1990—2019年中国归因于烟草的食管癌疾病负担趋势和死亡预测分析

doi:10.12114/j.issn.1007-9572.2023.0339

摘要/Abstract

摘要： 背景我国食管癌疾病负担较重，越来越多的研究显示，烟草对食管癌的发病有较大的不利影响。目的了解1990—2019年我国归因于烟草的食管癌死亡情况和疾病负担趋势，为公共卫生政策和干预措施的制定提供数据参考。方法本研究使用全球疾病负担（GBD）2019数据，提取其中中国1990—2019年由烟草引起的食管癌死亡的分年龄段、性别的数据。采用死亡率、伤残调整寿命年（DALYs）、早死寿命损失年（YLLs）、伤残寿命损失年（YLDs）指标评估中国归因于烟草的食管癌的疾病负担情况。应用Joinpoint回归软件和年龄-时期-队列模型方法分析疾病负担趋势和死亡率随年龄、时期和队列的时间变化趋势，最后运用贝叶斯年龄-时期-队列分析（BAPC）对2020—2030年中国归因于烟草的食管癌的死亡率进行预测。结果 1990—2019年，中国居民归因于烟草的食管癌所导致的死亡人数由7.64万例上升为12.39万例，增长了62.17%，标化死亡率由9.30/10万逐年下降至6.20/10万，下降了33.33%；DALYs由197.25万人年上升至282.26万人年，增长了43.10%，DALYs率由220.50/10万下降至134.47/10万，下降了39.02%。从性别上看，归因于烟草的食管癌的疾病负担主要由男性造成，2019年因为烟草所致的食管癌导致男性的死亡人数为11.77万例，标化死亡率为12.82/10万，女性的死亡人数为0.62万例，标化死亡率为0.63/10万。2019年，中国居民归因于烟草的食管癌死亡人数在>69~74岁年龄组达到顶峰，而DALYs在>64~69岁年龄组达到顶峰，分别是2.30万例和51.03万例。死亡率随着年龄的增加不断增加，尤其是50岁以后增长迅速。Joinpoint回归分析结果显示，1990—2019年中国归因于烟草的食管癌死亡率的平均年度变化百分比（AAPC）值为-1.4%〔95%CI（-1.6%，-1.2%）〕，其中女性为-3.3%〔95%CI（-3.6%，-2.9%）〕，男性为-1.3%〔95%CI（-1.4%，-1.1%）〕；DALYs率的AAPC为-1.7%〔95%CI（-1.9%，-1.5%）〕，其中女性为-3.7%〔95%CI（-4.0%，-3.4%）〕，男性为-1.5%〔95%CI（-1.7%，-1.3%）〕。归因于烟草的食管癌的死亡率年龄-时期-队列模型分析显示净偏移值为-1.690%〔95%CI（-2.024%，-1.354%）〕。预计在2020—2030年，中国居民归因于烟草的食管癌的死亡人数和死亡率较稳定，下降幅度不大，其中男性的死亡率从2020年的12.64/10万下降至2030年的12.63/10万，女性的死亡率从2020年的0.6/10万下降至2030年的0.46/10万。结论 1990—2019年中国居民归因于烟草的食管癌所导致的死亡率、DALYs率先增长后下降，从性别上看归因于烟草的食管癌的疾病负担主要由男性造成，从年龄上看主要是中老年人造成，应对该人群给予足够的重视。预计2020—2030年归因于烟草的食管癌的死亡人数和死亡率较稳定，轻微下降。

关键词: 食管癌, 吸烟, 死亡率, 伤残调整寿命年, 疾病负担, 贝叶斯年龄-时期-队列分析

Abstract:

Background

The disease burden of esophageal cancer is high in China, more and more studies have shown that tobacco has a greater adverse effect on the development of esophageal cancer.

Objective

To understand trends in esophageal cancer deaths and burden of disease attributable to tobacco in China from 1990 to 2019, and provide data to inform the development of public health policies and interventions.

Methods

Global burden of disease 2019 (GBD 2019) data were used to extract the age-specific and sex-specific data on esophageal cancer deaths attributable to tobacco in China from 1990 to 2019. Mortality, disability adjusted life years (DALYs) , years of life lost (YLLs) , and disability adjusted life years (YLDs) were used to assess the disease burden of esophageal cancer attributable to tobacco in China. Joinpoint regression software and age-period-cohort modeling methods were applied to analyze the trends of disease burden and mortality with age, period and cohort. the Bayesian-period-cohort analysis (BAPC) was applied to predict the mortality rate of esophageal cancer attributable to tobacco in China from 2020 to 2030.

