我国1990-2019年归因于吸烟的口腔癌疾病负担分析及趋势预测

Disease burden and prediction of oral cancer attributable to smoking in China from 1990 to 2019

目的通过分析1990-2019年我国归因于吸烟的口腔癌疾病负担变化趋势,为制订针对性的口腔癌防治策略和实现“健康中国2030”目标提供科学依据。方法利用2019年全球疾病负担中国部分数据,采用归因死亡和伤残调整生命年(disability adjusted life year,DALY)进行描述。以世界人口为标准,使用Joinpoint回归模型估计年龄标化死亡率和年龄标化DALY率的平均年度百分比变化率,分析归因于吸烟的口腔癌疾病负担变化趋势。同时,基于贝叶斯年龄-时期-队列模型预测2020—2034年归因于吸烟的口腔癌死亡和DALY趋势。结果1990-2019年我国年龄标化死亡率和DALY率整体呈上升趋势,平均每年分别上升1.49%(95%CI:1.34%~1.65%,P<0.001)和1.41%(95%CI:1.24%~1.59%,P<0.001),且高于全球及不同社会人口学指数(socio-demographic index,SDI)地区。2019年我国有46.74%(10584/22642)的口腔癌死亡归因于吸烟,与1990年相比,2019年归因死亡人数增长了293.75%(7896/2688),DALY增长了257.97%(189039/73280),且男性归因死亡人数增长率和DALY增长率[分别为304.95%(7584/2487)和265.60%(183349/69033)]均显著高于女性[分别为154.73%(311/201)和133.95%(5690/4248)](P<0.001)。年龄分组结果显示,归因死亡人数和DALY占比逐渐向老年人(>60岁)过渡。预计死亡人数将从2020年的10731人上升至2034年的14125人,增长31.63%(3394/10731);DALY将从2020年的267064人年上升至2034年的326634人年,增长22.31%(59570/267064)。结论1990—2019年我国归因于吸烟的口腔癌疾病负担呈升高趋势,且涨幅高于全球及不同SDI地区,不同性别、年龄间归因于吸烟的口腔癌疾病负担存在差异;2020—2034年我国归因于吸烟的口腔癌疾病负担将持续加重,有必要加强烟草消费行为的宣传教育,同时应加强高危人群的口腔自我检查,助力口腔癌的早发现早干预。

Objective To analyze the trend of disease burden of oral cancer attributable to smoking in China from 1990 to 2019,and predict the mortality trend of oral cancer from 2020 to 2034,providing scientific basis for formulating targeted oral cancer prevention and treatment strategy to achieve the goal of"Healthy China 2030".Methods Using partial data on the global burden of disease in China in 2019,attributive death and disability adjusted life year(DALY)were used to describe.The trend of changes in the burden of oral cancer disease attributed to smoking was analyzed by using the Joinpoint regression model to estimate the annual average percentage change(AAPC)of age standardized mortality and DALY rates.Meanwhile,the Bayesian age-period-cohort model is used to predict oral cancer deaths and DALY trends attributed to smoking over the next 15 years.Results The age-standardized mortality rate and DALY rate in China from 1990 to 2019 showed an overall upward trend,with an average annual increase of 1.49%(95%CI:1.34%-1.65%,P<0.001)and 1.41%(95%CI:1.24%-1.59%,P<0.001)respectively,higher than around the earth and in regions with different socio-demographic index(SDI).In 2019,46.74%(10584/22642)of oral cancer deaths in China were attributed to smoking.Compared to 1990,the number of attributed deaths in 2019 increased by 293.75%(7896/2688),while DALY increased by 257.97%(189039/73280).Moreover,the growth rates of attributed deaths and DALY in males[304.95%(7584/2487)and 265.60%(183349/69033),respectively]were significantly higher than those in females[154.73%(311/201)and 133.95%(5690/4248),respectively](P<0.001).The age group results showed that the proportion of deaths and DALY gradually transitioned towards the elderly(>60 years old).The expected number of deaths would increase from 10731 in 2020 to 14125 in 2034,with a rise of 31.63%(3394/10731).Simultaneously,DALY would increase from 267064 person years in 2020 to 326634 person years in 2034,with a rise of 22.31%(59570/267064).Conclusions From 1990 to 2019,the burden of oral cancer diseases attributed to smoking in China showed an increasing trend,with a higher growth rates than in the global and different SDI regions.There were differences in gender and age,and the burden of oral cancer diseases attributed to smoking in China would continue to increase in the next 15 years.It is necessary to educate on the adverse effects of tobacco consumption and to conduct vigilant oral self-examination among high-risk groups to help early detection and intervention at the same time.