1990—2019年中国肝癌发病与死亡年龄—时期—队列模型分析及预测

Analysis and prediction of age-period-cohort model of incidence and death of liver cancer in China from 1990 to 2019

目的:了解中国人群肝癌发病率及死亡率的流行趋势,评估不同年龄、时期、出生队列对肝癌发病及死亡风险的影响,并对2020—2034年中国肝癌发病和死亡情况进行预测。方法:通过全球疾病负担数据库获得1990—2019年中国不同性别人群的肝癌发病及死亡数据,描述肝癌发病率与死亡率的时间变化趋势,并基于年龄—时期—队列模型和内生因子法估算肝癌发病及死亡的年龄效应、时期效应、队列效应。采用NORDPRED年龄—时期—队列模型对肝癌发病和死亡趋势进行拟合,并预测2020—2034年肝癌发病和死亡情况。结果:1990—2019年中国肝癌发病人数、发病率、标化发病率、死亡人数、死亡率和标化死亡率均呈现先下降后上升态势。中国肝癌的发病率和死亡率随年龄的增长呈现先下降后增长再下降的趋势,时期效应结果显示中国肝癌发病和死亡风险在1990—2014年随着年份的增加呈现逐年下降趋势,在2015—2019年有轻度上升趋势,队列效应结果显示全人群和女性的发病和死亡风险随出生队列的发展呈现显著下降趋势,男性的发病和死亡风险在1895—1909年呈现上升趋势,1910年后呈现下降趋势。2020—2034年中国肝癌的标化发病率呈现下降态势。结论:中国男性与女性肝癌发病风险和死亡风险均不同程度地受年龄效应、时期效应及队列效应的影响。不断提高肝癌筛查、诊断和治疗是降低我国肝癌发病与死亡的根本途径。

Objective:To understand the epidemiological trends of liver cancer incidence and mortality among the Chinese population,evaluate the impact of different ages,periods,and birth cohorts on the risk of liver cancer incidence and mortality,and to predict the incidences and mortality of liver cancer in China from 2020 to 2034.Methods:Using the Global Burden of Disease database,data on liver cancer incidence and mortality among different gender groups in China from 1990 to 2019 were obtained.This study describes the temporal trends of liver cancer incidence and mortality rates,and estimates the age,period,and cohort effects on liver cancer incidence and mortality using the Age-Period-Cohort model and intrinsic estimator method.The NORDPRED Age-Period-Cohort model is employed to fit the trends of liver cancer incidence and mortality,and to predict the incidence and mortality of liver cancer from 2020 to 2034.Results:From 1990 to 2019,the number of liver cancer cases,the incidence rate and standardized incidence rate,the number of liver cancer deaths,the mortality rate,the standardized mortality rate,in China all initially declining then rising.The incidence and mortality rates of liver cancer in China first decreased,then increased,and then decreased again with age.Period effect results indicated that the risk of liver cancer incidence and mortality in China decreased year by year from 1990 to 2014,with a slight upward trend from 2015 to 2019.Cohort effect results showed that the risk of incidence and mortality for the entire population and females presented a significant declining trend with the development of birth cohorts.For males,the risk of incidence and mortality increased for those born between 1895—1909 and then showed a decreasing trend from 1910 onwards.The standardized incidence rate of liver cancer in China from 2020 to 2034 is expected to decline.Conclusion:The risk of liver cancer incidence and mortality among Chinese men and women is influenced to varying degrees by age effects,period effects,and cohort effects.Continuously improving liver cancer screening,diagnosis,and treatment is the fundamental approach to reducing the incidence and mortality of liver cancer in China.