基于GBD数据的中国和美国肺癌发病和死亡趋势及危险因素对比分析

摘要/Abstract

摘要：目的基于全球疾病负担研究2019（GBD 2019）数据对比分析1990—2019年中国和美国肺癌发病和死亡情况、发病率和死亡率的长期变化趋势以及危险因素。方法使用GBD 2019数据库提取1990—2019年中国和美国按照不同性别和年龄组的肺癌新发病例、死亡病例、年龄标准化率数据，用于分析1990—2019年中国和美国基于不同性别和年龄组的肺癌发病和死亡情况。采用Joinpoint软件计算1990—2019年中国和美国肺癌年龄标准化发病率（ASIR）和年龄标准化死亡率（ASMR）的年度变化百分比（APC）和平均年度变化百分比（AAPC），分析其长期变化趋势。采用伤残调整生命年（DALY）分析中美两国的肺癌死亡相关危险因素。结果中国肺癌新发病例由1990年的25.70万例上升至2019年的83.29万例，ASIR由1990年的30.20/10万上升至2019年的41.71/10万；死亡病例由1990年的25.63万例上升至2019年的75.72万例，ASMR由1990年的31.18/10万上升至2019年的38.70/10万。美国肺癌的ASIR由1990年的58.87/10万下降至2019年的45.13/10万，ASMR由1990年的49.35/10万下降至2019年的36.11/10万。从性别上看，1990年和2019年中国男性的肺癌疾病负担高于女性，男性肺癌新发病例由1990年的17.90万例上升至2019年的57.62万例，ASIR由1990年的44.29/10万上升至2019年的61.74/10万；死亡病例由1990年的17.79万例上升至2019年的52.32万例，ASMR由1990年的46.33/10万上升至2019年的58.10/10万。中国女性肺癌新发病例数由1990年的7.81万例上升至2019年的25.67万例，ASIR由1990年的18.01/10万上升至2019年的24.76/10万；死亡病例数由1990年的7.84万例上升为2019年的23.40万例，ASMR由1990年的18.63/10万上升至2019年的22.86/10万。2019年，中美两国男性和女性肺癌发病率随年龄的增长呈先上升后下降趋势，中国男性和女性肺癌发病率均在85~89岁年龄组达到高峰；美国男性肺癌发病率在85~89岁年龄组达到高峰，女性发病率在80~84岁年龄组达到高峰。2019年，中国男性肺癌死亡率随年龄增长呈先上升后下降趋势，在85~89岁年龄组达到高峰，女性肺癌死亡率随年龄增长呈上升趋势，在≥95岁年龄组达到高峰；美国男性和女性肺癌死亡率随年龄增长呈先上升后下降趋势，分别在85~89岁和80~84岁年龄组达到高峰。1990年及2019年中国和美国各年龄组男性的发病率和死亡率均高于女性。Joinpoint软件分析结果显示，1990—2019年，中国肺癌ASIR和ASMR整体呈上升趋势，ASIR的AAPC为1.16%（95%CI为0.93%~1.38%，P<0.001），ASMR的AAPC为0.78%（95%CI为0.56%~1.01%，P<0.001）；1997—2004年ASIR和ASMR上升趋势最为明显，APC分别为2.84%和2.58%。美国肺癌的ASIR和ASMR呈下降趋势，ASIR的AAPC为-1.08%（95%CI为-1.20%~0.96%，P<0.001），ASMR的AAPC为-1.05%（95%CI为-1.24%~-0.87%，P<0.001）。1990年及2019年中国和美国肺癌主要的死亡相关危险因素是吸烟，中国女性肺癌最主要的死亡相关危险因素为环境颗粒物污染。结论1990—2019年中国肺癌的ASIR及ASMR呈上升趋势，美国肺癌ASIR及ASMR呈下降趋势。2019年，中国男性和女性肺癌发病率均随年龄的增长呈先上升后下降趋势，男性肺癌死亡率随年龄增长呈先上升后下降趋势，女性肺癌死亡率随年龄增长呈上升趋势；美国男性和女性肺癌发病率、死亡率均随年龄增长呈先上升后下降趋势。1990年和2019年中国和美国各年龄组男性的发病率及死亡率均高于女性。吸烟是中国和美国肺癌主要的死亡相关危险因素，环境颗粒物污染是中国女性主要的肺癌死亡相关危险因素。

