中国及各省呼吸道癌症负担，1990-2021:2021年全球疾病负担研究的系统分析

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2025-02-01 DOI:10.1016/j.lanwpc.2025.101485

Xiaozhu Liu , Qizhi Yang , Liming Pan , Yanfang Ye , Lirong Kuang , Dandan Xu , Liuhua Wang , Shuang Hu , Yifeng Nie , Jian Huang , Jinxiu Qu , Chenan Liu , Wanyan Tang , Pengpeng Ye , Queran Lin , Ying Hu , Wenyi Jin

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引用次数: 0

摘要

背景：尽管有许多国家政策（如早期癌症筛查）到位，但呼吸道癌症已成为中国所有癌症类型中发病率和死亡率最高的公共卫生挑战。监测中国及其各省呼吸道癌症负担对于完善卫生战略至关重要。方法基于全球疾病负担（GBD）估计，本研究调查了1990年至2021年中国呼吸道癌症发病率、患病率、死亡率和残疾调整生命年（DALYs）的年龄-性别特异性模式变化，以及其估计年百分比变化（EAPC）、年龄标准化发病率（ASIR）和年龄标准化死亡率（ASMR）。研究结果：1990年至2021年间，中国呼吸道癌症负担不断增加，新病例从274,752例（95%不确定区间（UI）： 234,741-315,112例）激增至934,704例（750,040-1,136,938例），增加了240.20%（156.05-342.29）。他们的死亡人数同样从278,235人（238,518-322,013人）增加到814,121人（652,231-994,858人）。2021年，东部和东北地区发病率和死亡率最高，以山东最高，新增病例77225例（58842 - 101352例），西藏、青海和澳门最低。关于喉癌，广东报告的发病率最高，为3466(2230-4934)，海南的ASIR最高，为3.46(2.10-5.11)/ 100000人年，ASMR最高，为2.11(1.37-3.09)/ 100000人年。在同一时间段内，气管、支气管和肺癌的ASIR的EAPC为0.88 (0.63-1.14)，ASMR的EAPC为0.29(0.05-0.62)，呈上升趋势。相反，喉癌表现出稳定的ASIR， EAPC为0.04(- 0.22至0.30)，ASMR下降，EAPC为- 1.69（- 1.80至1.59）。气管、支气管和肺癌负担的性别差异显著，男性的ASIR为62.63(46.50-79.90)/ 10万人-年，女性为28.16(22.22-34.90)/ 10万人-年。对于喉癌，男性的ASIR为3.12(2.34-4.04)/ 10万人年，女性为0.58(0.35-0.79)/ 10万人年。吸烟和空气污染是导致气管、支气管和肺癌的主要危险因素，分别占死亡总数的61.58%（30.00 ~ 82.95%）和25.98%（16.94 ~ 35.00）。相比之下，吸烟对喉癌死亡的贡献更大（76.70%[65.55-85.15]），其次是饮酒（14.52%[7.70-20.99]）。在过去的三十年中，中国呼吸道癌症的负担有所增加，如果不进行干预，相关的健康损失可能会进一步升级。这种负担主要影响东部省份，尤其是老年男性。我们的研究结果提倡根据地区和性别差异制定有针对性的预防、筛查和干预策略。FundingBill,梅琳达·盖茨基金会。

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Burden of respiratory tract cancers in China and its provinces, 1990–2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Respiratory tract cancers emerged as a public health challenge with the highest incidence and mortality among all cancer types in China, despite many national policies in place, such as early cancer screening. It is of outmost importance to monitor the burden of respiratory tract cancers across China and its provinces for refining health strategies.

Methods

Based on Global Burden of Disease (GBD) estimates, the present study investigated the age-sex specific pattern alterations of incidence, prevalence, mortality, and disability adjusted life years (DALYs) of respiratory tract cancers in China from 1990 to 2021, as well as its Estimated Annual Percentage Change (EAPC), Age-Standardized Incidence Rate (ASIR), and Age-Standardized Mortality Rate (ASMR).

Findings

Between 1990 and 2021, China experienced an escalation in burdens of respiratory tract cancers, with the new cases surging from 274,752 (95% Uncertainty Interval (UI): 234,741–315,112) to 934,704 (750,040–1,136,938), marking an increase of 240.20% (156.05–342.29). Their attributed deaths similarly increased from 278,235 (238,518–322,013) to 814,121 (652,231–994,858). In 2021, the eastern and northeastern regions reported the highest incidence and mortality rates, particularly Shandong, with the highest new cases at 77,225 (58,842–101,352), while Tibet, Qinghai, and Macau observed the lowest. Regarding laryngeal cancer, Guangdong reported the highest incidence at 3466 (2230–4934), with Hainan exhibiting the highest ASIR at 3.46 (2.10–5.11) per 100,000 person-years and ASMR at 2.11 (1.37–3.09) per 100,000 person-years. Over the same timeframe, the EAPC for the ASIR of tracheal, bronchus, and lung cancer was 0.88 (0.63–1.14), and for ASMR, it was 0.29 (0.05–0.62), signifying an upward trend. Conversely, laryngeal cancer exhibited a stable ASIR with an EAPC of 0.04 (−0.22 to 0.30) and a declining ASMR with an EAPC of −1.69 (−1.80 to 1.59). Tracheal, bronchus, and lung cancer burdens exhibited notable sex differences, with their ASIR being 62.63 (46.50–79.90) per 100,000 person-years in males and 28.16 (22.22–34.90) per 100,000 person-years in females. For laryngeal cancer, the ASIR was 3.12 (2.34–4.04) per 100,000 person-years for males and 0.58 (0.35–0.79) per 100,000 person-years for females. Smoking and air pollution emerged as the predominant risk factors contributed to tracheal, bronchus, and lung cancer, accounting for 61.58% (30.00–82.95) and 25.98% (16.94–35.00) of deaths, respectively. In contrast, smoking contributed more to laryngeal cancer-caused deaths (76.70% [65.55–85.15]), followed by alcohol use (14.52% [7.70–20.99]).

Interpretation

The burden of respiratory tract cancers in China has increased over the past three decades, and without intervention, the associated health losses could escalate further. This burden predominantly affected the eastern provinces, particularly impacting older males. Our findings advocate for the formulation of targeted prevention, screening, and intervention strategies based on regional and sex disparities.

Funding

Bill & Melinda Gates Foundation.

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.