中国循证医学杂志

中国循证医学杂志

中国人群肝癌所致 DALYs 疾病负担:1990~2016 年长期分析及预测

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目的 分析中国人群因肝癌所致 DALYs 疾病负担的最新情况、既往长期趋势及对未来预测。 方法 基于 2016 年全球疾病负担项目平台,分析 2016 年中国人群肝癌所致伤残调整生命年(DALYs)数据,采用年均变化率(ARC)分析 1990~2016 年间的变化趋势,并基于 ARC 及联合国估计人口数据,预测至 2050 年中国人群肝癌负担。 结果 2016 年,中国人群肝癌所致 DALYs 负担为 1 153.9 万人年(占全球 54.6%),其中早死损失生命年和伤残损失生命年分别占比 98.9% 和 1.1%,标化 DALY 率为 844.1/10 万(为全球平均水平的 3.0 倍),男性为女性的 3.4 倍。1990~2016 年间,中国肝癌标化 DALY 率呈上升趋势(ARC=0.57%),尤其是近 5 年 ARC 为 1.75%,上升更为明显。在全部癌症所致 DALYs 负担中,肝癌约占 20%,始终居前两位(2005 年降至第二位)。亚组分析提示,男性 DALY 率上升而女性下降(ARC 分别为 0.77% 和–0.11%),乙型肝炎始终居肝癌归因首位(约占 57%)且逐步上升(ARC=0.43%);尽管 DALY 率的峰值基本稳定在 65~69 岁,但 DALYs 人群负担峰值从 1990 年的 55~59 岁后移至 2016 年的 60~64 岁。预测 2050 年中国肝癌 DALYs 将达 1 436.7 万人年,较 2017 年增加 20.0%。 结论 中国肝癌所致 DALYs 高于全球其他所有国家之和,占我国全部癌种 DALYs 的五分之一;男性肝癌负担在过去 20 余年持续上升,乙肝始终占肝癌归因首位。未来随着人口老龄化加剧,我国肝癌 DALYs 负担将持续加重,对乙肝等危险因素和肝癌高危人群的防控工作仍需长期加强。

Objective To estimate the latest burden of disability adjusted life years (DALYs) for liver cancer in China and the long-term trend, and to make future prediction. Methods Based on the visualization platform of Global Burden of Disease 2016, data on the DALYs for liver cancer in China was extracted. The very recent status in 2016 and the previous trend from 1990 to 2016 were described, using annualized rate of change (ARC). The burden from 2017 to 2050 was further predicted by combining the ARC and the Chinese population data projected by the United Nation. Results In 2016, the total DALYs for liver cancer in China was estimated as 11 539 000 person years (accounting for 54.6% of the global burden), and years of life lost (YLLs) and years lived with disability (YLDs) contributed 98.9% and 1.1%, respectively. The age-standardized DALY rate was 844.1 per 100 000 (3.0 times of the global average) and the male-to-female ratio was 3.4. The DALY rate continuously increased from 1990–2016 (ARC=0.57%), particularly in recent 5 years (ARC=1.75%). Among the DALYs for all cancers, liver cancer contributed about 20% and always remained as the top 2 (ranking as the number one before year 2005). There were inverse trends in gender, with increasing in males and decreasing in females (ARC was 0.77% and –0.11%, respectively). Hepatitis B infection continually kept the leading cause of DALYs for liver cancer (accounting for nearly 57%), and the DALY rate was gradually increasing (ARC=0.43%). Although the peak age of DALY rate was stable at 65to 69 years, the peak age of the DALYs changed from 55 to 59 years in 1990 to 60 ~ 64 years in 2016. In 2050, the estimated DALYs for liver cancer in China will reach 14.37 million person years, 20.0% more than that in 2017. Conclusion The DALYs caused by liver cancer in China exceeds the overall burden of all other countries in the world, and accounts for 1/5 of DALYs for all cancers in local population. The burden in males has been continuously rising, and the leading cause remained unchanged as hepatitis B infection. With population aging, the DALYs for liver cancer in China will be incessant to increase, suggesting the necessity to implement continuous effort in risk factors prevention (e.g. hepatitis B infection), and efficient management in high risk population of liver cancer.

关键词: 肝癌; 疾病负担; 伤残调整生命年; 归因; 预测; 中国

Key words: Liver cancer; Burden of disease; DALYs; Attribution; Prediction; China

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