背景:胰腺癌是世界上最致命的癌症之一。近年来,胰腺癌的发病率和死亡率呈逐年上升趋势。这项研究调查了年龄的独立影响,period,以及全球发病率的队列,死亡率,和1990年至2019年胰腺癌的残疾调整生命年(DALYs),并评估了不同社会人口统计学指数(SDI)水平的地区胰腺癌负担的差异。
方法:估计年龄的影响,period,和不同SDI地区的胰腺癌疾病负担队列,使用2019年全球疾病负担(GBD)研究的数据(95%不确定度区间[UI])和年龄标准化发病率净漂移(ASIR),年龄标准化死亡率(ASMR),和120个国家的胰腺癌年龄标准化DALY率(ASDR)。
结果:全球胰腺癌新病例数量从1990年的197,348(95%UI:188,604,203,971)增加到2019年的530,297(486,175,573,635),死亡人数从1990年的198,051(189,329至204,763)增加到531,107(491,948至2019年的7,566,566全球胰腺癌平均水平的ASIR从每100,000人口5.22(4.97至5.40)增加到每100,000人口6.57(6.00至7.09),ASMR从每100,000人口5.34(5.07至5.52)增加到每100,000人口6.62(6.11至7.06),ASDR从每100,000人口115.47(110.82至119.60)增加到每100,000人口139.61(130.18至149.14)。发病率,死亡率,胰腺癌的DALY发病率随着全球和所有SDI地区的年龄而增加,在85-89岁年龄组达到顶峰。在高和中高SDI地区,男性在85岁之前的增长率高于女性,而女性在85岁之后的增长率更高。75-79岁年龄组在高和中SDI地区表现出最高的DALY率,显著高于全球和其他SDI地区。从1990年到2019年,胰腺癌发病率的时期影响,死亡率,全球的DALY率大幅上升,而在高和中高SDI地区几乎保持不变。相比之下,中期效应显著增加,中低端,和低SDI地区。队列效应在中部更明显,中低端,和低SDI地区。
结论:随着人口老龄化的加剧,胰腺癌的发病率和死亡率在世界范围内都在上升,并通过减少风险因素的暴露来实现有效的防控措施。我们分析中使用的APC模型提供了一种新颖的方法来理解发病率的复杂趋势,死亡率,和胰腺癌的残疾调整寿命年。它可以告知有针对性的干预措施的发展,以减轻胰腺癌引起的严重疾病负担。
BACKGROUND: Pancreatic cancer is one of the deadliest cancers in the world. In recent years, the incidence and mortality rates of pancreatic cancer have shown an increasing trend year by year. This study investigates the independent effects of age, period, and cohort on the global incidence, mortality, and disability-adjusted life years (DALYs) of pancreatic cancer from 1990 to 2019, and evaluates the differences in the burden of pancreatic cancer across regions with different Sociodemographic Index (SDI) levels.
METHODS: Estimating the impact of age, period, and cohort on pancreatic cancer disease burden in different SDI regions using age-period-cohort modeling with data (with 95% uncertainty intervals [UI]) from the Global Burden of Disease (GBD) Study 2019 and net drift of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) for pancreatic cancer in 120 countries.
RESULTS: The number of new cases of pancreatic cancer worldwide increased from 197,348 (95% UI: 188,604,203,971) in 1990 to 530,297 (486,175,573,635) in 2019, the number of deaths increased from 198,051 (189,329 to 204,763) in 1990 to 531,107 (491,948 to 566,537) in 2019, and the number of DALY increased from 4,647,207 (4,465,440 to 4,812,129) in 1990 to 11,549,016 (10,777,405 to 1,238,912) in 2019. The ASIR of the average levels in global pancreatic cancer increased from 5.22 (4.97 to 5.40) per 100,000 population to 6.57 (6.00 to 7.09) per 100,000 population, the ASMR increased from 5.34 (5.07 to 5.52) per 100,000 population to 6.62 (6.11 to 7.06) per 100,000 population, and the ASDR increased from 115.47 (110.82 to 119.60) per 100,000 population to 139.61 (130.18 to 149.14) per 100,000 population. The incidence, mortality, and DALY rates of pancreatic cancer increase with age globally and across all SDI regions, peaking in the 85-89 age group. In high and high-middle SDI regions, the growth rate for males is higher than for females before the age of 85, while females have a higher growth rate after 85. The 75-79 age group exhibits the highest DALY rate in high and high-middle SDI regions, significantly higher than the global and other SDI regions. From 1990 to 2019, the period effects of pancreatic cancer incidence, mortality, and DALY rates have increased significantly worldwide, while remaining almost unchanged in high and high-middle SDI regions. In contrast, period effects have significantly increased in middle, low-middle, and low SDI regions. Cohort effects are more pronounced in middle, low-middle, and low SDI regions.
CONCLUSIONS: With the aggravation of population aging, the incidence and mortality rates of pancreatic cancer in the world are increasing, and effective prevention and control measures can be achieved by reducing the exposure of risk factors. The APC model used in our analysis provides a novel approach to understanding the complex trends in the incidence, mortality, and disability-adjusted life years of pancreatic cancer. It can inform the development of targeted interventions to reduce the severe disease burden caused by pancreatic cancer.