1990-2019年中国乙型肝炎病毒相关肝癌发病及死亡趋势分析

Incidence and mortality trends of hepatitis B virus-related liver cancer in China from 1990 to 2019

目的了解1990-2019年中国乙型肝炎病毒(HBV)相关肝癌的发病和死亡趋势,评估年龄、时期和出生队列对其影响,为制订科学、有效的防控措施提供理论依据.方法筛选2019年全球疾病负担(GBD 2019)数据库中1990-2019年中国相关数据,应用描述性流行病学方法对HBV相关肝癌的粗发病率和死亡率及标化发病率和死亡率的变化趋势进行分析,采用年龄-时期-队列(APC)模型评估年龄、时期和出生队列效应.所有统计分析均在R4.2.3以及APC Web Tool中完成.结果1990-2019年,男性HBV相关肝癌标化发病率和死亡率分别从1995年峰值30.6/10万和30.2/10万,逐年降低至2005年的11.8/10万和11.4/10万,之后基本平稳.女性标化发病率和死亡率在1995年之前均维持在6.0/10万左右,1995-2005年快速降至2.3/10万,之后逐年缓慢降至2019年的1.7/10万和1.6/10万.APC模型分析表明,1990-2019年,男性HBV相关肝癌发病率和死亡率年净变化值分别为-4.25%和-4.80%,女性分别为-5.68%和-6.14%.随着年龄增长,发病率和死亡率均呈倒"V"型变化,年龄效应在50~55岁达到顶点;时期效应在1997-2007年快速下降,之后男性发病率时期效应略有回升,女性发病率和死亡率时期效应缓慢下降并趋于稳定;男女性队列效应总体均呈下降趋势.结论1990年以来,中国HBV相关肝癌的发病率和死亡率均显著下降,但考虑到中国人口规模以及老龄化程度,HBV相关肝癌仍对中国公共卫生造成巨大压力,需加强相关研究,制定有效的防控措施.

Objective To understand the incidence and mortality trends of hepatitis B virus(HBV)-related liver cancer in China from 1990 to 2019,evaluate the impact of age,period,and birth cohort on it,and provide a theoretical basis for formulating scientific and effective prevention and control measures.Methods The trends in crude and standardized inci-dence and mortality rates of HBV-related liver cance were analyzed by applying descriptive epidemiological methods to China-related data from 1990-2019 in the Global Burden of Disease 2019(GBD 2019)database,and the age-period-cohort(APC)model was used to evaluate the effects of age,period and birth cohort.All statistical analyses were performed in R4.2.3 and APC Web Tool.Results From 1990 to 2019,the standardized incidence and mortality rates of HBV-related liver cancer in men decreased from the highest 30.6/100000 and 30.2/100000 in 1995 to 11.8/100000 and 11.4/100000 in 2005,respectively,and then remained stable.Before 1995,the standardized incidence and mortality rates of women fluctuated around 6.0/100000.From 1995 to 2005,both rapidly decreased to 2.3/100000 and then gradually de-creased to 1.7/100000 and 1.6/100000 in 2019.The results of APC model analysis showed that overall annual percent change of incidence and mortality rates of liver cancer caused by HBV from 1990 to 2019 were-4.25%and-4.80%for men and-5.68%and-6.14%for women,respectively.With the increase of age,the incidence and mortality rates of HBV-related liver cancer showed an inverted"V"distribution with a peak at the age of 50-55 years;the period effect rapidly decreased from 1997 to 2007,then the period effect of men's incidence rate slightly increased while that of women's inci-dence rate and mortality rate slowly decreased before stabilizing;the cohort effect of both men and women showed a downward trend overall.Conclusions Since 1990,the incidence and mortality rates of HBV-related liver cancer in China have significantly decreased.However,considering the population size and aging level of China,HBV-related liver cancer still poses a huge pressure on public health in China.It is necessary to strengthen relevant research and formulate effective prevention and control measures.