1990-2019年中国归因于吸烟因素的食管癌疾病负担分析

Disease Burden of Esophageal Cancer Attributable to Smoking from 1990 to 2019 in China

【目的】分析1990-2019年中国归因于吸烟因素的食管癌疾病负担变化趋势。【方法】利用Joinpoint4.9.1.0软件基于GBD2019在1990-2019年归因于吸烟因素的中国食管癌死亡人数、死亡率、伤残寿命调整年(DALY)数据和国家人口数据,描述疾病负担变化趋势,利用年龄-时期-队列模型分析年龄、时期、队列对归因于吸烟的食管癌疾病负担变化趋势的影响。【结果】Joinpoint分析结果显示,归因于吸烟因素的食管癌标化死亡率和DALY率的平均年变化百分比(AAPC)值分别为-1.42%和-1.72%,女性的标化死亡率和DALY率AAPC值分别为-3.26%和-3.70%,男性的标化死亡率和DALY率AAPC值分别为-1.28%和-1.54%。归因于吸烟因素的年龄别疾病负担变化趋势显示,各年龄段死亡率和DALY率随时间变化整体呈下降趋势。40~45岁段下降速度最快,死亡率和DALY率AAPC值分别为-3.05%和-3.04%,其次为45-49岁年龄段,AAPC值分别为-2.73%和-2.72%。年龄-时期-队列模型分析表明,年龄效应归因于吸烟因素的食管癌死亡率和DALY率随年龄的增大呈先上升后下降。时期效应显示归因于吸烟因素的中国食管癌死亡率随时期发展总体呈上升趋势,除2005到2010时间组下降外其他时间段均随时期推进而上升;归因于吸烟因素的中国食管癌DALY率随时期增加则呈波动变化。队列效应显示归因于吸烟因素的中国食管癌死亡率和DALY率随出生队列的发展均呈下降趋势。【结论】1990-2019年,归因于吸烟因素的食管癌疾病负担存在性别差异,随时间变化整体呈下降趋势。应加强对男性的相应健康教育,尤其是35~39岁等年龄段吸烟者的控烟教育,提高食管癌一级预防的整体水平。

【Objective】To analyze the trends in the disease burden of esophageal cancer attributed to smoking in Chi‐na from 1990 to 2019.【Methods】Using the Joinpoint 4.9.1.0 software,based on the Global Burden of Disease Study 2019 data,we examined the mortality,Disability-Adjusted Life Years(DALY)data,and death rates of esophageal cancer at‐tributed to smoking in China from 1990 to 2019,along with national population data.The trends in disease burden was de‐scribed and the age-period-cohort model was employed to analyze the effects of age,period,and cohort on the trends in disease burden due to smoking.【Results】Joinpoint analysis indicated that the age-standardized mortality rate(ASMR)and DALY rate attributable to smoking showed an average annual percent change(AAPC)of-1.42%and-1.72%,respec‐tively.For females,the AAPC values for ASMR and DALY rate were-3.26%and-3.70%,respectively,while for males,these were-1.28%and-1.54%,respectively.The disease burden by age attributable to smoking showed a general declin‐ing trend across all age groups in mortality and DALY rates.The disease burden from smoking,measured by age,dis‐played a consistent downward trend in both mortality and DALY rates across all age groups.The 40-44 age group saw the sharpest decline,with Annual Average Percent Changes(AAPC)of-3.05%for mortality and-3.04%for DALY rates.This was closely followed by the 45-49 age group,which experienced AAPC values of-2.73%and-2.72%,respectively.Analysis using the age-period-cohort model showed that the impact of age on mortality and DALY rates due to smoking ini‐tially increases with age before subsequently decreasing.The period effect revealed a general increase in the mortality rate from smoking in China,except for a dip between 2005 and 2010;otherwise,the trend was upward over time.The DALY rate demonstrated variability across different periods.The cohort effect indicated a decrease in both mortality and DALY rates due to smoking as successive birth cohorts progressed.【Conclusions】Our study reveals that the disease burden of esophageal cancer attributed to smoking factors exhibits gender differences and shows an overall declining trend over time.Efforts should be intensified to enhance health education for men,particularly focusing on smoking cessation education for smokers aged 35-39,in order to improve the overall level of primary prevention of esophageal cancer.