Results

From 1990 to 2019, the number of deaths caused by esophageal cancer attributable to tobacco among Chinese residents rose from 76 400 to 123 900, with an increase of 62.17%, and the standardized mortality rate declined from 9.30/100 000 to 6.20/100 000, with a decrease of 33.33%; the DALYs rose from 1 972 500 person-years to 2 822 600 person-years, with an increase of 43.10%, and the DALYs rate decreased from 220.50/100 000 to 134.47/100 000, with a decrease of 39.02%. In terms of gender, the disease burden of esophageal cancer attributable to tobacco was mainly caused by males, with 117 700 deaths and a standardized mortality rate of 12.82/100 000 in 2019 due to tobacco-attributable esophageal cancer in males, compared to 0.62 million deaths number and a standardized mortality rate of 0.63/100 000 in females. In 2019, the number of esophageal cancer deaths attributable to tobacco among Chinese residents peaked in the age group of >69-74 years, while DALYs peaked in the age group of >64-69 years, at 23 000 and 510 300 cases, respectively. The mortality rate continued to increase with age, especially after 50 years of age. The results of Joinpoint regression analysis showed that the average annual percent change (AAPC) of esophageal cancer mortality attributable to tobacco was -1.4%〔95%CI (-1.6%, -1.2%) 〕 in China from 1990 to 2019, with -3.3%〔95%CI (-3.6%, -2.9%) 〕 for females, and -1.3%〔95%CI (-1.4%, -1.1%) 〕 for males; the AAPC for DALYs rate was -1.7%〔95%CI (-1.9%, -1.5%) 〕, with -3.7%〔95%CI (-4.0%, -3.4%) 〕 for females and -1.5%〔95%CI (-1.7%, -1.3%) 〕 for males. Analysis of the age-period-cohort model of mortality from esophageal cancer attributable to tobacco showed a negative net offset of -1.690%〔95%CI (-2.024%, -1.354%) 〕. It is expected that the number of deaths and mortality rate from tobacco-attributable esophageal cancer among Chinese residents will be relatively stable with a small decrease from 2020 to 2030, with mortality rates declining from 12.64/100 000 in 2020 to 12.63/100 000 in 2030 for males, and from 0.6/100 000 in 2020 to 0.46/100 000 for females.

Conclusion

Mortality rate and DALYs rate due to tobacco-attributable esophageal cancer among Chinese residents increased and then declined from 1990 to 2019. The burden of disease due to tobacco-attributable esophageal cancer is mainly caused by males in term of gender, by middle-aged and elderly people by age, which should be given sufficient attention. It is expected that the number of deaths and mortality rates from tobacco-attributable esophageal cancer will be stable and slightly decreasing from 2020 to 2030.

Key words: Esophageal neoplasms, Smoking, Mortality, Disability-adjusted life years, Burden of illness, Bayesian age-period-cohort analysis

刘爱玲,周静静,李成程,等. 1990—2019年中国归因于烟草的食管癌疾病负担趋势和死亡预测分析[J]. 中国全科医学, 2023, 26(36): 4587-4594. DOI: 10.12114/j.issn.1007-9572.2023.0339.
LIU Ailing,ZHOU Jingjing,LI Chengcheng, et al. Analysis of the Disease Burden Trends and Death Projections for Esophageal Cancer Attributable to Tobacco in China from 1990 to 2019[J]. Chinese General Practice, 2023, 26(36): 4587-4594. DOI: 10.12114/j.issn.1007-9572.2023.0339.

图/表 9

图1 1990—2019年中国归因于烟草的食管癌的死亡人数、DALYs、YLDs、YLLs变化情况注：A~D分别表示死亡人数、伤残调整寿命年（DALYs）、伤残寿命损失年（YLDs）、早死寿命损失年（YLLs）变化图。

Figure 1 Changes in deaths，DALYs，YLDs，and YLDs in esophageal cancer attributable to tobacco in China from 1990 to 2019

图2 1990—2019年中国归因于烟草的食管癌的标化死亡率、DALYs率、YLDs率、YLLs率变化情况注：A~D分别表示标化死亡率、DALYs率、YLDs率、YLLs率变化图。

Figure 2 Changes in standardized mortality rate，DALYs rate，YLDs rate，and YLDs rate for esophageal cancer attributable to tobacco in China from 1990 to 2019

