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| 1992-2021年中国结直肠癌筛查居民疾病负担变化趋势分析 |
| Analysis of the Trends in Disease Burden of Colorectal Cancer Screening Population in China from 1992 to 2021 |
| 投稿时间：2025-07-07 修订日期：2025-10-30 |
| DOI： |
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| 中文关键词: 结直肠癌 筛查人群 疾病负担 |
| 英文关键词:colorectal cancer screening population disease burden |
| 基金项目:广州市科技计划项目/重点研发计划（202206080008），广州市科技计划项目/市校（院）企联合资助项目（2025A03J3584） |
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| 中文摘要: |
| 摘 要：[目的] 分析1992-2021年中国40-74岁结直肠癌筛查居民的疾病负担变化趋势，为优化结直肠癌筛查策略和降低疾病负担提供科学依据。[方法] 基于2021年全球疾病负担（Global Burden of Disease,GBD 2021）数据，选取1992-2021年中国40-74岁结直肠癌的发病、死亡、伤残调整寿命年（disability-adjusted life years,DALYs）等数据，采用Joinpoint和年龄-时期-队列（age-period-cohort, APC）模型分析发病和死亡趋势，并进行分解分析。[结果] 1992-2021年，筛查人群结直肠癌发病、死亡和DALYs数量均呈上升趋势，男性上升趋势超过女性。发病粗率和男性死亡、DALYs粗率呈上升趋势，而女性死亡和DALYs粗率呈下降趋势。发病标化率男性（AAPC=2.25%，95%CI：2.17%-2.32%）增长高于女性（AAPC=1.03%，95%CI：0.97%-1.07%）；男女性死亡和DALYs标化率均呈现下降趋势，男性（AAPC=-0.13%，95%CI：-0.18%--0.09%）下降低于女性（AAPC=-1.41%，95%CI：-1.47%--1.36%）），男性（AAPC=-0.10%，95%CI：-0.14%--0.06%）DALYs标化率下降也低于女性（AAPC=-1.47%，95%CI：-1.52%--1.43%）。年龄-时期-队列分析显示，结直肠癌风险随年龄增长呈指数上升，男性各年龄组发病和死亡风险均显著高于女性。2007年后男女性发病风险均持续升高，而女性死亡和DALYs风险持续下降。男发病风险从1920-1924年0.50（95%CI：0.46-0.54）增加到1975-1979年2.25（95%CI：2.03-2.49）。分解分析表明，人口增长和老龄化是发病率增长的主要原因，流行病学变化对发病率呈正向贡献，占37.27%，而对死亡率和DALYs率呈负向贡献，分别占-30.13%和-31.63%。[结论] 本研究揭示了中国结直肠癌筛查人群的疾病负担变化特征及影响因素，提示需针对男性老年高风险人群加强健康教育和生活方式干预，扩大筛查项目覆盖范围，提高早期诊断率，并进一步研发和应用筛查及治疗技术，以降低结直肠癌疾病负担。 |
| 英文摘要: |
| Abstract: [Objective] To analyze the trends in disease burden of colorectal cancer among Chinese residents aged 40-74 undergoing screening from 1992 to 2021, and to provide scientific basis for optimizing colorectal cancer screening strategies and reducing disease burden. [Methods] Based on the data from the Global Burden of Disease 2021 study (GBD 2021) , the incidence, mortality, and disability-adjusted life years (DALYs) of colorectal cancer in China among the population aged 40-74 from 1992 to 2021 were selected. The Joinpoint and age-period-cohort (APC) models were used to analyze the trends of incidence and mortality, and decomposition analysis was conducted. [Results] From 1992 to 2021, the number of incident cases, deaths, and DALYs due to colorectal cancer in the screening population increased, with a more pronounced upward trend in males than in females. The crude incidence rate, as well as the crude mortality and DALYs rates in males, increased, while the crude mortality and DALYs rates in females decreased. The age-standardized incidence rate increased more markedly in males (AAPC=2.25%, 95% CI: 2.17%-2.32%) than in females (AAPC=1.03%, 95% CI: 0.97%-1.07%). In contrast, the age-standardized mortality and DALYs rates decreased in both sexes, with a smaller decline in males (mortality AAPC=-0.13%, 95% CI: -0.18% to -0.09%; DALYs AAPC=-0.10%, 95% CI: -0.14% to -0.06%) compared to females (mortality AAPC=-1.41%, 95% CI: -1.47% to -1.36%; DALYs AAPC=-1.47%, 95% CI: -1.52% to -1.43%). The age-period-cohort analysis revealed that the risk of colorectal cancer increased exponentially with age, and the risk of incidence and mortality was significantly higher in males than in females across all age groups. After 2007, the risk of incidence continued to rise in both males and females, while the risk of mortality and DALYs continued to decline in females. The incidence risk in males increased from 0.50 (95% CI: 0.46-0.54) for the 1920-1924 birth cohort to 2.25 (95% CI: 2.03-2.49) for the 1975-1979 birth cohort. Decomposition analysis indicated that population growth and aging were the main drivers of the increase in incidence cases. Epidemiological changes contributed positively to the increase in incidence (37.27%), but negatively to the changes in mortality (-30.13%) and DALYs rates (-31.63%). [Conclusion] This study reveals the characteristics and influencing factors of the changing disease burden of colorectal cancer in the screening population in China. The findings suggest the need to strengthen health education and lifestyle interventions for high-risk groups, particularly among males and the elderly, to reduce the incidence of colorectal cancer. Additionally, expanding the coverage of screening programs, improving early diagnosis rates, and further developing and applying screening and treatment technologies are essential to reduce the disease burden of colorectal cancer. |
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