湖北省丹江口市居民食管癌患病危险因素的病例-对照研究

Case-control study on risk factors of esophageal cancer in residents in Danjiangkou City, Hubei Province

[背景]食管癌是常见的消化道恶性肿瘤,我国居民食管癌发病率和死亡率在世界范围内均处于较高水平,给我国人民群众的健康造成极大危害。湖北省丹江口市近几年食管癌的发病率在所有肿瘤中均居第一位,且高于湖北省其他地区食管癌的发病率。[目的]分析湖北省西北部丹江口市食管癌的流行现状和患病的危险因素,为采取有效的预防措施提供科学依据。[方法]从丹江口市疾病预防控制中心肿瘤登记系统收集2015-2016年新发食管癌患者419例,除去因无法联系上或无法自主完成访谈等情况的病例,实际调查病例351人。再根据患者的性别和年龄等基本情况按1∶1比例匹配未患食管癌的健康人群351人作为对照。通过问卷的形式由经过培训的调查员对研究对象进行一对一访谈,收集信息,对可能致病的危险因素进行分析。采用χ2检验及条件多因素logistic回归分析确定丹江口市食管癌的主要危险因素,并计算相关危险因素的调整人群归因危险度和综合人群归因危险度。[结果]2015-2016年丹江口市居民食管癌的发病率为45.25/10万(人年),这两年新发病例共419例,其中男性占67.78%,女性占32.22%;50岁以上人群占比为96.19%;新发病例主要居住在乡镇农村,占比为87.11%。丹江口市居民患食管癌的主要危险因素为:不良心理状况(OR=2.599,95%CI:1.204~5.609),有消化系统疾病史(OR=6.570,95%CI:3.977~10.853),有暴饮暴食习惯(OR=2.379,95%CI:1.033~5.477),每周至少进食3次腌渍酸菜类食品(OR=2.011,95%CI:1.111~3.639),每周进食1次或2次霉变食物(OR=3.906,95%CI:1.085~14.063)。不良心理状况、消化系统疾病史、有暴饮暴食习惯、吃腌渍酸菜食物、吃霉变食物的调整人群归因危险度分别为12.59%、50.64%、11.86%、27.77%、5.87%。这些因素的综合人群归因危险度为70.42%。[结论]不良心理状况、有消化系统疾病史、有暴饮暴食习惯、喜食腌渍酸菜等食物,喜食霉变食物可能是丹江口市居民食管癌患病的危险因素。

[Background] Esophageal cancer is a common malignant tumor of the digestive tract. The incidence and mortality of esophageal cancer in Chinese residents are at a high level in the world, which is extremely harmful to health. In Danjiangkou City, the incidence of esophageal cancer ranks first among all tumors and is higher than that in other areas of Hubei Province in recent years.[Objective] We aims to evaluate the prevalence and risk factors of esophageal cancer in Danjiangkou City of Hubei Province, and provide scientific data for adopting effective measures against esophageal cancer.[Methods] A total of 419 esophageal cancer incidents in 2015-2016 were collected from the Cancer Registry of the Danjiangkou City Center for Disease Control and Prevention, and eventually 351 patients were included in the study after removing the patients that were not contacted or did not complete the investigation on their own. According to sex and age of the patients, 351 healthy people with no esophageal cancer were matched as a control group. To explore the risk factors of esophageal cancer, trained investigators conducted a one-on-one interview with questionnaires. Chi-square test and conditional multivariate logistic regression analysis were used to determine the main risk factors of esophageal cancer in Danjiangkou City, and adjusted population attributable risk and synthesized population attributable risk of these factors were also calculated.[Results] The incidence rate of esophageal cancer in residents in Danjiangkou City in 2015-2016 was 45.25/100 000 person-years. Among the 419 registered cases, 67.78% were males, and 32.22% were females;96.19% were >50 years old;87.11% lived in rural areas and towns. The main risk factors of esophageal cancer in residents in Danjiangkou City were identified as adverse psychological status(OR=2.599, 95%CI: 1.204-5.609), history of digestive diseases(OR=6.570, 95%CI: 3.977-10.853), overeating habit(OR=2.379, 95%CI: 1.033-5.477), eating salted food and sauerkraut at least 3 times a week(OR=2.011, 95%CI: 1.111-3.639), and eating moldy food 1-2 times a week(OR=3.906, 95%CI: 1.085-14.063). The adjusted population attributable risks of adverse psychological status, history of digestive diseases, overeating habit, eating salted food and sauerkraut, and eating moldy food were 12.59%, 50.64%, 11.86%, 27.77%, and 5.87% respectively. The synthesized population attributable risk for these risk factors was 70.42%.[Conclusion] Adverse psychological status, history of digestive disease, overeating habit, and preference for salted food, sauerkraut and moldy food may be the risk factors for esophageal cancer in residents in Danjiangkou City.