1990-2019年全球胃癌发病率和死亡率变化趋势及地区差异

Regional disparities in trends of global gastric cancer incidence and mortality from 1990 to 2019

目的分析全球胃癌发病率和死亡率变化趋势,探讨不同地理区域和社会经济发展水平国家和地区的疾病负担差异。方法基于2019年全球疾病负担研究数据库,采用Joinpoint回归模型计算1990—2019年胃癌年龄标化发病率和死亡率的平均年度变化百分比(AAPC)及95%CI,采用线性回归分析胃癌标化发病率和死亡率的AAPC与社会人口指数(SDI)的关联,采用年龄-时期-队列模型探讨不同SDI水平的地区1900—1999年出生队列胃癌发病和死亡风险的变化趋势。结果1990—2019年全球胃癌标化发病率和死亡率的AAPC分别为-1.27%(95%CI:-1.43%~-1.11%)和-1.87%(95%CI:-2.01%~-1.72%)。SDI与胃癌发病和死亡率AAPC均呈负相关(均P<0.001),SDI较高的国家胃癌发病和死亡率下降较快,中低SDI国家胃癌疾病负担下降速度落后于全球平均水平。年龄-时期-队列模型显示,SDI较高的国家1900—1999年出生队列人群的胃癌发病和死亡风险下降幅度也要更大。结论不同社会经济发展水平国家的胃癌发病率和死亡率下降速度有明显差异,社会经济发展水平较高的国家胃癌疾病负担下降较快。

Objective To depict gastric cancer burden trends globally and analyze geographical and socioeconomic disparities among different countries and territories.Methods We extracted the data from Global Burden of Disease 2019 Database.We conducted the Joinpoint regression and calculated the average annual percent change(AAPC)and corresponding 95%confidence interval(CI)for age-standardized gastric cancer incidence and mortality from 1990 to 2019.Linear regression was performed to measure the association of sociodemographic index(SDI)with each country′s gastric cancer incidence and mortality AAPC.We applied the age-period-cohort analysis to assess the cohort effect on gastric cancer incidence and mortality.Results The AAPCs for gastric cancer age-standardized incidence and mortality rates from 1990 to 2019 were-1.27%(95%CI:-1.43%,-1.11%)and-1.87%(95%CI:-2.01%,-1.72%),respectively.SDI levels were negatively associated with AAPCs,which means that countries with higher SDI had higher AAPC(P<0.001).The decrease of gastric cancer burden in countries with low or medium SDI levels was slower than that globally.The age-period-cohort analysis indicated that countries with higher SDI levels had more apparent decline in birth cohort effects from 1900 to 1999.Conclusions Countries with different socioeconomic levels have various decreasing rates for gastric cancer incidence and deaths.Countries with higher SDI levels have higher declining rates for gastric cancer burden.