Prediction of colorectal cancer mortality burden and simulation of the effectiveness of controlling risk factors in Shandong Province by 2030
QI Xiao and YAO Xue contributed equally to this article
More Information
-
摘要:
目的 预测2030年山东省结直肠癌(colorectal cancer, CRC)的死亡负担，评估控制危险因素对减轻CRC死亡负担的效果。 方法 基于死亡风险与危险因素的相关性和比较风险评估理论，利用山东省危险因素监测数据和CRC死亡数据，结合WHO危险因素控制目标，设定不同的危险因素控制场景，采用比例变化模型估计2030年不同场景下CRC死亡情况。 结果 若危险因素暴露按自然趋势发展，2030年山东省>20岁人群CRC的死亡数和死亡率将比2013年分别增加47.68%和35.51%，标化死亡率和过早死亡概率将分别降低14.48%和10.10%。饮酒或BMI控制达标场景下，2030年山东省>20岁人群过早死亡概率将比2013年减少12.11%和11.02%。所有危险因素控制达标场景下，2030年山东省将避免413.24人死亡，过早死亡概率将降低13.14%。 结论 自然趋势下，2030年山东省>20岁人群CRC死亡数和死亡率将比2013年高，标化死亡率与过早死亡概率将下降。若所有危险因素控制达标，可降低CRC的负担，提示应加强控制饮酒和BMI管理等措施，以降低山东省CRC的死亡负担。 Abstract:Objective To predict the burden of mortality of colorectal cancer (CRC) in Shandong Province by 2030 and evaluate the effects of risk-controlling factors to reduce such burden of mortality. Methods We simulated different scenarios for colorectal cancer mortality through proportion change model in 2030. The scenarios were determined by the risk factors provided by the WHO targets. Our model was based on the correlation between mortality risk and the exposure factors and the theory of comparative risk assessment. Our data were from the risk factor surveillance and colorectal mortality data of Shandong Province. Results If the exposure to risk factors were to follow the existing trend, the number of deaths and mortality rate of colorectal cancer among people over 20 years old in Shandong Province in 2030 would increase by 47.68% and 35.51%, respectively, compared to 2013. Meanwhile, the standardized mortality rate and the probability of premature death would decrease by 14.48% and 10.10%, respectively. If alcohol consumption and BMI reached to the control targets, the probability of premature death would decrease by 12.11% and 11.02%, respectively, compared to 2013. If all risk factors reach to the control targets, we would be able to avoid 413.24 deaths by 2030 and decrease the probability of premature death by 13.14% (compared to 2013). Conclusions Under the existing trend, the number of deaths and the mortality rate of CRC in Shandong Province are expected to be higher in 2030 than in 2013, although the standardized mortality rate and the probability of premature death are anticipated decrease. Should the targeted reductions in risk factors be achieved, the burden of colorectal cancer could be reduced. The results suggest that measures such as alcohol control and BMI management will significantly reduce the mortality burden of CRC in Shandong Province. -
Key words:
- Colorectal cancer /
- Disease burden /
- Risk factors
-
表 1 2030年结直肠癌相关危险因素场景设定
Table 1. Scenario settings for colorectal cancer-related risk factors in 2030
危险因素控制场景Risk factor control scenario 场景定义Scenario definition 自然趋势Natural trend 2030年所有危险因素按2010―2018年暴露趋势变化By 2030, all risk factors are expected to change following the exposure trends from 2010 to 2018 控制场景Controlled scenario 饮酒情况达标Alcohol consumption compliance 2030年总体酒精消费量比2013年相对减少10%The overall alcohol consumption in 2030 will be 10% lower than in 2013 BMI达标BMI compliance 2030年BMI水平与2013年相同BMI levels in 2030 will remain the same as in 2013 各危险因素均达标All risk factors compliance 2030年总体酒精消费量比2013年相对减少10%，BMI水平与2013年相同Alcohol consumption in 2030 is 10% less than in 2013, with BMI unchanged 注：自然趋势场景下，采用比例变化模型[8]按既往变化趋势估计2030年危险因素暴露水平。
Notes: In the natural trend scenario, the 2030 risk factor exposure is estimated using the proportional change model.
