per year during 2000–2015, and were projected to increase by more than 11% until 2030. Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3% and 22.9%, whereas deaths are predicted to increase by 13.1% and 40.9%, respectively.Conclusions:The incidence and mortality of breast cancer continue to increase in China. There are no signs that this trend will stop by 2030, particularly in rural areas. Effective breast cancer prevention strategies are therefore urgently needed in China.     

Review of the Cervical Cancer Disease Burden in Mainland China

Human papillomavirus (HPV) infection is a common sexually transmitted infection (STI) worldwide. HPVmay cause several reproductive tract diseases and cervical cancer is the most serious health problem due topersistent high risk HPV infection. Although cervical cancer showed a declining trend over the past three decadesin China, it remains a major health problem in Chinese women especially women living in rural China. Thedisease burden is believed to be underestimated given the relatively high HPV prevalence shown in recent studies.To date, prophylactic vaccination as a primary prevention of cervical cancer are available in many countries andregions of the world; yet, they are not yet accessible in mainland China. Before introduction of HPV vaccines,screening remains the predominant method of prevention. Selected population based screening sites are availablein every province of China, yet, an organized screening program operating nationwide still does not exist. Abetter understanding of the disease burden is likely to help develop a comprehensive intervention policy forfuture management of cervical cancer in China. It is important to review the disease burden of cervical cancerand the current status of cervical cancer screening in mainland China.