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| 1975—2024年启东市宫颈癌死亡率及潜在寿命损失分析 |
| Analysis of cervical Cancer Mortality and Years of Potential Life Lost in Qidong City, 1975—2024 |
| 投稿时间：2026-07-25 修订日期：2026-09-11 |
| DOI： |
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| 中文关键词: 宫颈癌 死亡率 潜在寿命损失 趋势分析 |
| 英文关键词:Cervical cancer Mortality rate Years of life lost Trend analysis |
| 基金项目:南通大学临床医学专项课题(2025LQ017) |
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| 中文摘要: |
| 摘要:[目的] 研究分析1975—2024年江苏省启东市居民宫颈癌死亡的变化趋势和对潜在寿命损失的影响，为制定相关防治策略提供理论依据。[方法] 根据1975—2024年启东市肿瘤登记资料，对宫颈癌死亡率和潜在寿命损失指标进行分析，计算粗死亡率（crude rate, CR）、中国人口标化死亡率（age-standardized mortality rate by Chinese standard population，ASMRC）、平均减寿年数（Average Years of Life Lost, AYLL）、标化平均减寿年数（Standardized Average Years of Life Lost, SAYLL）、潜在寿命损失率（potential years of life lost rate, PYLLR）、标化潜在寿命损失率（Standardized potential years of life lost rate，SPYLLR）等指标，采用Joinpoint 5.1.0软件对上述指标进行趋势分析。[结果] 1975—2024年启东市共报告宫颈癌死亡1 193例，占全部恶性肿瘤死亡的2.88%，50年间宫颈癌总体CR为4.19/10万， ASMRC为2.58/10万。CR在1975—2002年间呈现下降趋势，APC为-2.53%（P<0.001），2002—2024年间呈现上升趋势，APC为5.95%（P<0.001）；ASMRC在1975—2001年间呈现下降趋势，APC为-4.25%（P<0.001），2001—2024年间呈现上升趋势，APC为3.67%（P<0.001）。50年来AYLL为14.68年/人，PYLLR为0.41‰，SAYLL为24.43年/人，SPYLLR为0.68‰。AYLL在1975—2001年间呈上升趋势，APC=2.62%(P<0.001)，2001—2024年间呈下降趋势，APC=-1.44%(P=0.028)，SAYLL趋势稳定无明显变化(P>0.05)；PYLLR和SPYLLR 在1975—1998年间的APC分别为0.23%和-1.41%(P均>0.05)，1998—2024年呈上升趋势，APC分别为5.14%和4.63%(P均<0.05)。宫颈癌各年龄组CR随着年龄增加而升高，80岁以上年龄组CR达23.25/10万，分别为60—69岁组（9.30/10万）的2.50倍和40—49岁组（3.38/10万）的6.89倍。年龄组40~49岁、50~59岁和60~69岁的PYLLR 则分别为0.84‰、0.91‰和0.48‰。趋势分析40~49岁组CR存在明显上升趋势，AAPC为7.57%(P=0.001)；50~59岁组1975—1999年间APC为-7.39%(P=0.064)，1999—2024年间APC为9.31%(P=0.024)；60~69岁、70~79岁和80+岁组CR均呈现为先降后升的趋势，其中60-69岁组1975—2000年间APC为-8.19%(P<0.001)，2000—2024年间APC为4.84%(P=0.011)；70-79岁组1975—2012年间APC为-6.12%(P<0.001)，2012—2024年间APC为10.21%(P=0.030)；80+岁组1975—2004年间APC为-6.85%(P<0.001)，2004—2024年间APC为4.95%(P=0.020)。宫颈癌PYLLR 40~49岁组存在明显上升趋势，AAPC为5.97%(P=0.001)，50~59岁和60~69岁组PYLLR均呈现为先降后升的趋势，其中50~59岁组1975—1999年间APC为-6.72%(P<0.001)，1999—2024年间APC为7.83%(P=0.011)；60~69岁组1975—2000年间APC为-8.88%(P<0.001)，2000—2024年间APC为6.26%(P=0.003)。 [结论] 启东市1975—2024年宫颈癌粗死亡率与标化死亡率分别于2002年和2001年由降转升，平均减寿年数于2001年由升转降，标化平均减寿年数长期稳定，潜在寿命损失率与标化潜在寿命损失率自1998年起加速上升，60岁以上高年龄组死亡绝对水平较高，而40~59岁中年龄组死亡率及潜在寿命减寿率增速显著。建议强化三级预防闭环，推进适龄女生HPV疫苗接种、扩大成年女性筛查覆盖并提升老年患者诊疗可及性，以降低宫颈癌疾病负担。 |
| 英文摘要: |
| Abstract:[Purpose]To investigate and analyze the long-term trends in cervical cancer mortality and its impact on potential years of life lost among residents in Qidong City, Jiangsu Province from 1975 to 2024, so as to provide theoretical evidence for formulating targeted prevention and control policies.[Methods]Based on population-based cancer registry data of Qidong City covering 1975—2024, indicators related to cervical cancer mortality and premature life loss were calculated and analyzed, including crude mortality rate (CR), age-standardized mortality rate by Chinese standard population (ASMRC), potential years of life lost (PYLL), standardized potential years of life lost (SPYLL), average years of life lost (AYLL), standardized average years of life lost (SAYLL), potential years of life lost rate (PYLLR), and standardized potential years of life lost rate (SPYLLR). Joinpoint Regression Program 5.1.0 was adopted to conduct trend analysis for all above indicators.