下载: 导出CSV
表 2 2030年山东省人口预测结果
Table 2. Predicted population of Shandong Province in 2030
年龄组/岁Age group/years 人口数Population 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 20~＜25 6 456 332 16.56 0.26 25~＜30 5 612 390 19.93 0.36 30~＜35 5 055 459 54.46 1.08 35~＜40 4 779 395 71.33 1.49 40~＜45 9 287 151 184.76 1.99 45~＜50 6 964 784 351.22 5.04 50~＜55 6 367 837 533.03 8.37 55~＜60 7 649 123 758.94 9.92 60~＜65 8 803 548 1 146.98 13.03 ≥65 21 826 735 8 856.53 40.58 合计Total 82 802 754 11 993.75 14.48
下载: 导出CSV
表 3 2013年和2030年自然趋势场景下山东省>20岁人群结直肠癌死亡情况
Table 3. Mortality situation from colorectal cancer among people aged 20 and over in Shandong Province under the natural trend scenario in 2013 and 2030
性别Gender 2013年Year 2030年Year 变化情况Change situation/% 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 标化死亡率Standardizedmortalityrate/100 000-1 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 标化死亡率Standardizedmortalityrate/100 000-1 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 标化死亡率Standardizedmortalityrate/100 000-1 男性Male 4 701.48 12.40 11.32 7 187.15 17.54 10.93 52.87 41.43 -3.42 女性Female 3 419.70 8.98 8.31 4 806.60 11.49 6.62 40.56 27.92 -20.32 合计Total 8 121.18 10.69 9.79 11 993.75 14.48 8.37 47.68 35.51 -14.48
下载: 导出CSV
表 4 2013年和2030年自然趋势场景下山东省结直肠癌过早死亡情况
Table 4. Premature mortality from colorectal cancer in Shandong Province under the natural trend scenario in 2013 and 2030
性别Gender 2013年Year 2030年Year 变化情况Change situation/% 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 早死概率Prematuredeathprobability/% 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 早死概率Prematuredeathprobability/% 死亡数/例Deaths/cases 死亡率Mortality/100 000-1 早死概率Prematuredeathprobability/% 男性Male 2 233.76 8.41 0.43 3 015.80 10.70 0.41 35.01 27.11 -4.67 女性Female 1 446.28 5.52 0.28 1 771.30 6.34 0.23 22.47 14.82 -16.12 合计Total 3 680.03 6.98 0.36 4 787.10 8.52 0.32 30.08 22.21 -10.10 注：早死概率由寿命表法计算得到，表示30~70岁人群因结直肠癌死亡的可能性。
Note: The premature death probability is calculated by the life table method, indicating the possibility of death from colorectal cancer in people aged 30-70 years old.
下载: 导出CSV
表 5 2030年各种危险因素控制场景下>20岁人群结直肠癌死亡变化情况
Table 5. Changes in colorectal cancer mortality among population over 20 years old under various risk factor control scenarios in 2030
场景Scenarios 死亡数Deaths 减少人数Number of reductions① 减少比例Reduction ratio ①/% 饮酒达标Alcohol consumption compliance 男性Male 6 862.10 325.05 4.52 女性Female 4 801.85 4.75 0.10 总计Total 11 663.94 329.80 2.75 BMI达标BMI compliance 男性Male 7103.48 83.67 1.16 女性Female 4 800.66 5.94 0.12 总计Total 11 904.14 89.61 0.75 双达标Double compliance 男性Male 6 784.59 402.56 5.60 女性Female 4 795.92 10.68 0.22 总计Total 11 580.50 413.24 3.45 注：①表示与2030年自然趋势下同指标比较。
Note: ① Denotes a comparison with the same indicator under the natural trend scenario for the year 2030.
下载: 导出CSV
表 6 2030年各种危险因素控制场景下结直肠癌过早死亡情况
Table 6. Premature deaths from colorectal cancer under various risk factor control scenarios in 2030
性别Gender 饮酒达标Alcohol consumption compliance BMI达标BMI compliance 双达标Double compliance 死亡数/例Deaths/cases 减少人数Number of reductions① 死亡数/例Deaths/cases 减少人数Number of reductions① 死亡数/例Deaths/cases 减少人数Number of reductions① 男性Male 2 899.75 116.05 2 960.49 55.31 2 847.95 167.85 女性Female 1 768.98 2.32 1 767.98 3.32 1 765.66 5.64 合计Total 4 668.73 118.37 4 728.47 58.63 4 613.61 173.49 注：①表示与2030年自然趋势场景下的30~70岁人群的死亡数相比。
Note: ① Indicates a comparison with the number of deaths in the 30-70 age group under the ′natural trend′ scenario for 2030.
