1990-2019年中国恶性肿瘤疾病负担变化趋势分析

高蓓; 初海超; 芦文丽; 王媛

doi:10.16462/j.cnki.zhjbkz.2022.04.012

1990-2019年中国恶性肿瘤疾病负担变化趋势分析

doi: 10.16462/j.cnki.zhjbkz.2022.04.012

300070 天津，天津医科大学公共卫生学院流行病与卫生统计学系

基金项目:

国家自然科学基金 72074166

详细信息

通讯作者:
王媛，E-mail: wangyuan@tmu.edu.cn

中图分类号: R181;R73-31
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出版历程
- 收稿日期: 2021-06-04
- 修回日期: 2021-12-03
- 刊出日期: 2022-04-10

Changing trend concerning the burden of cancer between 1990 and 2019 in China

Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China

Funds:

National Natural Science Foundation of China 72074166

More Information

Corresponding author: WANG Yuan, E-mail: wangyuan@tmu.edu.com

摘要

摘要: 目的分析1990―2019年恶性肿瘤在中国造成的疾病负担现状与趋势，为恶性肿瘤防治提供理论依据。方法使用2019年全球疾病负担研究的数据，采用粗发病率、粗死亡率及其标化率评估恶性肿瘤发病和死亡水平，采用伤残损失寿命年(years of lived with disability, YLDs)、过早死亡损失寿命年(years of life lost, YLLs)和伤残调整寿命年(disability-adjusted life years, DALYs)等疾病负担指标评价中国不同性别和年龄的恶性肿瘤疾病负担情况，分析1990―2019年恶性肿瘤的疾病负担变化趋势。结果与1990年相比，2019年中国恶性肿瘤发病人数及死亡人数分别增加170.07%和86.10%，粗发病率与粗死亡率分别上升124.76%和54.87%，标化发病率上升24.18%，标化死亡率下降19.06%。中国恶性肿瘤标化YLDs率在各级社会发展指数(socio-demographic index, SDI)国家中处于中等水平，但标化YLLs率及DALYs率处于较高水平。中国总体标化YLDs率[平均年度变化百分比(average annual percentage change，AAPC)为1.56%, P < 0.001)]呈上升趋势，标化YLLs率及标化DALYs率(AAPC分别为-1.15%和-1.10%, 均有P < 0.05)呈下降趋势。相较于女性，男性的整体标化YLDs率上升速度较快，标化YLLs率和DALYs率下降速度较慢。15~ < 50岁组的整体标化YLDs率上升速度较快，≥70岁组的整体标化YLLs率和DALYs率下降速度较慢。男性和50~ < 70岁组的YLDs、YLLs和DALYs构成占比最大。DALYs构成中，YLLs构成占比大于YLDs，且呈下降趋势。结论 1990―2019年中国恶性肿瘤的疾病负担仍较重，尤其是男性和中老年人群，YLLs是疾病负担过重的主要原因。应采取针对性措施进行管理和预防。
- 恶性肿瘤 /
- 疾病负担 /
- 变化趋势
Abstract: Objective To analyze the status and temporal trend on the burden of cancer between 1990 and 2019 in China, so as to provide evidence for formulating strategies for preventing and treating cancer. Methods Using the Global Burden of Disease Study 2019 (GBD2019) results, the incidence, mortality and their corresponding standardized rates were used to evaluate the morbidity and mortality level of cancer. Years of life lost (YLLs), years of lived with disability (YLDs) and disability-adjusted life years (DALYs) related to cancer were collated, and analysis of trend in these indicators were used to assess the burden of cancer between genders and age groups from 1990 to 2019. Results Comparing to 1990, the numbers of new cases and deaths of cancer in China increased by 170.07% and 86.10%, and the crude rates of incidence and mortality increased 124.76% and 54.87%, respectively in 2019. After age standardization, incidence increased by 24.18%, while mortality decreased by 19.06% in 2019. The standardized YLDs rate was at a medium level but YLLs and DALYs rates were at a high level among other socio-demographic index(SDI) countries. From 1990 to 2019, the overall standardized YLDs rate (AAPC=1.56%, P < 0.001) of cancer in China showed an increasing trend, while the overall standardized YLLs and DALYs rates (AAPC₁=-1.15%, AAPC₂=-1.10%, all P < 0.05) showed a decreasing trend. Compared with females, the average annual increase was faster of standardized YLDs rate in males whereas decline was smaller of standardized YLLs and DALYs rates. Similarly, the average annual increase was faster of standardized YLDs rate in 15- < 50 age group whereas decline was smaller of standardized YLLs and DALYs rates in≥70 age group. Moreover, the proportion of YLDs, YLLs and DALYs in males and 50- < 70 age group accounted for the largest. As for the composition in DALYs, YLLs appeared much larger than YLDs and decreased slowly. Conclusions The disease burden of cancer was higher in males and the middle-aged and elderly; YLLs was the leading cause of overburden. Therefore, to reduce the occurrence of YLDs and YLLs, effective measures should be taken for management and prevention.
- Cancer /
- Burden of disease /
- Changing trend

