2010—2020年中国城乡人口老龄化对四种主要癌症负担的量化研究

A Quantitative Study of the Burden of Aging on Four Major Cancers in Urban and Rural China from 2010 to 2020

目的:中国作为一个发展中国家,正面临着城乡差距大、人口老龄化加速的问题。因此,迫切需要量化人口老龄化对农村和城市的癌症负担的影响。方法:利用《全国疾病监测系统死因监测数据集》(2010—2020年),选取了我国癌症负担较重的四种癌症:肺癌、结直肠癌、食管癌、胃癌。按照城乡和性别进行分类,分别展现了这四种癌症的疾病负担变化情况,并通过分解法分解和量化了人口老龄化和其他因素对2010—2020年癌症负担的影响。R值用于比较人口老龄化和其他因素对疾病负担的影响。结果:我国肺癌、结直肠癌粗死亡率总体呈上升趋势,食管癌、胃癌总体呈下降趋势,标化年龄结构后,四种癌症标化死亡率均有所下降。通过对四种癌症的死亡率变化进行分解和量化分析,发现了三种模式:(1)人口老龄化是疾病负担的主导原因,超过了其他因素的保护作用,如城市地区肺癌(男性R=-0.51)、结直肠癌(男性R=-0.05)、食管癌(男性R=-0.51)及农村地区肺癌(男性R=-0.20);(2)人口老龄化并不占主导地位,不及其他因素的保护作用,从而呈现出疾病死亡率下降,如城乡胃癌(城市男性R=-1.26)和农村地区食管癌(男性R=-1.12);(3)人口老龄化和其他因素均导致疾病负担增加,如农村地区结直肠癌(男性R=0.31)。结论:卫生资源分配应优先考虑受人口老龄化影响较大的地区或癌症。由于人口迅速地老龄化,未来癌症负担将继续增加,但可以通过加强癌症控制和预防来抵消甚至扭转老龄化带来的影响。

Objective:As a developing country,China is facing the problem of large gap between urban and rural areas and accelerating population aging.There is therefore an urgent need to quantify the impact of population ageing on the cancer burden in both rural and urban areas.Methods:Four types of cancer with heavy cancer burden in China were selected based on the data set of National Disease Surveillance System for Cause of Death(2010—2020):lung cancer,colorectal cancer,esophageal cancer and gastric cancer.Disaggregated by urban and rural areas and by sex,the changes in disease burden of these four types of cancer are presented respectively,and the effects of population aging and other factors on cancer burden in 2010—2020 are decomposed and quantified by decomposition method.R-values are used to compare the effects of population aging and other factors on the burden of disease.Results:The crude death rate of lung cancer and colorectal cancer in China was on the rise,while that of esophageal cancer and gastric cancer was on the decline.The standardized death rate of the four cancers decreased after standardized age structure.By breaking down and quantifying mortality changes for the four cancers,three patterns were found:(1)Population aging is the leading cause of disease burden,outweighing the protective effect of other factors such as lung cancer(R=-0.51 men)in urban areas,colorectal cancer(R=-0.05 men),esophageal cancer(R=-0.51 men)and lung cancer in rural areas(R=-0.20 men).(2)Population aging is not dominant and is less protective than other factors,resulting in a decline in disease mortality,such as urban and rural gastric cancer(R=-1.26 in urban men)and rural esophageal cancer(R=-1.12 in rural men).(3)Population aging and other factors contribute to increased disease burden,such as colorectal cancer in rural areas(R=0.31 men).Conclusion:Priority should be given to areas affected by population aging or cancer in the allocation of health resources.Due to the rapid aging of the population,the burden of cancer will increase in the future.