下载: 导出CSV
表 7 2030年各控制场景结直肠癌过早死亡概率变化情况
Table 7. Changes in premature death probability from colorectal cancer under different control scenarios in 2030
性别Gender 饮酒达标Alcohol consumption compliance/% BMI达标BMI compliance/% 双达标Double compliance/% 早死概率Premature death probability 减少比例Reduction ratio① 早死概率Premature death probability 减少比例Reduction ratio① 早死概率Premature death probability 减少比例Reduction ratio① 男性Male 0.39 8.99 0.40 7.10 0.39 10.59 女性Female 0.24 15.66 0.23 15.70 0.23 15.81 合计Total 0.31 12.11 0.32 11.02 0.31 13.14 注：①表示与2013年30~70岁人群的死亡概率相比。
Note: ① Indicates the comparison with the mortality probability of people aged 30-70 in 2013.
下载: 导出CSV
-
[1] 刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-13. DOI: 10.12151/JMCM.2021.02-01.Liu ZC, Li ZX, Zhang Y, et al. Interpretation on the report of global cancer statistics 2020[J]. J Multidiscip Cancer Manag Electron Version, 2021, 7(2): 1-13. DOI: 10.12151/JMCM.2021.02-01. [2] Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China, 2016[J]. J Natl Cancer Cent, 2022, 2(1): 1-9. DOI: 10.1016/j.jncc.2022.02.002. [3] 陈万青, 李霓, 兰平, 等. 中国结直肠癌筛查与早诊早治指南(2020, 北京)[J]. 中国肿瘤, 2021, 30(1): 1-28. DOI: 10.11735/j.issn.1004-0242.2021.01.A001.Chen WQ, Li N, Lan P, et al. China guideline for the screening, early detection and early treatment of colorectal cancer(2020, Beijing)[J]. China Cancer, 2021, 30(1): 1-28. DOI: 10.11735/j.issn.1004-0242.2021.01.A001. [4] 高显华. 结直肠癌的可变更性危险因素[J]. 人人健康, 2023, (14): 53.Gao XH. Modifiable risk factors for colorectal cancer[J]. Health for Everyone, 2023, (14): 53. [5] United Nations. Goal 3(sustainable development goals): ensure healthy lives and promote well -being for all at all ages[EB/OL]. (2015-09-25)[2024-07-16]. https://unric.org/en/sdg-3/ .[6] 中国共产党中央委员会, 中华人民共和国国务院. 中共中央、国务院印发《"健康中国2030"规划纲要》[EB/OL]. (2016-10-25)[2024-07-16]. https://www.sport.gov.cn/gdnps/files/c25531179/25531211.pdf .[7] 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. [8] Roth GA, Nguyen G, Forouzanfar MH, et al. Estimates of global and regional premature cardiovascular mortality in 2025[J]. Circulation, 2015, 132(13): 1270-1282. DOI: 10.1161/CIRCULATIONAHA.115.016021. [9] GBD Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2018, 392(10159): 1923-1994. DOI: 10.1016/S0140-6736(18)32225-6. [10] 叶青, 范周全, 杨华凤, 等. 2011年与2017年南京市25岁以上人群归因于高盐饮食的疾病负担研究[J]. 东南大学学报(医学版), 2022, 41(4): 459-464. DOI: 10.3969/j.issn.1671-6264.2022.04.001.Ye Q, Fan ZQ, Yang HF, et al. The burden of diseases from high-sodium diet among population over 25 years old in Nanjing City in 2011 and 2017[J]. J Southeast Univ (Med Sci Ed), 2022, 41(4): 459-464. DOI: 10.3969/j.issn.1671-6264.2022.04.001. [11] 王萍萍. 中国人口普查年鉴2020[M]. 北京: 中国统计出版社有限公司, 2022: 106.Wang PP. China population census yearbook 2020[M]. Beijing: China Statistics Press, 2022: 106. [12] 陈卫, 刘金菊. 近年来中国出生人数下降及其影响因素[J]. 人口研究, 2021, 45(3): 57-64.Chen W, Liu JJ. Declining number of births in China: a decomposition analysis[J]. Population Research, 2021, 45(3): 57-64. [13] 山东省发展和改革委员会. 