1990和2019年中国与全球结直肠癌疾病负担和危险因素比较分析

Comparative analysis of disease burden and risk factors of colon and rectum cancer between China and the World in 1990 and 2019

目的分析1990和2019年中国与全球结直肠癌(CRC)疾病负担和主要危险因素的变化趋势,为CRC防治提供参考依据。方法采用2019年全球疾病负担(GBD 2019)数据,依据死亡人数、死亡率、伤残损失健康寿命年(YLD)、早死损失寿命年(YLL)、伤残调整寿命年(DALY)和标化死亡率等指标,描述1990和2019年中国与全球CRC疾病负担和主要危险因素等情况。采用Joinpoint模型分析我国与全球1990和2019年不同性别CRC疾病负担和主要危险因素的变化趋势。结果2019年,中国CRC死亡总数为26.18万例,死亡率为18.40/10万,标化死亡率为13.86/10万。中国标化YLD率、标化YLL率和标化DALY率分别为15.37/10万、305.19/10万和320.57/10万;全球分别为13.03/10万、282.51/10万和295.54/10万。1990-2019年,中国CRC死亡率(AAPC=3.53%,P<0.001)、标化死亡率(AAPC=1.05%,P<0.001)、标化YLD率(AAPC=3.70%,P<0.001)、标化YLL率(AAPC=0.81%,P<0.001)和标化DALY率(AAPC=0.91%,P<0.001)整体均呈上升趋势;全球标化YLD率呈现较为平稳的上升趋势(AAPC=0.85%,P<0.001),标化YLL率(AAPC=-0.18%,P=0.001)、标化DALY率(AAPC=-0.14%,P=0.011)整体呈现较为平稳的下降趋势。1990和2019年中国CRC前5位危险因素分别为钙摄入不足、奶制品摄入不足、谷类摄入不足、吸烟和饮酒。中国奶制品摄入不足和高身体质量指数顺位分别由1990年的第2位和第10位上升至2019年的第1位和第8位,低膳食纤维由1990的第9位顺位下降至2019年的第11位。结论与1990年相比,2019年我国CRC导致的疾病负担越来越严重且高于全球平均水平,男性人群应为防控重点,应采取针对性的措施进行预防和管理。

Objective To analyze the trend of disease burden and main risk factors of colorectal cancer(CRC)in China and around the world in 1990 and 2019,in order to provide reference for the prevention and treatment of CRC.Methods Based on the global burden of disease(GBD 2019)data in 2019,the disease burden and major risk factors of CRC in China and the world in 1990 and 2019 were described according to such indicators as the number of deaths,mortality,years lived with disability(YLD),years of life lost(YLL),disability adjusted life years(DALY),and standardized mortality.The joinpoint model was used to analyze the trend of disease burden and main risk factors of CRC by sex in China and the world in 1990and 2019.Results In 2019,the number of CRC deaths in China was 261800,therate(1/100000)for CRC illness prevalence,with mortality rate of 18.40/100000,and the standardized mortality rate of 13.86/100000.The standardized YLD rate,standardized YLL rate and standardized DALY rate were 15.37,305.19and 320.57.Among global residents in 2019,the standardized YLD rate,standardized YLL rate and standardized DALY rate were 13.03,282.51and295.54.From 1990to 2019,the mortality of CRC(AAPC=3.53%,P<0.001),standardized mortality(AAPC=1.05%,P<0.001),standardized YLD rate(AAPC=3.70%,P<0.001),standardized YLL rate(AAPC=0.81%,P<0.001),standardized DALY rate(AAPC=0.91%,P<0.001)in China showed an overall upward trend.There was a stable upward trend in the standardized YLD rate(AAPC=0.85%,P<0.001)globally,but the standardized YLL rate(AAPC=-0.18%,P=0.001),standardized DALY rate(AAPC=-0.14%,P=0.011)showed an stable downward trend.The top five risk factors for CRC in China were inadequate calcium intake,inadequate dairy intake,inadequate cereal intake,smoking and alcohol consumption in 1990and 2019.China’s ranking of dairy product intake deficiency and high body mass index rose from the second and the tenth in 1990to the first and the eighth in 2019,respectively,and the ranking of fiber deficiency fell from the ninth in 1990to the eleventh in 2019.Conclusion Compared with 1990,the disease burden caused by CRC in China is more serious than the global average in 2019.The male population should be the focus of prevention and control,and specific measures should be taken for prevention and management.