人类发展指数对女性恶性肿瘤发病和死亡的影响研究

Correlation of Human Development Index with the Incidence and Mortality of Gynaecological Cancers

[目的]探讨人类发展指数(HDI)对女性恶性肿瘤发病和死亡的影响。[方法]利用GLOBOCAN 2020的数据和以HDI为基础的人类发展水平分类,使用一般线性模型描述HDI与6种女性恶性肿瘤的发病率和死亡率的变化趋势,比较不同HDI分类的国家(地区)间的差异。使用Poisson对数线性模型探究HDI对女性恶性肿瘤的发病和死亡的影响。[结果] 2020年女性恶性肿瘤发病前3位为乳腺癌、宫颈癌、子宫体癌,死亡前3位为乳腺癌、宫颈癌、卵巢癌。乳腺癌和子宫体癌的世界人口标化发病率(简称世标发病率)随HDI的增加呈上升趋势,而宫颈癌世标发病率则呈下降趋势;宫颈癌世界人口标化死亡率(简称世标死亡率)随HDI的增加呈明显下降趋势,而子宫体癌世标死亡率则呈上升趋势。极高HDI国家(地区)的乳腺癌、子宫体癌和外阴癌世标发病率最高,低HDI国家(地区)的宫颈癌世标发病率最高。Poisson对数线性模型结果显示,HDI对子宫体癌发病的影响最大(HDI系数40.31,95%CI:27.47~59.14),其次是乳腺癌(HDI系数10.24,95%CI:8.83~11.88)和宫颈癌(HDI系数0.07,95%CI:0.05~0.08);HDI对宫颈癌的死亡影响最大(HDI系数0.02,95%CI:0.01~0.02),其次为阴道癌(HDI系数0.08,95%CI:0.01~0.77)和子宫体癌(HDI系数9.53,95%CI:4.57~19.86)。预期寿命、受教育年限和人均国民总收入越高,女性恶性肿瘤的世标发病率越高,而世标死亡率则越低。[结论]女性恶性肿瘤的发病和死亡负担仍然较重,乳腺癌和子宫体癌高发于极高HDI的国家(地区),而宫颈癌的发病率和死亡率均随着HDI的提升呈下降趋势,且与HDI有密切的关联。应根据不同癌种与HDI水平精准制定肿瘤防控政策。

[Purpose]To explore the correlation of human development index(HDI)with the inci-dence and mortality of gynecological cancers.[Methods]Based on the data estimated by GLOBO-CAN 2020 and the human development level the general linear model was constructed and the in-cidence and mortality of 6 gynecological cancers were compared among countries or regions with different HDI.The correlation of HDI with incidence and mortality of gynecological cancers were analyzed by Poisson regression.[Results]Among all gynecological cancers,the top three cancers with higher incidence were breast cancer,cervix uteri cancer and corpus uteri cancer,and the top three cancers with higher mortality were breast cancer,cervix uteri cancer and ovary cancer worldwide in 2020.The age-standardized incidence rate by Segi’s world population(ASIRW)of breast cancer and corpus uteri cancer increased with the increasing HDI,while that of cervix u-teri cancer was decreased.The age-standardized mortality by Segi’s world population(ASMRW)of cervix uteri cancer decreased with the increasing HDI,while that of corpus uteri cancer was in-creased.The ASIRW of breast cancer,corpus uteri cancer and vulva cancer were the highest in countries or regions with very high HDI,and that of cervix uteri cancer was the highest in coun-tries or regions with low HDI.Poisson log-linear model showed that HDI was positively correlated with the incidence of corpus uteri cancer(HDI coefficient=40.31,95%CI:27.47~59.14)and breast cancer(HDI coefficient=10.24,95%CI:8.83~11.88);and negatively with incidence of cervix uteri cancer(HDI coefficient=0.07,95%CI:0.05~0.08).HDI was negatively correlated with the mortality ate of cervix uteri cancer(HDI coefficient=0.02,95%CI:0.01~0.02)and positively correlated with mortality of corpus uteri cancer(HDI coefficient=9.53,95%CI:4.57~19.86).Higher life ex-pectancy,years of education and gross national income per capita were associated with higher ASIRW and lower ASMRW of gynecological cancers.[Conclusion]There is still a heavy burden on the incidence and mortality of gynecological cancers globally.Breast cancer and corpus uteri cancer are high in countries or regions with very high HDI;and the incidence and mortality of cervix uteri cancer are decreased with the improvement of HDI.The cancer prevention and control policies should be formulated according to different types of cancer and HDI levels.