图3 2019年中国归因于烟草的食管癌各年龄段分性别疾病负担变化趋势注：A表示2019年不同性别各年龄段死亡人数情况，B表示2019年不同性别各年龄段DALYs情况。

Figure 3 Trends in the burden of disease for esophageal cancer attributable to tobacco by age group and gender in China in 2019

图4 2019年中国归因于烟草的食管癌各年龄段分性别疾病负担变化趋势注：A表示2019年不同性别各年龄段死亡率，B表示2019年不同性别各年龄段DALYs率。

Figure 4 Trends in the burden of disease for esophageal cancer attributable to tobacco by age group and gender in China in 2019

表1 1990—2019年中国归因于烟草的食管癌死亡率的变化趋势

Table 1 Trends in esophageal cancer mortality attributable to tobacco in China from 1990 to 2019

分类	时间（年）	APC（%）	95%CI（%）	P值	AAPC（%）	95%CI（%）	P值
总人群	1990—1998	-0.1	（-0.4，0.1）	0.027	-1.4	（-1.6，-1.2）	<0.001
总人群	1998—2004	1.8	（1.3，2.3）	<0.001
总人群	2004—2014	-4.4	（-4.6，-4.3）	<0.001
总人群	2014—2017	-2.2	（-3.7，-0.7）	0.007
总人群	2017—2019	0.5	（1.3，2.3）	0.055
女性	1990—1993	3.7	（2.6，4.8）	<0.001	-3.3	（-3.6，-2.9）	<0.001
女性	1993—1998	-0.2	（-0.9，0.5）	0.052
女性	1998—2001	1.4	（-0.8，3.8）	0.019
女性	2001—2004	-1.1	（-3.4，1.3）	0.034
女性	2004—2015	-8.3	（-8.5，-8.2）	<0.001
女性	2015—2019	-2.7	（-3.3，-2.1）	<0.001
男性	1990—1997	-0.6	（-0.9，-0.3）	<0.001	-1.3	（-1.4，-1.1）	<0.001
男性	1997—2004	1.7	（1.3，2.1）	<0.001
男性	2004—2015	-3.8	（-3.9，-3.6）	<0.001
男性	2015—2019	-0.6	（-1.2，-0.1）	0.026

表2 1990—2019年中国归因于烟草的食管癌分年龄段的死亡率的变化趋势

Table 2 Trends in age-specific mortality rates for esophageal cancer attributable to tobacco in China from 1990 to 2019

年龄（岁）	AAPC（%）	95%CI（%）	P值
30~34	-1.7	（-2.6，-0.8）	<0.001
>34~39	-2.2	（-2.6，-1.8）	<0.001
>39~44	-3.0	（-3.3，-2.8）	<0.001
>44~49	-2.7	（-3.2，-2.2）	<0.001
>49~54	-2.4	（-2.7，-2.1）	<0.001
>54~59	-2.3	（-2.7，-1.9）	<0.001
>59~64	-1.8	（-2，-1.6）	<0.001
>64~69	-1.8	（-2.1，-1.4）	<0.001
>69~74	-1.3	（-1.6，-1.1）	<0.001
>74~79	-1.0	（-1.4，-0.6）	<0.001
>79~84	-0.5	（-0.8，-0.1）	0.007
>84~89	0.2	（0，0.5）	0.042
>89~94	-0.6	（-0.9，-0.2）	0.001
≥95	-1.7	（-2，-1.3）	<0.001

图5 1990—2019年中国归因于烟草的食管癌死亡率的年龄-时期-队列模型效应图注：A表示净偏移值，B表示年龄效应，C表示时期效应，D表示队列效应。

Figure 5 Age-period-cohort effect plot of esophageal cancer mortality attributable to tobacco in China from 1990 to 2019

图6 2020—2030年中国归因于烟草的食管癌死亡率预测

Figure 6 Projected esophageal cancer deaths rate attributable to tobacco in China from 2020 to 2030

图7 2020—2030年中国归因于烟草的食管癌分年龄段死亡率预测

Figure 7 Projected esophageal cancer deaths rate attributable to tobacco by age group in China from 2020 to 2030