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图 1 1990―2019年中国分年龄、性别的恶性肿瘤疾病负担构成

Figure 1. The composition of disease burden of cancer in different age groups and genders in China from 1990 to 2019

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图 2 1990―2019年中国与各级SDI国家疾病负担比较

Figure 2. Comparison of burden between China and other SDI countries from 1990 to 2019

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表 1 1990年与2019年中国恶性肿瘤发病与死亡情况

Table 1. The morbidity and mortality of cancer in China in 1990 and 2019

指标	人数(万)			粗率(/10万)			标化率(/10万)
指标	1990年	2019年	平均增长速度(%)	1990年	2019年	平均增长速度(%)	1990年	2019年	平均增长速度(%)
发病
总体	176.18	475.81	170.07	148.84	334.53	124.76	197.09	244.75	24.18
男性	102.55	286.06	178.95	168.07	394.67	134.82	241.00	309.56	28.45
女性	73.63	189.75	157.71	128.39	272.04	111.89	161.00	191.89	19.19
死亡
总体	145.72	271.19	86.10	123.11	190.66	54.87	173.78	140.66	-19.06
男性	89.22	174.62	95.72	146.22	240.92	64.77	226.00	197.23	-12.73
女性	56.50	96.57	70.92	98.52	138.44	40.52	131.23	95.79	-27.01

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表 2 1990―2019年中国分性别恶性肿瘤疾病负担变化情况(/10万)

Table 2. The trends of sex-specific burden of cancer in China from 1990 to 2019(/100 000)