[Results]A total of 1 193 cervical cancer deaths were reported in Qidong City from 1975 to 2024, accounting for 2.88% of all deaths from malignant tumors. Over the 50-year period, the overal CR of cervical cancer was 4.19/105, and the ASMRC was 2.58 /105. The CR showed a decreasing trend from 1975 to 2002, with an APC of ?2.53% (P < 0.001), followed by an increasing trend during 2002–2024, with an APC of 5.95%( P < 0.001). The ASMRC declined from 1975 to 2001 with an APC of ?4.25% (P < 0.001) and increased thereafter from 2001 to 2024 with an APC of 3.67% (P < 0.001).The total PYLL was 10 347.00 person-years, the AYLL was 14.68 years / person, and the PYLLR was 0.41‰. After standardization, the SPYLL was 17 224.84 person-years, the SAYLL was 24.43 years /person, and the SPYLLR was 0.68‰. Trends in PYLL, PYLLR, SPYLL and SPYLLR were not statistically significant from 1975 to 1998, with APCs of 0.39%, 0.23%, ?1.24% and ?1.41%, (all P > 0.05), and subsequently exhibited rising trends from 1998 to 2024, with APCs of 4.42%, 5.14%, 3.94% and 4.63%,(all P < 0.05), while the SAYLL remained stable without obvious fluctuation throughout the study period(P > 0.05). The AYLL increased from 1975 to 2001 with an APC of 2.62% (P < 0.001) and decreased from 2001 to 2024 with an APC of ?1.44% (P = 0.028).The cervical cancer CR increased gradually with age in all age groups. The 40–49 years age group showed a prominent upward trend in CR with an AAPC of 7.57% (P = 0.001). The CR values of the 50–59 years, 60–69 years, 70–79 years and 80+ years age groups all demonstrated a trend of initial decrease followed by subsequent increase. For the 50–59 years group, the APC was ?7.39% (P = 0.064) from 1975 to 1999 and 9.31% (P = 0.024) from 1999 to 2024. For the 60–69 years group, the APC was ?8.19% (P < 0.001) from 1975 to 2000 and 4.84% (P = 0.011) from 2000 to 2024. For the 70–79 years group, the APC was ?6.12% (P < 0.001) from 1975 to 2012 and 10.21% (P = 0.030) from 2012 to 2024. For the 80+ years group, the APC was ?6.85% (P < 0.001) from 1975 to 2004 and 4.95% (P = 0.020) from 2004 to 2024. In terms of the PYLLR of cervical cancer, the 40–49 years age group presented a significant increasing trend with an AAPC of 5.97% (P = 0.001). Both the 50–59 years and 60–69 years age groups showed a biphasic trend of an initial decline followed by a rise in PYLLR. In the 50–59 years group, the APC was ?6.72% (P < 0.001) from 1975 to 1999 and 7.83% (P = 0.011) from 1999 to 2024. In the 60–69 years group, the APC was ?8.88% (P < 0.001) from 1975 to 2000 and 6.26% (P = 0.003) from 2000 to 2024.[Conclusions]In Qidong City, the CR and ASMRC of cervical cancer shifted from declining to rising in 2002 and 2001, while the AYLL reversed from increasing to decreasing in 2001. The age-standardized average years of life lost remained stable over the long term. The PYLLR and SPYLLR have accelerated upward since 1998. The absolute mortality level was higher in the elderly group aged 60 years and above, whereas the CR and PYLLR increased markedly in the middle-aged group aged 40–59 years. It is recommended to strengthen the closed-loop three-level prevention system, promote HPV vaccination among age-eligible girls, expand screening coverage for adult women, and improve access to diagnosis and treatment for elderly patients, so as to reduce the disease burden of cervical cancer. |
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