关键词:肺肿瘤,发病率,死亡率,全球疾病负担

Abstract:ObjectiveTo conduct comparative analysis of lung cancer incidence and mortality， as well as long-term trends in incidence and mortality rates and risk factors in China and the United States from 1990 to 2019 based on data from the Global Burden of Disease Study 2019 （GBD 2019）.MethodsThe GBD 2019 database was used to extract new lung cancer cases， deaths， and age-standardized rate data for the analysis of lung cancer incidence and deaths in China and the United States based on different sex and age groups from 1990 to 2019. Joinpoint software was used to calculate and analyze annual percentage change （APC） and average annual percentage change （AAPC） of age-standardized incidence rate （ASIR） and age-standardized mortality rate （ASMR） of lung cancer in China and the United States from 1990 to 2019， and to analyze the long-term trends. Risk factors associated with lung cancer mortality in China and the United States were analyzed using the disability-adjusted life years （DALYs）.ResultsNew cases of lung cancer in China increased from 257 000 cases in 1990 to 832 900 cases in 2019， and ASIR increased from 30.20/100 000 in 1990 to 41.71/100 000 in 2019； deaths increased from 256 300 cases in 1990 to 757 200 cases in 2019， and ASMR increased from 31.18/100 000 in 1990 to 38.70/100 000 in 2019. ASIR and ASMR for lung cancer in the United States showed a decreasing trend from 1990 to 2019， with ASIR decreasing from 58.87/100 000 in 1990 to 45.13/100 000 in 2019， and ASMR decreasing from 49.35/100 000 in 1990 to 36.11/100 000 in 2019. In terms of gender， the disease burden of lung cancer in Chinese males was higher than that of females in 1990 and 2019， with new cases of lung cancer in males rising from 179 000 in 1990 to 576 200 in 2019， and ASIR rising from 44.29/100 000 in 1990 to 61.74/100 000 in 2019， mortality rising from 177 900 in 1990 to 523 200 in 2019， and ASMR rising from 46.33/100 000 in 1990 to 58.10/100 000 in 2019. The number of new cases of lung cancer in Chinese females rose from 78 100 in 1990 to 256 700 in 2019， and ASIR rose from 18.01/100 000 in 1990 to 24.76/100 000 in 2019； the number of deaths rose from 78 400 in 1990 to 234 000 in 2019， and ASMR rose from 18.63/100 000 in 1990 to 22.86/100 000 in 2019. In 2019， lung cancer incidence rates for males and females in China and the United States showed an increasing and then decreasing trend with age， with incidence rates of lung cancer in Chinese males and females peaking in the age group of 85-89 years old； and in the United States， incidence rates of lung cancer in males peaked in the age group of 85-89 years old， and incidence rates of females peaked in the age group of 80-84 years old. In 2019， it was shown that mortality rate of lung cancer among males in China increased and then decreased with age， reaching a peak in the age group of 85-89 years old， and mortality rate of lung cancer among females increased with age， reaching a peak in the age group of ≥95 years old. In the United States， lung cancer mortality rate for males and females showed an increasing and then decreasing trend with age， peaking in the 85-89 and 80-84 age groups， respectively. Incidence and mortality rates were higher for males than females in all age groups in China and the United States in 1990 and 2019. The analysis results of Joinpoint software showed that ASIR and ASMR of lung cancer in China showed an overall increasing trend from 1990 to 2019， with an AAPC of 1.16% （95%CI： 0.93%-1.38%，P<0.001） for ASIR and 0.78% （95%CI： 0.56%-1.01%，P<0.001） for ASMR， with the most obviously increasing trend in ASIR and ASMR from 1997 to 2004， the APC were 2.84% and 2.58%， respectively. Lung cancer ASIR and ASMR in the United States population showed a decreasing trend， with an AAPC of -1.08% （95%CI： -1.20%-0.96%，P<0.001） for ASIR and -1.05% （95%CI： -1.24%--0.87%，P<0.001） for ASMR. In 1990 and 2019， the major mortality-related risk factor for lung cancer in China and the United States was smoking， and the major mortality-related risk factor for lung cancer in Chinese females was environmental particulate matter pollution.ConclusionASIR and ASMR of lung cancer in China show an increasing trend from 1990 to 2019， and ASIR and ASMR of lung cancer in the United States show a decreasing trend. In 2019， incidence rate of lung cancer in males and females in China show an increasing and then decreasing trend with age， mortality rate of lung cancer for males show an increasing and then decreasing trend with age， and mortality rate of lung cancer for females show an increasing trend with age. Lung cancer incidence and mortality rates for males and females in the United States in 2019 show an increasing and then decreasing trend with age. In both 1990 and 2019， incidence rates and mortality rates are higher for males than for females in all age groups in both China and the United States. Smoking is the major mortality-related risk factor for lung cancer in China and the United States， and environmental particulate matter pollution is the major mortality-related risk factor for lung cancer in Chinese females.

Key words:Lung neoplasms,Incidence,Mortality,Global burden of disease

贺嘉慧, 胡钦勇. 基于GBD数据的中国和美国肺癌发病和死亡趋势及危险因素对比分析[J]. 国际肿瘤学杂志, 2024, 51(1): 29-36.

