1990—2019年高体质指数对我国肾癌疾病负担的影响及趋势分析

Impact of high BMI index on the disease burden of kidney cancer in China from 1990 to 2019 and its trends

目的分析1990—2019年高体质指数(BMI)对我国居民肾癌疾病负担的影响及其趋势,探讨对相关人群临床干预和肾癌防治的策略。方法收集2019年全球疾病负担研究(GBD2019)对中国居民肾癌疾病负担的估计数据,根据平均年度变化百分比等指标,采用Joinpoint回归模型对1990—2019年高BMI(BMI≥25 kg/㎡)导致的我国肾癌粗死亡率和伤残调整生命年(DALYs)进行趋势分析。结果我国因高BMI导致的肾癌死亡数、死亡率和DALYs由1990年的276人(占肾癌总死亡数的25.72%)、0.02/10万和0.69/10万,上升至2019年的2589人(占肾癌总死亡数的36.71%)、0.18/10万和4.96/10万。趋势分析发现,因高BMI导致的我国肾癌合计粗死亡率逐年上升8.24%,男性逐年上升9.62%,女性逐年上升6.56%(均P<0.001)。Joinpoint回归模型分析发现,因高BMI导致的肾癌合计DALYs存在5个拐点,1990—1996年逐年上升3.07%(Z=38.37,P<0.001),1996—1999年逐年上升9.08%(Z=18.67,P<0.001),1999—2004年逐年上升14.27%(Z=90.63,P<0.001),2004—2011年逐年上升7.69%(Z=94.14,P<0.001),2011—2016年逐年上升3.07%(Z=20.55,P<0.001),2016—2019年逐年上升6.74%(Z=28.02,P<0.001),与合计粗死亡率、全球肾癌疾病负担增长趋势一致。1990—2019年,我国肾癌疾病负担高于低社会人口指数(SDI)国家,低于全球平均、中等和高SDI国家或地区水平,但DALYs年均增速远大于上述地区(中国8.02%vs全球2.00%,高SDI国家1.58%,中等SDI国家5.10%,低SDI国家3.65%)。结论结合全球和我国居民肾癌疾病负担现状及其趋势,对有代谢风险的高危人群开展临床精准干预,有助于控制我国肾癌疾病负担的高速增长。

Objective To analyze the influence and trend of overweight and obesity(high BMI index)on the disease burden of kidney cancer in Chinese residents from 1990 to 2019,so as to explore the clinical intervention and prevention strategies of renal cancer.Methods According to the estimation of China's kidney cancer burden in the Global Burden of Disease Study 2019(GBD 2019),the annual percent change(APC),average annual percent change(AAPC)and other indicators were used to analyze the global and China's renal cancer mortality rate and disability adjusted life years(DALYs).Results The number of kidney cancer deaths,mortality and DALYs caused by metabolic risk factors in China increased from 276 in 1990(accounting for 25.72%,0.02/100000 and 0.69/100000 of the total kidney cancer deaths)to 2589 in 2019(accounting for 36.71%,0.18/100000 and 4.96/100000 of the total kidney cancer deaths).The trend analysis showed that the total crude mortality rate of kidney cancer caused by high BMI index in China increased by 8.24%per year,9.62%per year in males and 6.56%per year in females(all P<0.001).The joinpoint regression model found that there were five inflection points in the total DALYs of kidney cancer caused by metabolic risk factors,which increased by 3.07%(Z=38.37,P<0.001)per year from 1990 to 1996,9.08%(Z=18.67,P<0.001)per year from 1996 to 1999,14.27%(Z=90.63,P<0.001)per year from 1999 to 2004,7.69%(Z=94.14,P<0.001)per year from 2004 to 2011,and 3.07%(Z=20.55,P<0.001)per year from 2011 to 2016.From 2016 to 2019,it increased by 6.74%per year(Z=28.02,P<0.001),which was consistent with the growth trend of total crude mortality and global renal cancer disease burden.From 1990 to 2019,the disease burden of renal cancer in China was higher than that of low SDI countries,but lower than the global average,medium and high SDI countries or regions.However,the average annual growth rate of DALYs was much higher than that of the above regions(8.02%in China vs.2.00%in global,1.58%in high SDI countries,5.10%in middle SDI countries,3.65%in low SDI countries).Conclusions In combination with the current situation and trend of kidney cancer disease burden in the world and China,precise clinical intervention for high-risk groups with metabolic risk will help to control the rapid growth of kidney cancer disease burden in China.