1990-2019年中国食管癌疾病负担变化趋势及其危险因素分析

Analysis of disease burden, trends and risk factors of esophageal cancer in China during 1990-2019

目的分析1990-2019年中国人群食管癌流行情况、疾病负担变化趋势及危险因素。方法利用2019年全球疾病负担(GBD 2019)数据,采用发病、患病、死亡、伤残调整寿命年(DALYs)数目和年龄标化率,以及平均年度变化百分比(AAPC)对中国食管癌疾病负担变化趋势及危险因素进行分析。结果1990-1998年中国食管癌标化发病率、标化患病率、标化死亡率及标化DALYs率呈下降趋势,1998-2004年开始上升,在2004年达到最高,然后逐渐降低;所有标化率男性高于女性,且随着年龄的增长而升高,特别是40岁以后迅速升高;从2004年起,中国食管癌标化死亡率和标化DALYs率整体呈现下降趋势(AAPC分别为-1.8%和-2.1%),差异均有统计学意义,P<0.001。近30年,食管癌危险因素居前2位的均为吸烟和饮酒,另外,高身体质量指数(BMI)从1990年的第4位升至2004年的第3位,其他危险因素包括水果摄入不足、蔬菜摄入不足和无烟烟草;这30年危险因素种类未变化,但归因于各因素的占比变化较大,其中BMI、饮酒、吸烟和无烟烟草占比呈上升趋势,水果摄入不足和蔬菜摄入不足占比呈下降趋势。特别是高BMI导致的食管癌死亡占比增加107.40%,DALYs占比增加113.24%。结论近年来我国食管癌疾病负担有减轻趋势,但疾病负担依旧严重,其中人口老龄化仍然是食管癌防治需要面临的重要问题。针对已知食管癌危险因素,特别是高BMI、饮酒、吸烟、无烟烟草,对重点人群进行健康教育和生活方式的干预等,同时开展食管癌筛查与早诊早治工作,对减轻中国食管癌疾病负担意义重大。

Objective To analyze the epidemic situation and trends of burden and risk factors of esophageal cancer in China from 1990 to 2019.Methods Based on the global burden of disease data in 2019(GBD 2019),the number and standardized rate of incidence,prevalence,death and disability adjusted life years(DALYs)and the average annual percentage change(AAPC)were used to analyze the change trend and risk factors of the disease burden of esophageal cancer in China from 1990 to 2019.Results From 1990 to 1998,the standardized incidence rate,prevalence,mortality and DALYs of esophageal cancer in China showed a downward trend,rising from 1998 to 2004,reaching the highest level in 2004,and then gradually decreasing.All standardized rates of men were higher than those of women,and increased with age,especially at the age of≥40 years.Since 2004,the standardized mortality rate and the standardized DALYs rate of esophageal cancer in China had shown a downward trend(AAPC was-1.8%and-2.1%,respectively),with significant differences(P<0.001).In the past 30 years,smoking and alcohol were the top two risk factors for esophageal cancer.In addition,the high body mass index(BMI)rose from the fourth place in 1990 to the third place in 2004.Other risk factors included insufficient intake of fruits,vegetables and smokeless tobacco.The types of risk factors had not changed in the past 30years,but the proportion of each factor had changed greatly.Among them,the proportion of BMI,alcohol consumption,smoking and smokeless tobacco had increased,while the proportion of insufficient fruit intake and insufficient vegetable intake had decreased.In particular,the proportion of esophageal cancer deaths caused by high BMI increased by107.40%,and the proportion of DALYs increased by 113.24%.Conclusions In recent years,there is a trend to reduce the disease burden of esophageal cancer in China,but the disease burden is still serious,among which population aging is still an important issue that needs to be faced in the prevention and treatment of esophageal cancer.Aiming at the known risk factors of esophageal cancer,especially high BMI,alcohol consumption,smoking,smokeless tobacco,health education and lifestyle intervention for key populations,and the screening,early diagnosis and early treatment of esophageal cancer are of great significance to reduce the burden of esophageal cancer in China.