| 严永锋,张亚琴,樊春笋,等.1992—2021年全球及中国乙型肝炎病毒相关肝癌发病和死亡趋势及年龄-时期-队列模型分析[J].中国肿瘤,2025,34(9):698-705. |
| 1992—2021年全球及中国乙型肝炎病毒相关肝癌发病和死亡趋势及年龄-时期-队列模型分析 |
| Trends and Age-Period-Cohort Model Analysis of Incidence and Mortality of Hepatitis B Virus-Related Liver Cancer Globally and in China from 1992 to 2021 |
| 投稿时间：2025-04-07 |
| DOI：10.11735/j.issn.1004-0242.2025.09.A002 |
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| 中文关键词: 肝癌 乙型肝炎病毒 Joinpoint 年龄-时期-队列模型 中国 全球 |
| 英文关键词:liver cancer hepatitis B virus Joinpoint age-period-cohort model China globe |
| 基金项目:南通市“十四五”科教强卫工程（通卫科技〔2021〕15号）；南通市卫生健康委员会科研课题（MSZ2023109） |
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| 中文摘要: |
| 摘 要：［目的］ 分析1992—2021年全球及中国乙型肝炎病毒（hepatitis B virus，HBV）相关肝癌的发病和死亡变化趋势。［方法］ 基于2021年全球疾病负担数据库收集1992—2021年全球及中国HBV相关肝癌的年龄标化发病率、死亡率等指标，通过Joinpoint回归模型分析流行特征变化趋势，采用年龄-时期-队列模型分析年龄、时期、队列因素对全球及中国HBV相关肝癌发病和死亡风险的影响。［结果］ 1992—2021年全球HBV相关肝癌的标化发病率和标化死亡率总体呈先升后降趋势，平均年度变化百分比分别为-0.31%和-0.61%，下降趋势均有统计学意义（P均<0.05）。同期中国HBV相关肝癌的标化发病率和标化死亡率平均年度变化百分比分别为-0.45%和-0.90%，下降趋势均有统计学意义（P均<0.05）。年龄-时期-队列模型分析结果显示，1992—2021年全球及中国HBV相关肝癌发病率的年净漂移率分别为-0.71%（95%CI：-0.84%~-0.57%）和-0.73%（95%CI：-1.01%~-0.44%），死亡率的年净漂移率分别为-1.15%（95%CI：-1.28%~-1.02%）和-1.42%（95%CI：-1.69%~-1.14%），整体均呈下降趋势。年龄效应显示，全球及中国HBV相关肝癌发病风险30岁后上升、70~74岁达峰，死亡风险40岁后剧增、80岁以上达峰值；时期效应显示，1997—2001年发病和死亡风险最高，2017—2021年最低；队列效应显示，1962年后出生人群发病和死亡风险逐渐降低，2007—2011年队列风险最低。Wald χ2检验结果显示全球及中国HBV相关肝癌发病率和死亡率的年龄、时期、队列效应变化趋势差异均有统计学意义（P均<0.05）。［结论］ 1992—2021年全球及中国HBV相关肝癌的标化发病率和标化死亡率均呈下降趋势，中国HBV相关肝癌发病和死亡水平高于全球平均水平。年龄-时期-队列模型揭示了HBV相关肝癌发病和死亡的历史变迁，当前及未来HBV相关肝癌的疾病负担形势不容乐观。建议针对不同年龄、时期、出生队列人群实施精准分层干预，积极转变HBV相关肝癌的防治与管理策略。 |
| 英文摘要: |
| Abstract： ［Purpose］ To analyze the changing trends of the disease burden of liver cancer related to hepatitis B virus (HBV) globally and in China from 1992 to 2021. ［Methods］ Based on the Global Burden of Disease database in 2021， indicators such as the age-standardized incidence rate and mortality rate of HBV-related liver cancer globally and in China from 1992 to 2021 were collected. The Joinpoint regression model was used to analyze the changing trends of epidemiologi-cal characteristics， and the age-period-cohort model was adopted to analyze the impacts of age， period， and cohort factors on the incidence and mortality risks of HBV-related liver cancer globally and in China. ［Results］ From 1992 to 2021， the age-standardized incidence rate and age-standardized mortality rate of HBV-related liver cancer globally generally showed a trend of decreasing. The average annual percentage changes were -0.31% and -0.61%， respectively， and all the downward trends were statistically significant (both P<0.05). During the same period， the average annual percentage changes of the age-standardized incidence rate and age-standardized mortality rate of HBV-related liver cancer in China were -0.45% and -0.90%， respectively， and all the downward trends were statistically significant(both P<0.05). The results of the age-period-cohort model analysis showed that from 1992 to 2021， the annual net drift rates of the incidence of HBV-related liver cancer globally and in China were -0.71% (95%CI：-0.84%~-0.57%) and -0.73% (95%CI：-1.01%~-0.44%)， respectively. The annual net drift rates of the mortality were -1.15% (95%CI：-1.28%~-1.02%) and -1.42% (95%CI：-1.69%~-1.14%)， respectively， all showing an overall decline. The age effect showed that the risk of HBV-related liver cancer incidence in both the global and Chinese populations began to increase after 30 years of age， peaking in the 70~74 age group， while the risk of mortality surged after 40 years of age and peaked in the population aged 80 and above. The period effect indicated that the incidence and mortality risks were the highest from 1997 to 2001 and the lowest from 2017 to 2021. The cohort effect revealed that the incidence and mortality risks gradually decreased in populations born after 1962， with the 2007—2011 birth cohort having the lowest risks.The results of the Wald χ2 test showed that there were statistically significant differences in the changing trends of the age， period， and cohort effects on the incidence and mortality of HBV-related liver cancer globally and in China (all P<0.05). ［Conclusion］ From 1992 to 2021， the age-standardized incidence rate and age-standardized mortality rate of HBV-related liver cancer showed a downward trend both globally and in China. The disease burden of HBV-related liver cancer in China was higher than the global level. The age-period-cohort model has revealed the historical changes in the incidence and mortality of HBV-related liver cancer. The current and future situation of the disease burden of HBV-related liver cancer is not optimistic. It is recommended to implement precise stratified interventions for populations of different ages， periods， and birth cohorts， and actively transform the prevention， treatment， and management strategies for HBV-related liver cancer. |
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