摘要
目的:探讨1990—2019年中国人群肝癌各病因疾病负担变化趋势。方法:采用描述性流行病学方法。收集1990—2019年华盛顿大学健康测量及评价研究院全球疾病负担数据库中国人群因乙型肝炎病毒(HBV)感染、丙型肝炎病毒(HCV)感染、酒精、非酒精性脂肪性肝炎(NASH)及其他因素共5种病因导致的肝癌负担相关数据,包括新发病例、粗发病率、年龄标化发病率、死亡例数、粗死亡率以及年龄标化死亡率。根据全球疾病负担数据库2019年全世界标准化人口结构计算年龄标化率。观察指标:(1)1990—2019年中国人群肝癌各病因发病情况。(2)1990—2019年中国人群肝癌各病因死亡情况。(3)1990—2019年中国人群肝癌各病因年龄标化发病率变化趋势。(4)1990—2019年中国人群肝癌各病因年龄标化死亡率变化趋势。计数资料以绝对数、百分率和比值表示。依托联结点回归模型,采用Joinpoint(V.4.9.1.0)软件计算不同时段各病因导致的肝癌年龄标化发病率和死亡率的年变化率、年平均变化率(AAPC)及其95%可信区间(CI)。结果:(1)1990—2019年中国人群肝癌各病因发病情况。中国人群肝癌新发病例、粗发病率从1990年的236825例、20.01/10万变化为2019年的210462例、14.80/10万。HBV感染、HCV感染和其他因素导致的肝癌新发病例呈下降趋势,绝对数变化率分别为-14.76%、-3.98%和-26.67%。而酒精和NASH导致的肝癌新发病例呈增加趋势,绝对数变化率分别为9.31%和13.91%。(2)1990—2019年中国人群肝癌各病因死亡情况。中国人群肝癌死亡例数、粗死亡率从1990年的232449例、19.64/10万变化为2019年的187700例、13.20/10万。HBV感染、HCV感染和其他因素导致的肝癌死亡例数呈下降趋势,绝对数变化率分别为-23.34%、-10.99%和-33.75%。酒精导致的肝癌死亡例数呈缓慢下降趋势,绝对数变化率为-0.51%。而NASH导致的肝癌死亡例数呈增加趋势,绝对数变化率为6.03%。(3)1990—2019年中国人群肝癌各病因年龄标化发病率变化趋势。1990—2019年,HBV感染、HCV感染、酒精、NASH、其他因素导致的中国人群肝癌年龄标化发病率的AAPC分别为-3.61%(95%CI为-4.10%~-3.11%)、-3.57%(95%CI为-3.99%~-3.14%)、-2.79%(95%CI为-3.24%~-2.33%)、-2.65%(95%CI为-3.09%~-2.21%)、-3.62%(95%CI为-4.05%~-3.19%)。(4)1990—2019年中国人群肝癌各病因年龄标化死亡率变化趋势。1990—2019年,HBV感染、HCV感染、酒精、NASH、其他因素导致的中国人群肝癌年龄标化死亡率的AAPC分别为-3.92%(95%CI为-4.42%~-3.41%)、-3.90%(95%CI为-4.45%~-3.35%)、-3.15%(95%CI为-3.71%~-2.58%)、-2.86%(95%CI为-3.34%~-2.38%)、-4.09%(95%CI为-4.64%~-3.55%)。结论:1990—2019年中国人群肝癌疾病负担整体呈下降趋势,HBV和HCV感染导致的肝癌负担下降明显,但其仍然是导致肝癌负担严重的主要原因。酒精和NASH导致的肝癌年龄标化发病率和死亡率呈下降趋势,但新发病例仍显著增长。其他因素导致的肝癌负担呈下降趋势。
Objective To investigate the change trend of etiological burden of disease of liver cancer in the Chinese population from 1990 to 2019.Methods The descriptive epidemiologic method was conducted.Based on the Global Burden of Disease data from the Institute for Health Metrics and Evaluation at the University of Washington,the data related to liver cancer burden caused by hepatitis B virus(HBV)infection,hepatitis C virus(HCV)infection,alcohol,nonalcoholic steatohepatitis(NASH)and other factors,including number of new cases,the crude incidence rate,age-specific incidence rate,number of deaths,crude mortality rate and age-specific mortality rate,in the Chinese population from 1990 to 2019 were collected.The age-standardized rate was calculated based on the world standardized population structure in 2019 from the Global Burden of Disease data.Observation indicators:(1)the incidence of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019;(2)the mortality of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019;(3)the change trend of age-specific incidence rate of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019;(4)the age-specific mortality rate of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019.Count data were expressed as absolute numbers,percentages and ratio.Based on the junction point regression model,the Joinpoint software(V.4.9.1.0)was used to calculate the annual percentage change,average annual percentage change(AAPC)and 95%confidence intervals(CI)of age-specific incidence rate and age-specific mortality rate of liver cancer caused by different etiologies.Results(1)The incidence of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019.From 