| 李天一,郑渊杰,滕 熠,等.1990—2021年全球及中国肺癌疾病负担变化趋势及因素分解[J].中国肿瘤,2025,34(5):355-367. |
| 1990—2021年全球及中国肺癌疾病负担变化趋势及因素分解 |
| Trends and Decompostion of Disease Burden for Lung Cancer Worldwide and in China from 1990 to 2021 |
| 投稿时间：2024-12-16 |
| DOI：10.11735/j.issn.1004-0242.2025.05.A005 |
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| 中文关键词: 肺癌 疾病负担 变化趋势 危险因素 中国 |
| 英文关键词:lung cancer disease burden changing trend risk factor China |
| 基金项目:首都卫生发展科研专项（2024-1G-4023） |
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| 中文摘要: |
| 摘 要：［目的］ 分析1990—2021年全球及我国肺癌疾病负担变化趋势，并对全球及我国肺癌年龄相关死亡病例数变化和伤残调整寿命年（disability-adjusted life years，DALY）变化进行因素分解。［方法］ 从2021年全球疾病负担研究（GBD 2021）数据库提取1990—2021年全球、5个不同社会人口指数（socio-demographic index，SDI）地区及中国、日本、韩国、英国、法国、美国、加拿大、澳大利亚共8个国家不同性别、不同年龄组人群的肺癌疾病负担与人口数据，同时提取1990年、2021年中国人群归因于7种肺癌3级危险因素的肺癌年龄标化死亡率（age-standardized mortality rate，ASMR）、年龄标化DALY率（age-standardized DALY rate，ASDR）数据。通过反事实分析，将1990—2021年肺癌年龄相关死亡病例数变化和DALY变化分解为人口数、人口结构、肺癌年龄标化发病率或患病率、肺癌病死率或疾病严重程度4部分，并分别计算上述4个因素导致的肺癌死亡病例数和DALY变化率。［结果］ 2021年，中国肺癌新发病例数为934 704例，死亡病例数为814 364例。1990—2021年，中国肺癌发病率、患病率、死亡率和DALY率均呈上升趋势，且增长速度高于全球及中高SDI地区，与日本、韩国相似；美国、英国肺癌死亡率呈下降趋势；美国、英国、加拿大、澳大利亚肺癌DALY率有所下降。1990—2021年，中国肺癌年龄相关死亡病例数和DALY分别增长193.91%、146.20%，其中男性、女性肺癌死亡病例数增长的首要原因分别为人口老龄化（102.82%）和肺癌年龄标化发病率升高（119.00%），男性、女性肺癌DALY增长的首要原因均为肺癌年龄标化患病率升高（153.12%、218.77%）。2021年，中国肺癌归因ASMR和ASDR最高的3个危险因素均依次为吸烟、颗粒物污染、职业性致癌物。与1990年相比，仅颗粒物污染和水果摄入不足导致的肺癌ASMR及其占比有所下降，吸烟和二手烟所致肺癌ASDR占比有所提高。［结论］ 肺癌是我国重大公共卫生问题，与全球、中高SDI地区和部分发达国家相比，我国肺癌新发病例数、死亡病例数、现患病例数和DALY增长迅速，且女性人群增长更快。故我国应有针对性地持续推进肺癌防控工作，以降低肺癌疾病负担。 |
| 英文摘要: |
| Abstract： ［Purpose］ To analyze the trends of disease burden for lung cancer worldwide and in China from 1990 to 2021. ［Methods］ Data of the disease burden of lung cancer and population demographics in 1990 and 2021 stratified by sex and age groups for global， five SDI quintiles regions， and eight countries including China， Japan， Republic of Korea， United Kingdom， France， United States， Canada， and Australia were extracted from the Global Burden of Disease Study 2021 (GBD 2021) database. The age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) of lung cancer attributable to 7 level-3 risk factors in China for 1990 and 2021 were also extracted. Counterfactual analysis was used to decompose changes in lung cancer deaths and DALY from 1990 to 2021 into four contributing factors: population size， population structure， age-standardized incidence or prevalence， and lung cancer case fatality or disease severity. The percentage changes in lung cancer deaths and DALY attributed to these four factors were calculated respectively. ［Results］ In 2021， there were 934 704 new cases and 814 364 deaths of lung cancer in China. From 1990 to 2021， the incidence， prevalence， mortality， and DALY rates of lung cancer in China increased faster than those worldwide and in high-middle SDI regions， which was similar to Japan and Republic of Korea. In contrast， the mortality rates of lung cancer decreased in United States and United Kingdom; and the DALY rates of lung cancer decreased in United States， United Kingdom， Canada and Australia. From 1990 to 2021， the age-related lung cancer deaths and DALY in China increased by 193.91% and 146.20%， respectively. The primary contributor to the increase in lung cancer deaths was population aging (102.82%) among men and rising age-standardized incidence (119.00%) among women， while the primary contributor to the increase in DALY was rising age-standardized prevalence for both men (153.12%) and women (218.77%). In 2021， the top three risk factors contributing to lung cancer ASMR and ASDR in China were smoking， particulate matter pollution and occupational carcinogen exposure. Compared with 1990， the ASMR of lung cancer and its proportion attributable to particulate matter pollution and low dietary fruits were decreased， while the proportions in ASDR of lung cancer attributable to smoking and secondhand smoke increased. ［Conclusion］ Lung cancer is a major public health challenge in China. Compared with worldwide， high-middle SDI regions and certain developed countries， China has experienced faster growth in the incidence， prevalence， mortality and DALY of lung cancer， especially among women. To reduce disease burden， sustained efforts on lung cancer prevention and control are urgently required in China. |
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