指标	总体			男性			女性
指标	时间段(年)	估计值(%)	(95% CI)值	时间段(年)	估计值(%)	(95% CI)值	时间段(年)	估计值(%)	(95% CI)值
标化YLDs率
APC	1990―1996	0.42	0.17~0.66 ^a	1990―1997	0.45	0.22~0.68 ^a	1990―1995	0.45	0.17~0.73 ^a
	1996―2007	2.10	1.98~2.21 ^a	1997―2007	2.45	2.29~2.61 ^a	1995―2007	1.73	1.65~1.82 ^a
	2007―2010	3.05	1.58~4.54 ^a	2007―2010	3.67	1.91~5.47 ^a	2007―2010	2.43	1.15~3.72 ^a
	2010―2016	0.51	0.19~0.84 ^a	2010―2016	0.92	0.53~1.31 ^a	2010―2013	-0.30	-1.54~0.96
	2016―2019	2.55	1.82~3.29 ^a	2016―2019	2.05	1.18~2.93 ^a	2013―2016	0.50	-0.75~1.76
							2016―2019	2.85	2.21~3.49 ^a
AAPC	1990―2019	1.56	1.38~1.74 ^a	1990―2019	1.73	1.52~1.94 ^a	1990―2019	1.36	1.13~1.58 ^a
标化YLLs率
APC	1990―2000	-0.52	-0.57~-0.46 ^a	1990―2004	-0.42	-0.49~-0.35 ^a	1990―2001	-0.77	-0.86~-0.67 ^a
	2000―2004	-0.91	-1.25~-0.56 ^a	2004―2007	-2.36	-3.78~-0.91 ^a	2001―2004	-1.72	-3.10~-0.33 ^a
	2004―2007	-2.67	-3.35~-1.99 ^a	2007―2010	- 0.68	-2.13~0.79	2004―2007	-3.12	-4.47~-1.74 ^a
	2007―2010	-1.35	-2.03~-0.66 ^a	2010―2015	-1.81	-2.26~-1.35 ^a	2007―2015	-2.50	-2.68~-2.32 ^a
	2010―2015	-2.16	-2.38~-1.95 ^a	2015―2019	-0.73	-1.19~-0.27 ^a	2015―2019	0.11	-0.34~0.55
	2015―2019	-0.39	-0.61~-0.17 ^a
AAPC	1990―2019	-1.15	-1.26~-1.04 ^a	1990―2019	-0.93	-1.15~-0.71 ^a	1990―2019	-1.47	-1.68~-1.27 ^a
标化DALYs率
APC	1990―2000	-0.50	-0.55~-0.44 ^a	1990―2004	-0.39	-0.46~-0.32 ^a	1990―2002	-0.75	-0.85~-0.66 ^a
	2000―2004	-0.85	-1.19~-0.51 ^a	2004―2007	-2.27	-3.67~-0.85 ^a	2002―2015	-2.51	-2.60~-2.41 ^a
	2004―2007	-2.60	-3.27~-1.92 ^a	2007―2010	-0.60	-2.03~0.84	2015―2019	0.25	-0.26~0.76
	2007―2010	-1.25	-1.94~-0.57 ^a	2010―2015	-1.75	-2.20~-1.30 ^a
	2010―2015	-2.10	-2.32~-1.89 ^a	2015―2019	-0.67	-1.12~-0.22 ^a
	2015―2019	-0.32	-0.54~-0.11 ^a
AAPC	1990―2019	-1.10	-1.21~-0.99 ^a	1990―2019	-0.88	-1.10~-0.67 ^a	1990―2019	-1.41	-1.49~-1.32 ^a
注：^a表示P < 0.05。

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表 3 1990―2019年中国分年龄别恶性肿瘤疾病负担变化情况(/10万)

Table 3. The trends of age-specific burden of cancer in China from 1990 to 2019(/100 000)

