1990-2017年中国分省食管癌疾病负担分析

Disease burden of esophageal cancer in China from 1990 to 2017

目的分析1990-2017年中国人群食管癌疾病负担及其变化情况,为制定食管癌预防控制策略措施提供依据。方法利用2017年全球疾病负担(GBD)中国分省研究结果,分析2017年中国食管癌疾病负担现状,比较1990年与2017年中国食管癌的发病、死亡和伤残调整寿命年(DALY)等指标,描述1990年和2017年各省食管癌发病、死亡及其造成的疾病负担及归因死亡情况。应用SAS 9.4软件对各年龄组发病率、死亡率和DALY率进行Cochran-Armitage趋势检验,采用Joinpoint 4.8.0.1软件计算平均年度变化百分比(AAPC)。结果 2017年中国食管癌发病人数和死亡人数分别为23.46万和21.26万,标化发病率和标化死亡率分别为12.23/10万和11.25/10万,较1990分别下降了36.89%和45.20%。1990年与2017年中国食管癌标化死亡率均随年龄增加而上升,均有统计学意义(P<0.05)。2017年食管癌DALY标化率为222.58/10万,与1990年相比下降了50.14%。2017年中国食管癌标化死亡率最高的3个省分别为江苏(22.83/10万)、河南(20.26/10万)和四川(18.61/10万)。与1990年相比,全国33个省级行政单位(含特别行政区)食管癌的标化死亡率均有所下降,降低幅度最大的3个省分别为河北(-63.11%)、江西(-61.02%)和山西(-60.19%)。2017年中国可归因于吸烟、饮酒、高体质指数(BMI)、低水果饮食和嚼用烟草的食管癌死亡比例分别为44.42%、32.22%、14.94%、20.04%和5.83%。结论 2017年食管癌疾病负担仍处于较高水平,与1990年相比,2017年全国食管癌疾病负担下降,各省份食管癌死亡率均下降,但仍存在差异。

Objective To analyze the disease burden of esophageal cancer and its changes in Chinese population from 1990 to 2017,and to provide the basis for formulating the esophageal cancer prevention and control strategies and measures. Methods The Chinese province study results of the Global Burden of Disease 2017(GBD2017) were used to analyze the disease burden of esophageal cancer of China in 2017;the differences of morbidities,mortalities and disability-adjusted life years(DALY) of esophageal cancer in China between 1990 and 2017 were compared,and the changes of morbidities,mortalities,disease burden and attributable deaths of esophageal cancer in all provinces between 1990 and 2017 were described. Cochran-Armitage trend test was used to analyze the morbidity,mortality and DALY rate of each age group,the used software was SAS 9.4. Joinpoint 4.8.0.1 was used to calculate the average annual percentage change(AAPC). Results In 2017,the numbers of the new cases and deaths of esophageal cancer in China were 234 600 and 212 600,the age standardized morbidity and mortality were 12.23/105 and 11.25/105,respectively;which reduced by 36.89% and 45.20%,respectively,as compared with 1990. In 1990 and 2017,the standardized mortalities increased with age(P<0.05). In 2017,the age standardized DALY rate for esophageal cancer was 222.58/105,which decreased by 50.14% as compared with 1990. In 2017,three provinces with top standardized mortalities of esophageal cancer in China were Jiangsu(22.83/105),Henan(20.26/105) and Sichuan(18.61/105). Compared with 1990,the standardized mortalities of 33 provincial-level administrative units(including special administrative regions) all decreased,three provinces with the largest decrease were Hebei(-63.11%),Jiangxi(-61.02%) and Shanxi(-60.19%). In 2017,the proportions of deaths from esophageal cancer attributable to smoking,alcohol drinking,high body mass index(BMI),low fruit diet,and chewing tobacco were 44.42%,32.22%,14.94%,20.04% and 5.83% respectively. Conclusion The disease burden of esophageal cancer was still at a high level in 2017. Compared with 1990,the disease burden of esophageal cancer in China decreased in 2017. The mortalities of esophageal cancer decreased in all provinces,but still there were differences.