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| 上海市杨浦区1999-2023年消化系统恶性肿瘤发病趋势及年龄-时期-队列模型分析 |
| Trends in Incidence of Digestive System Malignancies and Age-Period-Cohort Model Analysis in Yangpu District,Shanghai,1999–2023 |
| 投稿时间：2026-06-30 修订日期：2026-09-28 |
| DOI： |
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| 中文关键词: 消化系统恶性肿瘤 发病率 年龄-时期-队列模型 流行趋势 |
| 英文关键词:Digestive system malignancies Incidence rate Age-period-cohort model Epidemiological trend |
| 基金项目:上海市公共卫生研究专项(2025GKM08)；杨浦区医学“高岭”学科群建设计划(25YPGL210) |
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| 中文摘要: |
| 目的 本研究分析1999—2023年上海市杨浦区消化系统恶性肿瘤的发病流行特征与变化趋势，为杨浦区消化系统肿瘤精准防控策略制定提供流行病学依据。方法 整理1999—2023年杨浦区消化系统恶性肿瘤监测数据，计算粗发病率、中标率、世标率、截缩率等流行病学指标，分析不同时期、性别、年龄、消化系统瘤别的发病特征及时间变化趋势。利用Joinpoint软件分析发病趋势的平均年度变化百分比（AAPC）。运用年龄-时期-队列模型评估年龄、时期和出生队列三类效应对消化系统恶性肿瘤发病趋势变化的影响。结果 1999—2023年上海市杨浦区消化系统恶性肿瘤发病47422例，占同期全部恶性肿瘤发病数的37.19%，粗发病率由149.30/10万升至214.00/10万（AAPC=1.70%，95%CI:0.93%~2.46%; t=4.93,P<0.01），呈显著上升趋势；中标率由130.25/10万降至105.41/10万（AAPC=-1.06%，95%CI:-1.89%~-0.24%; t=-2.38，P<0.01），世标率由128.76/10万降至103.29/10万（AAPC=-0.95%，95%CI: -1.79%~-0.12%; t=-2.11，P<0.01），标化后呈显著下降趋势；总体35~64 岁截缩率113.18/10万，0~74岁累积率8.74%。男性粗发病率、中标率、世标率分别为267.34/10万、152.37/10万、149.85/10万，均显著高于女性（162.45/10万、89.72/10万、87.34/10万）；男女粗发病率均呈现显著上升趋势，标化后，女性发病率呈现显著下降趋势（P<0.01）。消化系统不同瘤别发病趋势差异明显，结直肠癌粗发病率最高，由44.42/10万升至91.71/10万，AAPC为3.61%（95% CI:3.13%~4.10%; t=14.60,P<0.01）；胰腺癌粗发病率AAPC为3.83%（95% CI:3.15%~4.48%; t=11.09,P<0.01），是所有粗发病率中增幅最显著的癌种；标化后胃癌和肝癌的发病率呈显著下降趋势，其中肝癌中标率AAPC为-4.16%（95% CI:-6.90%~-1.44%;t=-4.19,P<0.01）、世标率AAPC为-4.04%（95% CI:-7.39%~-0.75%; t=-3.92,P<0.05），是标化发病率中下降趋势最显著的癌种。年龄-时期-队列模型分析显示，消化系统恶性肿瘤发病净漂移值为-1.09%/年，校正后发病风险随时间下降，呈中年达峰、高龄回落特征，各效应变化差异均有统计学意义（均 P<0.05）。结论 杨浦区消化系统恶性肿瘤1999-2023年粗发病率显著上升，标化后发病率显著下降，提示区域肿瘤防控已取得一定成效，同时受人口深度老龄化影响，消化系统肿瘤发病占比高、疾病负担突出，仍是本区肿瘤防控的重点。未来需结合不同人群及癌种流行特征，差异化制定消化系统恶性肿瘤的综合防控策略。 |
| 英文摘要: |
| Objective This study analyzed the epidemiological characteristics and temporal trends of digestive system malignancies in Yangpu District, Shanghai from 1999 to 2023, so as to provide epidemiological evidence for formulating targeted prevention and control strategies for digestive system cancers in this district. Methods Surveillance data on digestive system malignancies in Yangpu District during 1999–2023 were collected. Epidemiological indicators including crude incidence rate (CR), China age-standardized rate (ASRC) and world age-standardized rate (ASRW), as well as truncated rate were calculated. The incidence characteristics and temporal trends across different periods, genders, age groups and cancer types were analyzed. Joinpoint software was used to estimate the average annual percentage change (AAPC) of incidence trends. The age-period-cohort model was applied to assess the effects of age, period and birth cohort on the incidence trends. Results A total of 47 422 cases of digestive system malignancies were identified from 1999 to 2023, accounting for 37.19% of all malignant tumor cases in the same period. The crude incidence rate rose from 149.30/10? to 214.00/10? (AAPC=1.70%, 95%CI: 0.93%-2.46%; t=4.93, P<0.01), showing a significant upward trend. The Chinese standard rate decreased from 130.25/10? to 105.41/10? (AAPC=-1.06%, 95%CI: -1.89%-0.24%; t= -2.38, P<0.01), and the world standard rate dropped from 128.76/10? to 103.29/10? (AAPC= -0.95%, 95%CI: -1.79%--0.12%; t= -2.11, P<0.01), with both standardized rates presenting a notable declining trend. The overall truncated rate for the 35-64 age group was 113.18/10?, and the cumulative rate for the 0-74 age group was 8.74%.For males, the crude incidence rate, Chinese standard rate and world standard rate were 267.34/10?, 152.37/10? and 149.85/10? respectively, all significantly higher than those of females (162.45/10?, 89.72/10?, 87.34/10?). The crude incidence rates increased significantly in both genders, while the standardized incidence rate declined obviously in females (P<0.01). Distinct differences were observed in the incidence trends among different digestive tract cancers. Colorectal cancer had the highest crude incidence rate, which increased from 44.42/10? to 91.71/10? (AAPC=3.61%, 95%CI: 3.13%-4.10%; t=14.60, P<0.01). Pancreatic cancer had an AAPC of 3.83% (95%CI: 3.15%- 4.48%; t=11.09, P<0.01), representing the most remarkable increase in crude incidence rate among all cancer types. After standardization, the incidence rates of gastric cancer and liver cancer decreased significantly. Liver cancer showed the largest decline in standardized rates, with an AAPC of -4.16% (95%CI: -6.90%– -1.44%; t=-4.19, P<0.01) for the Chinese standard rate and -4.04% (95%CI:-7.39%– -0.75%; t= -3.92, P<0.05) for the world standard rate. Age-period-cohort model analysis showed that the net drift of digestive system malignancies was -1.09% per year. After adjustment, the incidence risk declined over time, peaking in middle age and decreasing in the elderly. All differences in the above effects were statistically significant (all P<0.05).
Conclusion From 1999 to 2023, the crude incidence rate of digestive system malignancies in Yangpu District increased markedly, whereas the standardized incidence rates decreased substantially, indicating that long-term cancer prevention and control work has achieved certain effects. Affected by profound population aging, digestive system cancers still account for a large proportion of malignant tumors and bring a heavy disease burden, remaining a top priority for local cancer control. In the future, differentiated comprehensive prevention and control strategies should be formulated according to the epidemiological characteristics of different populations and cancer types. |
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