He Jiahui, Hu Qinyong. Comparative analysis of lung cancer incidence and mortality trends and risk factors in China and the United States based on GBD data[J]. Journal of International Oncology, 2024, 51(1): 29-36.

图/表5

表1

1990年和2019年中国和美国肺癌发病与死亡情况"

年份	中国			美国
年份	男女合计	女性	男性	男女合计	女性	男性
1990
新发病例数（万）	25.70	7.81	17.90	18.46	6.81	11.65
ASIR（1/10万）	30.20	18.01	44.29	58.87	38.89	85.83
95%UI	26.20~34.26	15.12~21.04	36.72~52.43	57.24~59.96	37.31~40.14	83.85~87.42
死亡病例数（万）	25.63	7.84	17.79	15.63	5.63	9.99
ASMR（1/10万）	31.18	18.63	46.33	49.35	31.47	73.87
95%UI	27.14~35.52	15.62~21.64	38.78~55.03	47.82~50.29	30.03~32.48	71.59~75.29
2019
新发病例数（万）	83.29	25.67	57.62	25.48	11.72	13.76
ASIR（1/10万）	41.71	24.76	61.74	45.13	38.35	53.44
95%UI	35.22~48.80	19.89~30.26	48.93~75.20	39.11~52.21	31.30~46.39	43.64~64.67
死亡病例数（万）	75.72	23.40	52.32	20.62	9.26	11.36
ASMR（1/10万）	38.70	22.86	58.10	36.11	29.58	44.15
95%UI	32.80~45.03	18.52~27.52	46.53~70.89	34.09~37.51	27.26~31.48	42.14~45.69
1990—2019
ASIR变化率（%）	38.11	37.48	39.40	-23.34	-1.39	-37.74
ASMR变化率（%）	24.12	22.71	25.40	-26.83	-6.01	-40.23

表1

图1

表2

1990—2019年中美两国分性别肺癌ASIR的APC和AAPC（%）"

国家	年份		APC			P值		AAPC		95%CI	P值
中国
男女合计	1990—1997		0.88			<0.001		1.16		0.93~1.38	<0.001
	1997—2004		2.84			<0.001
	2004—2007		0.42			0.448
	2007—2010		2.01			0.005
	2010—2016		-0.43			0.022
	2016—2019		0.99			0.092
女性	1990—1997		0.77			<0.001		1.12		0.94~1.30	<0.001
	1997—2004		2.66			<0.001
	2004—2010		0.53			0.003
	2010—2016		-0.79			0.001
	2016—2019		3.44			<0.001
男性	1990—1994		0.22			0.250		1.16		1.02~1.30	<0.001
	1994—1998		1.70			<0.001
	1998—2004		2.94			<0.001
	2004—2007		0.52			0.181
	2007—2010		2.82			<0.001
	2010—2019		-0.16			0.008
美国
男女合计		1990—1995		0.78	0.001		-1.08		-1.20~0.96		<0.001
		1995—2002		-0.77	<0.001
		2002—2019		-1.75	<0.001
女性		1990—1995		2.48	<0.001		-0.05		-0.42~0.32		0.793
		1995—2002		0.72	<0.001
		2002—2005		-1.43	0.028
		2005—2009		-0.43	0.167
		2009—2017		-1.77	<0.001
		2017—2019		0.85	0.739
男性		1990—1995		-0.37	0.177		-1.89		-2.04~-1.75		<0.001
		1995—2001		-1.90	<0.001
		2001—2019		-2.31	<0.001

表2

表3

1990—2019年中美两国分性别肺癌ASMR的APC和AAPC（%）"

国家	年份	APC	P值	AAPC	95%CI	P值
中国
男女合计	1990—1997	0.77	<0.001	0.78	0.56~1.01	<0.001
	1997—2004	2.58	<0.001
	2004—2007	-0.15	0.813
	2007—2010	1.38	0.036
	2010—2016	-0.88	<0.001
	2016—2019	0.33	0.544
女性	1990—1997	0.61	<0.001	0.72	0.55~0.89	<0.001
	1997—2004	2.42	<0.001
	2004—2010	-0.15	0.306
	2010—2016	-1.22	<0.001
	2016—2019	2.70	<0.001
男性	1990—1994	0.13	0.590	0.81	0.64~0.97	<0.001
	1994—1998	1.56	<0.001
	1998—2004	2.65	<0.001
	2004—2007	0.02	0.965
	2007—2010	2.28	<0.001
	2010—2019	-0.65	<0.001
美国
男女合计	1990—1995	0.17	0.270	-1.05	-1.24~-0.87	<0.001
	1995—2002	-0.96	<0.001
	2002—2017	-1.82	<0.001
	2017—2019	1.45	0.260
女性	1990—1995	1.78	<0.001	-0.21	-0.34~-0.08	0.001
	1995—2001	0.56	<0.001
	2001—2009	-0.83	<0.001
	2009—2017	-1.71	<0.001
	2017—2019	1.04	0.211
男性	1990—1995	-0.90	<0.001	-1.74	-1.92~-1.57	<0.001
	1995—2001	-2.06	<0.001
	2001—2016	-2.41	<0.001
	2016—2019	0.88	0.211

