背景:通过系统了解癌症负担的现状和未来趋势为专家提供了重要信息,政策制定者,和特定的风险人群。
方法:本研究的目的是比较当前和未来胃肠道(GI)和呼吸道的癌症负荷的大小和分布。收集了全球疾病负担(GBD)数据库中总共八种消化道和呼吸道癌症的数据。年龄标准化发病率/死亡率(ASIR/ASDR),残疾调整寿命年(DALYs),并对估计的年度百分比变化(EAPC)进行了分析。使用贝叶斯年龄周期队列(BAPC)和NORDPRED模型预测未来趋势。
结果:在2019年,与1990年相比,消化道和呼吸道癌症的DALY均显着增加。同时,ASIR略有增加,ASDR显著下降。2019年,DALY的全球呼吸道和消化道癌症负担分别为38568363.53和66912328.72,在ASIR中34.28和55.32,每100,000人口的ASDR分别为656.82和808.22,变化分别为54.63%和43.93%,+2.92%和+5.65%,与1990年相比,分别为-17.39%和-26.83%。在区域之间观察到癌症负担的显着跨区域差异。与四种代表性慢性病相比,癌症的负担显示出更少的缓解和更大的全球不平等。就ASIR而言,男性的消化道和呼吸道癌症的负担均高于女性,ASDR,DALY男性呼吸道癌症的发病率和死亡率是女性的3-4倍,而男性和女性消化道癌症发病率之间的差异相对较小。与各种消化道和呼吸道癌症相关的主要危险因素是烟草,导致呼吸道癌症的ASDR为18.5,DALY为3.38×107;消化道癌症的ASDR为8.29,DALY为1.60×107,2019年。此外,饮酒有助于大多数消化道和呼吸道癌症(对于呼吸道癌症,在ASDR中为1.23/1.03,在DALY中为1.60×106/2.57×106;对于消化道癌症,在ASDR中为4.19/3.82,在DALY中为4.49×106/8.06×106),除了胃癌和气管,支气管,还有肺癌.在2020年至2044年间,呼吸道和消化道的癌症负担可能会大幅下降。对于大多数指标,除了ASIR和ASDR和ASDALY在消化道癌症中的男女比例,在过去的几十年中,全球范围内的负担指标差异一直在减少,并且可能在未来保持稳定的趋势。
结论:呼吸道和胃肠道癌症的流行病学具有共同特征和个体特征,反映在地理上,年龄特征,和风险因素。流行病学现状,未来趋势,这些疾病负担的全球化是科学规划资源以最大程度地减少癌症负担指标及其跨区域不平等的重要因素。
BACKGROUND: Understanding the current status and future trends of cancer burdens by systems provides important information for specialists, policymakers, and specific risk populations.
METHODS: The aim of this study was to compare the current and future cancer burdens of the gastrointestinal (GI) and respiratory tracts in terms of their magnitude and distribution. Data from a total of eight cancers of the digestive and respiratory tracts in the Global Burden of Disease (GBD) database were collected. The age-standardized incidence/death rates (ASIR/ASDRs), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) were analyzed. Future trends were predicted with Bayesian age-period-cohort (BAPC) and NORDPRED models.
RESULTS: In 2019, there was a significant increase in DALY for both digestive and respiratory tract cancers compared to 1990. Meanwhile, ASIR increased slightly and ASDR decreased notably. In 2019, the global cancer burdens of respiratory and digestive tracts were 38568363.53 and 66912328.72 in DALY, 34.28 and 55.32 in ASIR, and 656.82 and 808.22 in ASDR per 100,000 population with changes of +54.63% and +43.93%, +2.92% and +5.65%, and -17.39% and -26.83% compared to those in 1990, respectively. Significant cross-regional differences in the cancer burdens were observed among the regions. Compared to four representative chronic diseases, the burden of cancers showed less remission and greater global inequalities. The burdens of both digestive and respiratory tract cancers were higher in males than in females in terms of the ASIR, ASDR, and DALY. The incidence and mortality rates of respiratory tract cancers were up to 3-4 times higher in males than in females, whereas the difference between male and female rates of digestive tract cancers was relatively smaller. The main risk factor associated with all kinds of digestive and respiratory tract cancers is tobacco, leading to 18.5 in ASDR and 3.38×107 in DALY for respiratory tract cancers; 8.29 in ASDR and 1.60×107 in DALY for digestive tract cancers, in 2019. Additionally, alcohol use contributes to most digestive and respiratory tract cancers (1.23/1.03 in ASDR and 1.60×106/2.57×106 in DALY for respiratory tract cancers; 4.19/3.82 in ASDR and 4.49×106/8.06×106 in DALY for digestive tract cancers), except for stomach cancer and tracheal, bronchus, and lung cancer. The cancer burdens of respiratory and digestive tracts are likely to decrease substantially between 2020 and 2044. For most metrics, except for the ASIR and male-to-female ratios of ASDR and ASDALY in digestive tract cancers, the worldwide variances of burden metrics have been decreasing in the past decades and will possibly maintain stable trends in the future.
CONCLUSIONS: The epidemiology of respiratory and GI tract cancers has common features and individual characteristics that are reflected in geography, age characteristics, and risk factors. Current epidemiological status, future trends, and the globalization of these disease burdens are important factors for making scientific planning of resources to minimize the cancer burden metrics and their cross-regional inequalities.