1990-2019年中国人群肾癌、膀胱癌和前列腺癌疾病负担分析

Disease burden of kidney cancer,bladder cancer and prostate cancer in population in China,1990-2019

目的分析1990-2019年中国肾癌、膀胱癌和前列腺癌疾病负担变化情况,并梳理不同危险因素归因疾病负担,为综合防控策略制定提供参考依据。方法采用2019年全球疾病负担研究数据,摘录1990-2019年中国肾癌、膀胱癌和前列腺癌的发病、死亡和伤残调整寿命年(DALY)粗率和年龄标化率。采用对数线性回归模型计算平均年变化百分比(AAPC),描述疾病负担变化趋势。结果1990-2019年,中国肾癌、膀胱癌和前列腺癌粗发病率均呈增长趋势,对应AAPC(95%CI)分别为5.4%(4.9%~5.9%),4.1%(3.9%~4.2%)和5.6%(5.3%~6.0%)(均P<0.001);年龄标化发病率AAPC稍减小,趋势维持一致。肾癌年龄标化死亡率(ASMR)和年龄标化DALY率呈增长趋势,AAPC(95%CI)分别为2.2%(1.5%~2.8%)和1.5%(1.2%~1.9%)(均P<0.001),膀胱癌和前列腺癌ASMR呈缓慢降低趋势,AAPC(95%CI)分别为-0.6%(-0.7%~-0.5%)(P<0.001)和-0.2%(-0.3%~-0.1%)(P=0.002),膀胱癌和前列腺癌年龄标化DALY率呈缓慢降低趋势,AAPC(95%CI)分别为-0.6%(-0.8%~-0.4%)(P<0.001)和-0.2%(-0.3%~-0.1%)(P=0.002)。吸烟所致膀胱癌、肾癌和前列腺癌DALY占比分别为48.2%、18.8%和9.8%。吸烟及高BMI所致肾癌年龄标化DALY率呈增长趋势,对应AAPC(95%CI)分别为3.0%(2.8%~3.2%)和4.9%(4.7%~5.0%)(均P<0.001),吸烟所致膀胱癌和前列腺癌年龄标化DALY率稍下降,AAPC(95%CI)分别为-0.4%(-0.6%~-0.2%)(P<0.001)和-0.3%(-0.4%~-0.1%)(P=0.001)。结论既往30年中国肾癌、膀胱癌和前列腺癌发病负担逐步加重,膀胱癌和前列腺癌死亡和DALY稍有降低。应继续加强针对吸烟、肥胖等危险因素的一级预防策略,并探索适宜人群的筛查及早诊早治干预策略。

Objective To analyze the disease burden of kidney cancer,bladder cancer and prostate cancer and attributed risk factors in China from 1990 to 2019,and provide reference for the development of comprehensive prevention and control strategies.Methods Based on the Global Burden of Disease Study 2019 platform,we collected the crude and age-standardized incidence rate,age-standardized mortality rate(ASMR),and disability-adjusted life year(DALY)of kidney cancer,bladder cancer and prostate cancer in China from 1990 to 2019.By using the log-linear regression model,trends were analyzed for overall and risk-attributable disease burden by calculating the average annual percentage change(AAPC).Results From 1990 to 2019,the crude incidence rates of kidney cancer,bladder cancer and prostate cancer showed increasing trends in China,with an AAPC of 5.4%(95%CI:4.9%-5.9%),4.1%(95%CI:3.9%-4.2%)and 5.6%(95%CI:5.3%-6.0%)(all P<0.001),respectively.Similar trends were found in age-standardized incidence rates with smaller AAPCs.For kidney cancer,the ASMR and age-standardized DALY rate significantly increased,with AAPC of 2.2%(95%CI:1.5%-2.8%)and 1.5%(95%CI:1.2%-1.9%)(all P<0.001),while the ASMR of bladder cancer and prostate cancer decreased gradually,with AAPC of-0.6%(95%CI:-0.7%--0.5%)(P<0.001)and-0.2%(95%CI:-0.3%--0.1%)(P=0.002).The age-standardized DALY rate of bladder cancer and prostate cancer decreased gradually,with AAPC of-0.6%(95%CI:-0.8%--0.4%)(P<0.001)and-0.2%(95%CI:-0.3%--0.1%)(P=0.002).Smoking was responsible for 48.2%of bladder cancer,18.8%of kidney cancer and 9.8%of prostate cancer in total DALY.The age-standardized DALY rate of kidney cancer caused by smoking and high BMI showed an increasing trend,with AAPC of 3.0%(95%CI:2.8%-3.2%)and 4.9%(95%CI:4.7%-5.0%)(all P<0.001),and smoking-attributed age-standardized DALY rates of bladder cancer and prostate cancer decreased gradually with AAPC of-0.4%(95%CI:-0.6%--0.2%)(P<0.001)and-0.3%(95%CI:-0.4%--0.1%)(P=0.001).Conclusions In the past 30 years,the disease burden of kidney cancer,bladder cancer and prostate cancer in China increased gradually,while the deaths and DALY of bladder cancer and prostate cancer decreased slightly.We should continue to strengthen the primary prevention strategies for smoking,obesity and other risk factors,and explore the appropriate screening tests and population-based screening strategies.