指标	15~＜50岁			50~＜70岁			≥70岁
指标	时间段(年)	估计值(%)	(95% CI)值	时间段(年)	估计值(%)	(95% CI)值	时间段(年)	估计值(%)	(95% CI)值
标化YLDs率
APC	1990―1993	2.56	1.34~3.79 ^a	1990―1998	-0.30	-0.46~-0.13 ^a	1990―1998	0.99	0.84~1.15 ^a
	1993―1999	4.51	3.95~5.06 ^a	1998―2004	3.04	2.70~3.39 ^a	1998―2004	4.03	3.71~4.36 ^a
	1999―2006	1.07	0.66~1.48 ^a	2004―2007	1.74	0.22~3.28 ^a	2004―2007	1.72	0.29~3.16 ^a
	2006―2010	6.41	5.15~7.69 ^a	2007―2011	2.95	2.18~3.73 ^a	2007―2010	3.21	1.77~4.68 ^a
	2010―2016	1.41	0.87~1.95 ^a	2011―2016	0.32	-0.16~0.80	2010―2016	0.67	0.35~0.98 ^a
	2016―2019	3.60	2.37~4.85 ^a	2016―2019	1.94	1.18~2.71 ^a	2016―2019	2.51	1.79~3.24 ^a
AAPC	1990―2019	2.99	2.70~3.27 ^a	1990―2019	1.38	1.17~1.60 ^a	1990―2019	2.01	1.79~2.23 ^a
标化YLLs率
APC	1990―1996	2.17	1.57~2.78 ^a	1990―1998	-1.28	-1.47~-1.09 ^a	1990―1998	0.08	-0.07~0.22
	1996―2000	0.57	-1.17~2.35	1998―2004	-0.33	-0.73~0.07	1998―2004	1.76	1.46~2.06 ^a
	2000―2006	-4.06	-4.81~-3.31 ^a	2004―2007	-2.98	-4.70~-1.23 ^a	2004―2007	-2.13	-3.41~-0.84 ^a
	2006―2010	0.69	-1.05~2.47	2007―2012	-1.42	-1.98~-0.86 ^a	2007―2010	-0.70	-2.00~0.61
	2010―2015	-1.36	-2.45~-0.26 ^a	2012―2015	-2.45	-4.17~-0.69 ^a	2010―2015	-1.90	-2.31~-1.49 ^a
	2015―2019	0.07	-1.04~1.18	2015―2019	-0.88	-1.44~-0.32 ^a	2015―2019	-0.06	-0.47~0.36
AAPC	1990―2019	-0.47	-0.89~-0.04 ^a	1990―2019	-1.35	-1.63~-1.08 ^a	1990―2019	-0.25	-0.46~-0.05 ^a
标化DALYs率
APC	1990―1996	2.19	1.59~2.80 ^a	1990―1998	-1.27	-1.46~-1.08 ^a	1990―1998	0.09	-0.05~0.23
	1996―2000	0.61	-1.14~2.39	1998―2004	-0.28	-0.68~0.11	1998―2004	1.79	1.50~2.09 ^a
	2000―2006	-3.99	-4.74~-3.23 ^a	2004―2007	-2.90	-4.60~-1.17 ^a	2004―2007	-2.06	-3.33~-0.77 ^a
	2006―2010	0.82	-0.93~2.60	2007―2012	-1.34	-1.89~-0.79 ^a	2007―2010	-0.62	-1.91~0.69
	2010―2015	-1.29	-2.38~-0.19 ^a	2012―2015	-2.40	-4.11~-0.65 ^a	2010―2015	-1.84	-2.24~-1.43 ^a
	2015―2019	0.15	-0.96~1.26	2015―2019	-0.82	-1.37~-0.26 ^a	2015―2019	0.00	-0.41~0.42
AAPC	1990―2019	-0.40	-0.82~0.02	1990―2019	-1.30	-1.58~-1.03 ^a	1990―2019	-0.21	-0.41~-0.01 ^a
注：^a表示P<0.05。

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表 4 1990―2019年中国分年龄、性别的恶性肿瘤DALYs构成(%)

Table 4. The composition of DALYs of cancer in different age groups and genders in China from 1990 to 2019(%)

年份(年)	年龄组(岁)						性别
	15~ < 50岁		50~ < 70岁		≥70岁		男性		女性
	YLDs	YLLs	YLDs	YLLs	YLDs	YLLs	YLDs	YLLs	YLDs	YLLs
1990	1.1	98.9	1.2	98.8	1.5	98.5	1.1	98.9	1.5	98.5
1995	1.2	98.8	1.2	98.8	1.6	98.4	1.1	98.9	1.6	98.4
2000	1.4	98.6	1.4	98.6	1.7	98.3	1.3	98.7	1.9	98.1
2005	1.8	98.2	1.6	98.4	1.9	98.1	1.5	98.5	2.2	97.8
2010	2.3	97.7	2.1	97.9	2.3	97.7	1.9	98.1	2.8	97.2
2015	2.7	97.3	2.4	97.6	2.6	97.4	2.2	97.8	3.2	96.8
2019	3.0	97.0	2.6	97.4	2.9	97.1	2.4	97.6	3.4	96.6

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