中国归因于饮酒的食管癌疾病负担分析与预测:基于1990—2019年中国疾病负担的年龄-时期-队列研究

Analysis and prediction of disease burden of esophageal cancer attributed to alcohol consumption in China:an age-period-cohort study based on disease burden from 1990 to 2019

目的:基于对中国归因于饮酒的食管癌疾病负担近30年来(1990—2019年)的数据整理与分析,探索如何加强公共卫生政策的制定与管理,从而控制该疾病所带来的疾病负担。方法:基于全球疾病负担(Global Burden of Disease,GBD)2019研究数据库数据,采用死亡率及失能调整生命年(disability-adjusted life years,DALYs)等指标评估中国归因于饮酒的食管癌疾病负担情况;应用Joinpoint回归软件和年龄-时期-队列模型方法分析疾病负担趋势以及死亡率随年龄、时期和队列的时间变化趋势;运用贝叶斯年龄-时期-队列分析对2020—2030年中国归因于饮酒的食管癌死亡率进行预测。结果:1990—2019年,中国归因于饮酒的食管癌死亡人数由3.38万例上升为6.19万例,标准化死亡率由3.95/10万逐年下降至3.04/10万;DALYs由93.40万人年上升至151.26万人年,DALYs率由101.36/10万下降至71.39/10万。2019年,中国归因于饮酒的食管癌死亡人数和DALYs均在65~69岁年龄组达到峰值,其中男性死亡5.88万例,标准化死亡率为6.21/10万,女性死亡0.31万例,标准化死亡率为0.31/10万,死亡率和DALYs率均随着年龄的增长不断提升。Joinpoint回归分析结果显示,总体归因于饮酒的食管癌死亡率的平均年度变化百分比(average annual percent change,AAPC)为-0.97%[95%置信区间(confidence interval,CI):-1.2%~-0.8%],其中女性死亡率的AAPC为-2.32%(95%CI:-2.6%~-2.1%),男性死亡率的AAPC为-0.81%(95%CI:-1.0%~-0.6%);归因于饮酒的食管癌死亡率年龄-时期-队列模型分析显示死亡率的净漂移值为-1.301%(95%CI:-1.577%~-1.025%,P<0.05),预测在2020—2030年期间,归因于饮酒的食管癌死亡率负担将稳定增加。结论:与整个食管癌疾病负担趋势相比,中国归因于饮酒的食管癌的疾病负担下降较慢,男性群体疾病负担高于女性,中老年群体的疾病负担高于青年,预计未来几年中国归因于饮酒的食管癌死亡率负担将稳定增加,提示相关部门应在重视对男性、中老年群体干预的同时,加强对全人群的健康科普教育工作和公共卫生政策的制定,提高居民食管癌的“三早”预防意识以及防范患病风险因素的意识。

Objective:Based on the data compilation and analysis of the disease burden of esophageal cancer attributed to alcohol consumption in China over the past three decades(1990-2019),this study aims to explore how to strengthen the formulation and management of public health policies to control the disease burden caused by this disease.Methods:Based on the data from the Global Burden of Disease(GBD)2019 study database,indicators such as mortality rate and disability-adjusted life years(DALYs)were used to assess the disease burden of esophageal cancer attributed to alcohol consumption in China.Joinpoint regression software and the age-period-cohort model were employed to analyze the trends in disease burden and mortality rates over time by age,period,and cohort.Bayesian age-period-cohort analysis was used to predict the mortality rates of esophageal cancer attributed to alcohol consumption in China from 2020 to 2030.Results:From 1990 to 2019,the number of deaths from esophageal cancer attributed to alcohol consumption increased from 33800 cases to 61900 cases,while the standardized mortality rate decreased from 3.95 per 100000 to 3.04 per 100000.DALYs increased from 934000 person-years to 1512600 person-years,and the DALYs rate decreased from 101.36 per 100000 to 71.39 per 100000.In 2019,both the number of deaths and DALYs reached their peak in the age group of 65-69 years with 58800 deaths and a standardized mortality rate of 6.21 per 100000 for males,and 3100 deaths and a standardized mortality rate of 0.31 per 100000 for females.Both the mortality rates and the DALYs rates increased with age.The Joinpoint regression analysis showed that the average annual percentage change(AAPC)of mortality rates attributed to alcohol consumption-related esophageal cancer was-0.97%[95%confidence interval(CI):-1.2%--0.8%],with an AAPC of-2.32%(95%CI:-2.6%--2.1%)for females and-0.81%(95%CI:-1.0%-0.6%)for males.The ageperiod-cohort analysis of mortality rates attributed to alcohol consumption-related esophageal cancer showed a net drift of-1.301%(95%CI:-1.577%--1.025%,P<0.05).It is predicted that the burden of esophageal cancer mortality attributed to alcohol consumption will steadily increase during the period of 2020-2030.Conclusion:Compared to the overall trend of esophageal cancer burden,the burden of esophageal cancer attributed to alcohol consumption is declining at a slower rate.The burden of the disease is higher in the male population than that in females,and higher in the middle-aged and elderly population compared to the younger population.It is expected that in the coming years,the burden of esophageal cancer mortality attributed to alcohol consumption in China will steadily increase,suggesting that while focusing on the intervention for males and the middle-aged and elderly population,relevant departments should also strengthen health education in the entire population,formulate public health policies,and raise awareness of early prevention and risk factors of esophageal cancer among residents.