1990—2019年中国女性乳腺癌发病及死亡趋势的年龄-时期-队列模型分析

Age-Period-Cohort Analysis of Trends of Breast Cancer Incidence and Mortality among Chinese Females from 1990 to 2019

背景 乳腺癌位居全球女性癌因死亡首位,具有发病率高、疾病负担重等特点。目的 评估1990—2019年中国女性乳腺癌发病率及死亡率的流行变化趋势。方法 提取《2019年全球疾病负担》数据库中1990—2019年中国≥15岁女性乳腺癌发病及死亡数据,应用年龄-时期-队列的贝叶斯模型对中国1990—2019年女性乳腺癌发病及死亡趋势进行拟合,进一步估计中国女性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。结果 1990—2019年中国女性乳腺癌粗发病率从14.14/10万升至52.81/10万,粗死亡率从7.22/10万升至13.40/10万。乳腺癌标化发病率总体呈上升趋势(1990年为17.07/10万,2019年为35.61/10万),标化死亡率呈平稳略减趋势(1990年为9.16/10万,2019年为8.98/10万)。年龄-时期-队列模型分析结果显示:所有年龄组女性乳腺癌发病率净漂移值为2.58%〔95%CI(2.34%,2.83%)〕,局部漂移值在65~69岁年龄段达到最高,为3.46%〔95%CI(3.11%,3.80%)〕;死亡率净漂移值为-0.75%〔95%CI(-1.09%,-0.41%)〕,局部漂移值在15~44岁呈平稳趋势,且约60岁之后局部漂移值>0;年龄效应中乳腺癌发病和死亡风险随着年龄增长而增加;以2000—2004年为参考时期,发病风险的时期效应总体呈上升趋势(RR值为0.79~1.47),死亡风险的时期效应总体呈下降趋势(RR值为1.08~0.90);以1955—1959年为对照组,乳腺癌发病风险的队列效应总体上有所升高(RR值为0.27~2.48),乳腺癌死亡风险的队列效应呈先增(RR值为0.78~1.06)后降趋势(RR值为1.06~0.44)。结论 中国女性1990—2019年乳腺癌发病率和死亡率均呈持续上升趋势,乳腺癌发病和死亡风险的年龄效应和队列效应占主导地位。

Background Breast cancer is the leading cause of death among women worldwide,characterized by high incidence and heavy disease burden.Objective To assess the secular trend of breast cancer incidence and mortality in Chinese females from 1990 to 2019.Methods The data on breast cancer incidence and mortality in Chinese females aged ≥15 years from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019.The Bayesian age-period-cohort(APC) model was used to fit breast cancer incidence and mortality trends during 1990—2019 to assess the effects of age,period and cohort on breast cancer incidence and mortality.Results The crude incidence of breast cancer among Chinese females increased from 14.14/100 000 to 52.81/100 000,and the crude mortality increased from 7.22/100 000 to 13.40/100 000 during 1990—2019.The standardized incidence of breast cancer showed an increasing trend in general(17.07/100 000 in 1990,35.61/100 000 in 2019),while the standardized breast cancer mortality was basically stable(9.16/100 000 in 1990,8.98/100 000 in 2019).The results of the APC model showed that the average net drift value of breast cancer incidence in females of all age groups was 2.58%〔95%CI(2.34%,2.83%)〕,and the highest value of local drift was 3.46%〔95%CI(3.11%,3.80%)〕in the 65-69 years old group.The average net drift value of mortality was-0.75%〔95%CI(-1.09%,-0.41%)〕.The local drift value was stable in 15-44-year-olds,and was above 0 in age groups above 60 years old.The incidence and mortality of breast cancer increased with age.The period effect of incidence showed an increasing trend(RR:0.79-1.47),while the period effect of mortality showed a decreasing trend(RR:1.08-0.90)when the period of 2000—2004 was set as the control group.The cohort effect of breast cancer incidence increased(RR:0.27-2.48),and the cohort effect of breast cancer mortality risk increased firstly and decreased after then(RR:0.78-1.06-0.44) when the cohort of 1955—1959 was set as the control group.Conclusion The incidence and mortality of breast cancer in Chinese females increased continuously from 1990 to 2019,which was dominantly influenced by age and cohort.