中国居民癌症等四大慢病危险因素及归因疾病负担分析

Analysis of risk factors and attributable disease burden of four major chronic diseases including cancer in the Chinese population

目的评估癌症、心脑血管疾病、糖尿病及慢性呼吸系统疾病(以下简称“四大慢病”)的主要危险因素及相关危险因素暴露的疾病负担。方法本研究数据来源于2019年全球疾病负担研究(Global Burden of Disease Study,GBD)数据库,通过获取2019年我国居民四大慢病的死亡病例数和伤残调整寿命年(disability-adjusted life years,DALYs),分析四大慢病归因于相关危险因素暴露的比例。结果烟草暴露是造成恶性肿瘤疾病负担最主要的危险因素,导致的DALYs占比达31.4%;心脑血管疾病的首要危险因素是高收缩压,导致的DALYs占比达55.6%。四大慢病的共同危险因素有烟草暴露、空气污染和高身体质量指数,其中烟草暴露在恶性肿瘤和慢性呼吸系统疾病中归因风险比例最高,饮食相关危险因素、饮酒和体力活动不足与恶性肿瘤、心脑血管疾病及糖尿病密切相关。对主要恶性肿瘤疾病负担的归因分析结果显示,烟草暴露归因风险比例最高的是肺癌,其次是食管癌、胃癌、肝癌及结直肠癌。结论烟草暴露、空气污染和高身体质量指数是我国居民癌症等四大慢病的共同危险因素,能为四大慢病高风险人群筛选提供重要依据。

Objective To explore the main risk factors for cancer,cardiovascular and cerebrovascular diseases,diabetes and chronic respiratory disease(referred to as the four major chronic diseases),and to evaluate the disease burden associated with the exposure to risk factors.Methods The data of this study were collected from the 2019 Global Burden of Disease Study(GBD)database.By analyzing the number of deaths and disabilityadjusted life years(DALYs)of four major chronic diseases among Chinese residents in 2019,the proportion of these four major chronic diseases attributable to the exposure to related risk factors was determined.Results The primary risk factor for disease burden was the tobacco exposure,which accounted for 31.4%of DALYs.High systolic blood pressure was the main risk factor for cardiovascular and cerebrovascular diseases,which accounted for 55.6%of DALYs.The common risk factors of four major chronic diseases were tobacco exposure,air pollution and high body mass index(BMI);among them,tobacco exposure had the highest proportion of attributable risk in the disease burden of cancer and chronic respiratory disease.Diet related risk factors,alcohol consumption,and physical inactivity were associated with cancer,cardiovascular and cerebrovascular diseases,and diabetes.The results of the attribution analysis of major cancers showed that lung cancer had the highest proportion of attributable risk due to tobacco exposure,followed by esophageal cancer,gastric cancer,liver cancer,and colorectal cancer.Conclusions Tobacco exposure,air pollution and high BMI are common risk factors for the four major chronic diseases in Chinese residents.This result provides important evidence for highrisk population screening.