山东省人口发展中长期规划(2021-2030年)[EB/OL]. (2021-08-27)[2024-07-16]. http://fgw.shandong.gov.cn/art/2021/8/27/art_250631_10338923.html .[14] World Health Organization. Global status report on noncommunicable diseases 2014[EB/OL]. (2014-10-26)[2024-07-16]. https://www.who.int/publications/i/item/9789241564854 .[15] 曾新颖, 李镒冲, 刘世炜, 等. 1990—2015年中国四类慢性病早死概率与"健康中国2030"下降目标分析[J]. 中华预防医学杂志, 2017, 51(3): 209-214. DOI: 10.3760/cma.j.issn.0253-9624.2017.03.004.Zeng XY, Li YC, Liu SW, et al. Subnational analysis of probability of premature mortality caused by four main non-communicable diseases in China during 1990-2015 and "Health China 2030" reduction target[J]. Chin J Prev Med, 2017, 51(3): 209-214. DOI: 10.3760/cma.j.issn.0253-9624.2017.03.004. [16] 李镒冲, 刘世炜, 王丽敏, 等. 1990年与2010年中国慢性病主要行为危险因素的归因疾病负担研究[J]. 中华预防医学杂志, 2015, 49(4): 303-308. DOI: 10.3760/cma.j.issn.0253-9624.2015.04.005.Li YC, Liu SW, Wang LM, et al. Burden of disease attributable to main behavioral risk factor of chronic disease inactivity in China, 1990 and 2010[J]. Chin J Prev Med, 2015, 49(4): 303-308. DOI: 10.3760/cma.j.issn.0253-9624.2015.04.005. [17] Wanjau MN, Aminde LN, Veerman JL. The avoidable disease burden associated with overweight and obesity in Kenya: a modelling study[J]. E Clinical Medicine, 2022, 50: 101522. DOI: 10.1016/j.eclinm.2022.101522. [18] GBD Colorectal Cancer Collaborators. The global, regional, and national burden of colorectal 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, 2019, 4(12): 913-933. DOI: 10.1016/S2468-1253(19)30345-0. [19] 李若曈, 饶蓁蓁, 傅晏红, 等. 2030年中国慢性阻塞性肺疾病的疾病负担预测与危险因素控制效果模拟[J]. 中华流行病学杂志, 2022, 43(2): 201-206. DOI: 10.3760/cma.j.cn112338-20210803-00606.Li RT, Rao ZZ, Fu YH, et al. Prediction on the burden of disease of chronic obstructive pulmonary disease and simulation of the effectiveness of controlling risk factors in China by 2030[J]. Chin J Epidemiol, 2022, 43(2): 201-206. DOI: 10.3760/cma.j.cn112338-20210803-00606. [20] 郭晓雷, 鹿子龙. 山东省慢性病及其危险因素流行现状-2018[M]. 济南: 山东科学技术出版社, 2020: 27-38.Guo XL, Lu ZL. Prevalence of chronic diseases and their risk factors in Shandong Province -2018[M]. Jinan: Shandong Science and Technology Press, 2020: 27-38. [21] 宁佩珊, 胡国清. 有害饮酒所致疾病负担的归因方法综述[J]. 中华疾病控制杂志, 2015, 19(10): 1047-1050. DOI: 10.16462/j.cnki.zhjbkz.2015.10.019.Ning PS, Hu GQ. Review on the methods of alcohol-attributable burden of diseases[J]. Chin J Dis Control Prev, 2015, 19(10): 1047-1050. DOI: 10.16462/j.cnki.zhjbkz.2015.10.019. [22] 马靖茹, 王智奕, 孙美晨, 等. 中国超重肥胖流行状况与防控工作进展[J]. 中国预防医学杂志, 2024, 25(4): 406-412. DOI: 10.16506/j.1009-6639.2024.04.004.Ma JR, Wang ZY, Sun MC, et al. Prevalence of overweight and obesity in China and progress in prevention and control[J]. Chin Prev Med, 2024, 25(4): 406-412. DOI: 10.16506/j.1009-6639.2024.04.004. [23] 翟屹. 中国成人肥胖十年变化及对死亡影响的研究[D]. 北京: 中国疾病预防控制中心, 2017.Zhai Y. A study on the change of adult obesity and its influence on mortality in China[D]. Beijing: China Center for Disease Control and Prevention, 2017. -