参考文献 21

[1]	LAGERGREN J, SMYTH E, CUNNINGHAM D，et al. Oesophageal cancer[J]. Lancet，2017,390(10110):2383-2396. DOI：10.1016/s0140-6736(17)31462-9.
[2]	BRAY F, FERLAY J, SOERJOMATARAM I，et al. Global cancer statistics 2018：GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin，2018,68(6):394-424. DOI：10.3322/caac.21492.
[3]	Global Burden of Disease Cancer Collaboration, FITZMAURICE C, ABATE D，et al. Global，regional，and national cancer incidence，mortality，years of life lost，years lived with disability，and disability-adjusted life-years for 29 cancer groups，1990 to 2017：a systematic analysis for the global burden of disease study[J]. JAMA Oncol，2019,5(12):1749-1768. DOI：10.1001/jamaoncol.2019.2996.
[4]	GBD 2017 Oesophageal Cancer Collaborators. The global，regional，and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories，1990-2017：a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet Gastroenterol Hepatol，2020,5(6):582-597. DOI：10.1016/S2468-1253(20)30007-8.
[5]	GBD Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and teRRitories，1990-2019：a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet，2020,396(10258):1223-1249. DOI：10.1016/S0140-6736(20)30752-2.
[6]	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories，1990-2019：a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet，2020,396(10258):1204-1222. DOI：10.1016/S0140-6736(20)30925-9.
[7]	KIM H J, FAY M P, FEUER E J，et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med，2000,19(3):335-351. DOI：10.1002/(sici)1097-0258(20000215)19:3<335:aid-sim336>3.0.co;2-z.
[8]	曾四清. Joinpoint回归模型及其在传染病流行趋势分析中的应用[J]. 中国卫生统计，2019,36(5):787-791.
[9]	曾四清，李艳，刘珺，等. 两组序列数据趋势变化特征对比分析的Joinpoint回归模型方法及应用[J]. 中国卫生统计，2021,38(2):307-311. DOI：10.3969/j.issn.1002-3674.2021.02.039.
[10]	李辉章，杜灵彬. Joinpoint回归模型在肿瘤流行病学时间趋势分析中的应用[J]. 中华预防医学杂志，2020,54(8):908-912. DOI：10.3760/cma.j.cn112150-20200616-00889.
[11]	LIU X, YU C, BI Y，et al. Trends and age-period-cohort effect on incidence and mortality of prostate cancer from 1990 to 2017 in China[J]. Public Health，2019,172:70-80. DOI：10.1016/j.puhe.2019.04.016.
[12]	WANG L, YU C H, ZHANG G S，et al. Comparison of secular trends in road injury mortality in China and the United States：an age-period-cohort analysis[J]. Int J Environ Res Public Health，2018,15(11):2508. DOI：10.3390/ijerph15112508.
[13]	梁珊珊，周智华，李成程，等. 1990—2019年中国糖尿病疾病负担及发病预测分析[J]. 中国全科医学，2023,26(16):2013-2019. DOI：10.12114/j.issn.1007-9572.2023.0009.
[14]	许晴晴，严永富，陈浩，等. 中国四大慢性病死亡率可持续发展目标实现的预测研究[J]. 中华流行病学杂志，2022,43(6):878-884. DOI：10.3760/cma.j.cn112338-20211028-00830.
[15]	陈飞，王悠清. 1990—2019年中国食管癌疾病负担及其变化趋势分析[J]. 中国肿瘤，2021,30(6):401-407. DOI：10.11735/j.issn.1004-0242.2021.06.A001.
[16]	刘俊生，武勇杰，原悦. 人口老龄化、公共支出与生态可持续[J]. 经济问题，2023(4):37-44. DOI：10.16011/j.cnki.jjwt.2023.04.010.
[17]	COOK M B, DAWSEY S M, FREEDMAN N D，et al. Sex disparities in cancer incidence by period and age[J]. Cancer Epidemiol Biomarkers Prev，2009,18(4):1174-1182. DOI：10.1158/1055-9965.EPI-08-1118.
[18]	EDGREN G, LIANG L M, ADAMI H O，et al. Enigmatic sex disparities in cancer incidence[J]. Eur J Epidemiol，2012,27(3):187-196. DOI：10.1007/s10654-011-9647-5.
[19]	GU D F, KELLY T N, WU X G，et al. Mortality attributable to smoking in China[J]. N Engl J Med，2009,360(2):150-159. DOI：10.1056/NEJMsa0802902.
[20]	WANG Q L, XIE S H, LI W T，et al. Smoking cessation and risk of esophageal cancer by histological type：systematic review and meta-analysis[J]. J Natl Cancer Inst，2017,109(12):10.1093/jnci/djx115. DOI：10.1093/jnci/djx115.
[21]	健康中国行动（2019—2030年）[EB/OL].(2019-07-15)[2023-03-02].