表3

图2

参考文献20

[1]	Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J].Chin Med J (Engl),2022,135(5): 584-590. DOI:10.1097/CM9.000000000 0002108.
[2]	Gao S, Li N, Wang S, et al. Lung cancer in people's republic of China[J].J Thorac Oncol,2020,15(10): 1567-1576. DOI:10.1016/j.jtho.2020.04.028. pmid:32981600
[3]	Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023[J].CA Cancer J Clin,2023,73(1): 17-48. DOI:10.3322/caac.21763.
[4]	IHME. Explore results from the 2019 Global Burden of Disease (GBD) study[EB/OL]. [2023-08-06].https://vizhub.healthdata.org/gbd-results/.
[5]	GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease study 2019[J].Lancet Psychiatry,2022,9(2): 137-150. DOI:10.1016/S2215-0366(21)00395-3. pmid:35026139
[6]	蔡美钦, 宇传华, 胡樱. 基于GBD数据的中美德尘肺病疾病负担对比[J].公共卫生与预防医学,2021,32(1): 5-9. DOI:10.3969/j.issn.1006-2483.2021.01.002
[7]	Safiri S, Kolahi AA, Smith E, et al. Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017[J].Ann Rheum Dis,2020,79(6): 819-828. DOI:10.1136/annrheumdis-2019-216515. pmid:32398285
[8]	Wei J, Chen L, Huang S, et al. Time trends in the incidence of spinal pain in China, 1990 to 2019 and its prediction to 2030: the Global Burden of Disease study 2019[J].Pain Ther,2022,11(4): 1245-1266. DOI:10.1007/s40122-022-00422-9. pmid:35969366
[9]	He F, Wang J, Liu L, et al. Esophageal cancer: trends in incidence and mortality in China from 2005 to 2015[J].Cancer Med,2021,10(5): 1839-1847. DOI:10.1002/cam4.3647.
[10]	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022[J].CA Cancer J Clin,2022,72(1): 7-33. DOI:10.3322/caac.21708.
[11]	Schilsky RL, Nass S, Le Beau MM, et al. Progress in cancer research, prevention, and care[J].N Engl J Med,2020,383(10): 897-900. DOI:10.1056/NEJMp2007839.
[12]	Jemal A, Thun MJ, Ries LA, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control[J].J Natl Cancer Inst,2008,100(23): 1672-1694. DOI:10.1093/jnci/djn389. pmid:19033571
[13]	Fillon M. Pairing smoking cessation with lung cancer screening may save lives[J].CA Cancer J Clin,2021,71(4): 283-284. DOI:10.3322/caac.21675.
[14]	Pelosi G, Pasini F. Over-time risk of lung cancer is largely owing to continuing smoking exposition: a good reason to quit[J].J Thorac Oncol,2021,16(8): e57-e59. DOI:10.1016/j.jtho.2021.04.013. pmid:34304855
[15]	Jemal A, Center MM, DeSantis C, et al. Global patterns of cancer incidence and mortality rates and trends[J].Cancer Epidemiol Biomarkers Prev,2010,19(8): 1893-1907. DOI:10.1158/1055-9965.EPI-10-0437.
[16]	Chen P, Liu Y, Wen Y, et al. Non-small cell lung cancer in China[J].Cancer Commun (Lond),2022,42(10): 937-970. DOI:10.1002/cac2.12359.
[17]	Wu W, Zhang R, Jin Y, et al. Cancer trends and risk factors in China over the past 30 years (1990-2019)[J].J Cancer,2023,14(10): 1935-1945. DOI:10.7150/jca.83162. pmid:37476192
[18]	Ye P, Jin Y, Er Y, et al. A scoping review of national policies for healthy ageing in mainland China from 2016 to 2020[J].Lancet Reg Health West Pac,2021,12: 100168. DOI:10.1016/j.lanwpc.2021.100168.
[19]	Cao M, Li H, Sun D, et al. Cancer screening in China: the current status, challenges, and suggestions[J].Cancer Lett,2021,506: 120-127. DOI:10.1016/j.canlet.2021.02.017. pmid:33684533
[20]	Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2019: a review of current American Cancer Society guidelines and current issues in cancer screening[J].CA Cancer J Clin,2019,69(3): 184-210. DOI:10.3322/caac.21557.