1990 to 2019,the number of new cases of liver cancer in Chinese population decreased from 236825 to 210462,and the crude incidence rate decreased from 20.01/100,000 to 14.80/100,000.The new cases of liver cancer caused by HBV infection,HCV infection and other factors showed a downward trend,and the absolute change rates were‒14.76%,‒3.98%and‒26.67%,respectively.The new cases of liver cancer caused by alcohol and NASH showed a increase trend,and the absolute change rates were 9.31%and 13.91%,respectively.(2)The mortality of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019.From 1990 to 2019,the number of deaths of liver cancer in Chinese population decreased from 232449 to 187700,and the crude mortality rate decreased from 19.64/100,000 to 13.20/100,000.The number of deaths of liver cancer caused by HBV infection,HCV infection and other factors showed a down-ward trend,and the absolute change rates were‒23.34%,‒10.99%and‒33.75%,respectively.The number of deaths of liver cancer caused by alcohol showed a slow downward trend,and the absolute change rate was‒0.51%.The number of deaths of liver cancer caused by NASH showed a increase trend,and the absolute change rate was 6.03%.(3)The change trend of age-specific incidence rate of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019.From 1990 to 2019,the AAPC of age-specific incidence rate of liver cancer caused by HBV infection,HCV infection,alcohol,NASH and other factors was‒3.61%(95%CI as‒4.10%to‒3.11%),‒3.57%(95%CI as‒3.99%to‒3.14%),‒2.79%(95%CI as‒3.24%to‒2.33%),‒2.65%(95%CI as‒3.09%to‒2.21%)and‒3.62%(95%CI as‒4.05%to‒3.19%),respectively.(4)The age-specific mortality rate of liver cancer caused by different etiologies in the Chinese population from 1990 to 2019.From 1990 to 2019,the AAPC of age-specific mortality rate of liver cancer caused by HBV infection,HCV infection,alcohol,NASH and other factors was‒3.92%(95%CI as‒4.42%to‒3.41%),‒3.90%(95%CI as‒4.45%to‒3.35%),‒3.15%(95%CI as‒3.71%to‒2.58%),‒2.86%(95%CI as‒3.34%to‒2.38%)and‒4.09%(95%CI as‒4.64%to‒3.55%),respectively.Conclusions From 1990 to 2019,the liver cancer burden of the Chinese population shows an overall downward trend,in which the liver cancer burden caused by HBV and HCV infection decreases the most,but HBV and HCV infection is still the main reason for the heavy burden of liver cancer.The age-specific incidence rate and age-specific mortality rate of liver cancer caused by alcohol and NASH show a downward trend,but the number of new cases of liver cancer caused by alcohol and NASH shows significant growth.The liver cancer burden caused by other factors shows a downward trend.
作者
张绍丽
曹毛毛
杨帆
李贺
严鑫鑫
何思怡
李倩茹
滕熠
夏昌发
陈万青
Zhang Shaoli;Cao Maomao;Yang Fan;Li He;Yan Xinxin;He Siyi;Li Qianru;Teng Yi;Xia Changfa;Chen Wanqing(National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第1期122-130,共9页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金面上项目(81974492)
深圳医疗卫生三名工程(SZSM201911015)。
关键词
肝肿瘤
疾病负担
危险因素
变化趋势
死亡
发病
Liver neoplasms
Disease burden
Risk factors
Change trend
Death
Incidence
作者简介
同等贡献:张绍丽;同等贡献:曹毛毛;通信作者:陈万青,Email:chenwq@cicams.ac.cn。
