| 李 科,刘维峰,梁伯衡,等.1992—2021年中国结直肠癌筛查居民疾病负担变化趋势分析[J].中国肿瘤,2026,35(3):172-182. |
| 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 Among Chinese Residents from 1992 to 2021 |
| 投稿时间：2025-07-07 |
| DOI：10.11735/j.issn.1004-0242.2026.03.A002 |
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| 中文关键词: 结直肠癌 筛查人群 疾病负担 中国 |
| 英文关键词:colorectal cancer screening population disease burden China |
| 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岁结直肠癌筛查人群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）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，DALY）等数据，采用Joinpoint和年龄-时期-队列模型分析发病和死亡趋势并计算平均年度变化百分比（average annual percentage change，AAPC）及其95%置信区间（confidence interval，CI），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DALY数量均呈上升趋势，男性上升幅度超过女性。发病粗率和男性死亡、DALY粗率均呈上升趋势，而女性死亡和DALY粗率均呈下降趋势。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DALY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%）DALY标化率下降幅度也低于女性（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上升趋势，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DALY风险持续下降。男性发病风险从1920—1924年的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DALY率呈负向贡献，分别占-30.13%和-31.63%。［结论］ 我国结直肠癌筛查人群结直肠癌疾病负担呈现“发病数、死亡数及DALY数、发病率持续攀升而标化死亡率、DALY显著下降”的双重特征，且存在明显的性别、年龄和出生队列差异。 |
| 英文摘要: |
| Abstract： ［Purpose］ To analyze the trends in disease burden of colorectal cancer among Chinese residents aged 40~74 years old from 1992 to 2021， and to provide scientific basis for optimizing colo-rectal 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 (DALY) of colorectal cancer in China among the population aged 40~74 years old from 1992 to 2021 were selected. The Joinpoint and age-period-cohort models were used and average annual percentage change (AAPC) and 95% confidence interval (CI） were calculated 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 DALY due to colorectal cancer increased， with a more pronounced upward trend in male than in female. The crude incidence rate， as well as the crude mortality and DALY rates in male increased， while the crude mortality and DALY rates in female decreased. The age-standardized incidence rate increased more markedly in male (AAPC=2.25%， 95%CI： 2.17%~2.32%) than that in female (AAPC=1.03%， 95%CI： 0.97%~1.07%). In contrast， the age-standardized mortality and DALY rates decreased in both sexes， with a smaller decline in male(mortality AAPC=-0.13%， 95%CI： -0.18%~ -0.09%； DALY AAPC=-0.10%， 95%CI： -0.14%~-0.06%) compared to female (mortality AAPC=-1.41%， 95%CI： -1.47%~-1.36%； DALY AAPC=-1.47%， 95%CI： -1.52%~-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 male than that in female across all age groups. After 2007， the risk of incidence continued to rise in both male and female， while the risk of mortality and DALY continued to decline in female. The incidence risk in male 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 DALY rates (-31.63%). ［Conclusion］ The screening population of colorectal cancer in China presents the characteristics of a continuous rise in the number of new cases， deaths， DALY and incidence rates while a significant decline in age-standardized mortality rate and DALY， with obvious differences in sex， age and birth cohort. |
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