中国人群消化系统癌症疾病负担分析

Analysis on disease burden of digestive system cancers in population in China

目的了解中国人群消化系统癌症的发病、死亡情况及不同危险因素所导致的疾病负担的变化趋势。方法资料来源于GLOBOCAN 2020和2019年全球疾病负担研究数据库中的中国人群数据,应用Excel 2019和R 4.2.1软件,采用年龄标化发病率(ASIR)、年龄标化死亡率(ASMR)、年龄标化伤残调整寿命年(DALY)率及其变化率等指标,描述消化系统癌症归因于各类危险因素的疾病负担及其变化趋势。结果2020年中国消化系统癌症的ASIR为83.00/10万,ASMR为63.80/10万,发病和死亡例数均随年龄增长而增加,且各年龄组男性消化系统癌症发病及死亡例数均高于女性。1990-2019年中国食管癌、胃癌、肝癌的年龄标化DALY率呈下降趋势(变化率分别为-45.26%、-46.87%、-65.63%),而胰腺癌、结直肠癌、胆囊胆管癌的年龄标化DALY率呈上升趋势(变化率分别为67.61%、30.52%、7.21%),死亡率的变化趋势与DALY率一致。与归因于行为因素的年龄标化DALY率的比例相比,1990-2019年食管癌、肝癌、胰腺癌和结直肠癌归因于代谢因素的年龄标化DALY率占该癌种总年龄标化DALY率的比例均逐年升高。1990-2019年中国胃癌、肝癌、胰腺癌、胆囊胆管癌不同归因的年龄标化DALY率排序无显著变化,但食管癌和结直肠癌年龄标化DALY率的部分归因因素排序有所提前(食管癌:高BMI;结直肠癌:低牛奶摄入、低全谷物摄入)。结论2020年中国消化系统癌症的发病及死亡流行情况严重,1990-2019年中国消化系统癌症归因于代谢因素的疾病负担比例逐年上升,且部分消化系统癌症的疾病负担归因次序发生了显著变化。

Objective To explore the incidence and mortality of digestive system cancers,and the trend of the disease burden attributed to different risk factors in population in China.Methods Data were obtained from the GLOBOCAN 2020 and the Global Burden of Disease Study in 2019 databases and only the data from the Chinese population were included.Using Excel 2019 and R 4.2.1 software,indicators including age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),age-standardized disability-adjusted life year(DALY)rate and its rate of change were used to illustrate the disease burden of digestive system cancers attributed to different factors and their trends.Results In 2020,the ASIR of digestive system cancers in China was 83.00/100000,and the ASMR was 63.80/100000.The numbers of digestive system cancer cases and deaths increased with age,and more cases and deaths occurred in men than in women in all age groups.The age-standardized DALY rate of esophageal cancer,gastric cancer and liver cancers showed decreasing trends in China from 1990 to 2019(rate of change:-45.26%,-46.87%,and -65.63%,respectively),whereas the age-standardized DALY rate of pancreatic cancer,colorectal cancer and gallbladder and biliary tract cancer showed increasing trends(rate of change:67.61%,30.52%,and 7.21%,respectively).The trend of the mortality rate was consistent with the DALY rate.Compared with the age-standardized DALY rate attributed to behavioral factors,the annual proportion of the age-standardized DALY rate attributed to metabolic factors to the total age-standardized DALY rate of esophageal cancer,liver cancer,pancreatic cancer,and colorectal cancer increased from 1990 to 2019.There was no significant change in the rank of age-standardized DALY rate of gastric cancer,liver cancer,pancreatic cancer,and gallbladder and biliary tract cancer attributed to different risk factors in China from 1990 to 2019,but the rank of certain attributed risk factors for the age-standardized DALY rate of esophageal cancer and colorectal cancer moved ahead(esophageal cancer:high BMI;colorectal cancer:low milk intake,and low whole-grain intake).Conclusions The incidence and mortality of digestive system cancers was serious in China in 2020,and the annual proportion of the disease burden of digestive system cancers attributed to metabolic factors increased from 1990 to 2019.The rank of attributed risk factors for several digestive system cancers changed significantly.