全球女性居民1990—2019年乳腺癌发病和死亡变化趋势及预测分析

Breast cancer incidence and mortality–trends from 1990 to 2019 and projections for 2020 to 2029 in the world female population:a GBD 2019 data-based analysis

目的分析全球女性居民1990—2019年乳腺癌发病和死亡变化趋势并对2020—2029年乳腺癌的年龄标化发病率(ASIR)和年龄标化死亡率(ASMR)进行预测,为制定全球女性居民乳腺癌的预防与控制提供参考依据。方法收集2019年全球疾病负担(GBD 2019)研究中1990—2019年全球女性居民乳腺癌发病和死亡的相关数据,采用发病数、发病率、ASIR、死亡数、死亡率和ASMR等指标进行描述性分析,采用平均年度变化百分比(AAPC)分析全球女性居民1990—2019年乳腺癌发病和死亡的变化趋势,应用年龄–时期–队列模型(APC)拟合并估计全球女性居民乳腺癌发病及死亡风险中的年龄效应、时期效应和队列效应,并应用自回归差分移动平均模型(ARIMA)对全球女性居民2020—2029年乳腺癌发病和死亡的变化趋势进行预测。结果全球女性居民1990—2019年乳腺癌发病数、发病率、ASIR、死亡数和死亡率分别从1990年的867620.84例、32.67/10万、40.12/10万、375016.06例和14.12/10万分别上升至2019年的1977211.62例、51.27/10万、45.86/10万、688562.26例和17.85/10万,总变化率分别为127.89%、56.93%、14.31%、83.61%和26.42%;乳腺癌ASMR从1990年的17.76/10万下降至2019年的15.88/10万,总变化率为–10.54%。Joinpoint回归模型分析结果显示,全球女性居民1990—2019年乳腺癌ASIR总体呈上升趋势(AAPC=0.44%,P<0.001),而ASMR总体呈下降(AAPC=–0.37%,P<0.001);全球不同水平社会人口指数(SDI)区域女性居民1990—2019年乳腺癌发病和死亡变化趋势不同,中高SDI区域、中SDI区域、中低SDI区域和低SDI区域女性居民1990—2019年乳腺癌ASIR总体均呈上升趋势,中SDI区域、中低SDI区域和低SDI区域女性居民1990—2019年乳腺癌ASMR总体均呈上升趋势,高SDI区域和中高SDI区域女性居民1990—2019年乳腺癌ASMR总体均呈下降趋势(均P<0.001)。APC模型分析结果显示,全球女性居民乳腺癌发病率和死亡率的年龄效应总体均随年龄的增长而增加,效应系数分别从20~24岁的–2.878和–2.946增加到75~79岁的0.706和1.053;乳腺癌发病率和死亡率的时期效应亦均呈上升趋势,效应系数分别从1990—1994年的–0.310和–0.206增至2015—2019年的0.296和0.235;而乳腺癌发病率和死亡率的队列效应则总体均呈下降趋势,效应系数分别从1915—1919年的0.848和0.866降至1995—1999年的–0.575和–0.672。ARIMA模型预测结果显示,全球女性居民2020—2029年乳腺癌的ASIR将持续上升,而ASMR则持续下降,预计2029年乳腺癌的ASIR和ASMR分别为47.86/10万和15.31/10万。结论全球女性居民1990—2019年乳腺癌ASIR总体呈上升趋势,而ASMR总体呈下降趋势,预测在2020—2029年乳腺癌的ASIR将持续上升,而ASMR持续下降。

Objective To analyze the trends in breast cancer incidence and mortality from 1990 to 2019 and to predict the age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)of breast cancer from 2020 to 2029 in the world female population,providing a reference for the prevention and control of female breast cancer in the world.Methods Data on breast cancer incidence and mortality in the global female population from 1990 to 2019 were collected from the Global Burden of Disease(GBD)2019 study.Incidence count,incidence rate,ASIR,death count,mortality rate,and ASMR were used for descriptive analysis.Average annual percentage change(AAPC)was used to analyze trends in breast cancer incidence and mortality from 1990 to 2019.The age-period-cohort(APC)model was used to estimate the age effect,period effect,and cohort effect on breast cancer incidence and mortality risk in the world female population;the autoregressive integrated moving average(ARIMA)model was used to predict trends in breast cancer incidence and mortality from 2020 to 2029 in the female population.Results Increases in breast cancer in the global female population from 1990 to 2019 were observed in incidence number(867620.84 to 1977211.62),incidence rate(32.67/100000 to 51.27/100000),ASIR(40.12/100000 to 45.86/100000),number of deaths(375016.06 to 688562.26),and mortality rate(14.12/100000 to 17.85/100000),with total percentage changes of 127.89%,56.93%,14.31%,83.61%,and 26.42%,respectively.The breast cancer ASMR decreased from 17.76/100000 in 1990 to 15.88/100000 in 2019,with an overall percentage change of–10.54%.Joinpoint regression analysis showed that breast cancer ASIR for the global female population generally increased from 1990 to 2019(AAPC=0.44,P<0.001),while breast cancer ASMR generally decreased(AAPC=–0.37,P<0.001).Trends in female breast cancer incidence and mortality varied across global regions with different levels of socio-demographic index(SDI)from 1990 to 2019.The ASIR generally increased in global regions with different SDI levels.The ASMR generally increased in the middle,low-middle,and low SDI regions,but generally decreased in the high and high-middle SDI regions from 1990 to 2019(all P<0.001).The APC model analysis showed that the age effects on breast cancer incidence and mortality rates in the global female population generally increased with age,with coefficients increasing from–2.878 and–2.946 at ages 20–24 years to 0.706 and 1.053 at ages 75–79 years,respectively.Period effects on breast cancer incidence and mortality also showed increasing trends,with coefficients increasing from–0.310 and–0.206 in 1990–1994 to 0.296 and 0.235 in 2015–2019,respectively.However,cohort effects on breast cancer incidence and mortality generally decreased,with coefficients decreasing from 0.848 and 0.866 for the 1915–1919 birth cohort to–0.575 and–0.672 for the 1995–1999 birth cohort,respectively.ARIMA model predictions showed that the global female breast cancer ASIR will continue to increase while the ASMR will continue to decrease from 2020 to 2029,with predicted ASIR and ASMR of 47.86/100000 and 15.31/100000,respectively,in 2029.Conclusion From 1990 to 2019,the ASIR for breast cancer has generally increased while the ASMR has generally decreased in the global female population.From 2020 to 2029,the ASIR is projected to continue to increase while the ASMR is projected to continue to decrease.