Bilano Ver Luanni Feliciano, Borja Maridel P, Cruz Eduardo L, Tan Alvin G, Mortera Lalaine L, Reganit Paul Ferdinand M
Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines.
Tob Control. 2015 May;24(3):263-8. doi: 10.1136/tobaccocontrol-2013-051082. Epub 2014 Jan 8.
In the Philippines, smoking is highly prevalent and tobacco control policies fail to fully implement the WHO Framework Convention on Tobacco Control provisions. To aid in policy change, intervention implementation, monitoring and evaluation, this study aimed to provide the first internally consistent and latest Philippine estimates of the following: disability-adjusted life-years (DALYs) lost due to lung cancer; population-attributable fractions (PAFs) of smoking; and smoking-attributable lung cancer DALYs.
This study applied the Global Burden of Disease and Comparative Risk Assessment frameworks to secondary data, supplemented by expert opinion. A comprehensive internally consistent assessment of disease epidemiology was conducted using DISMOD II and disease impact was quantified as DALYs. PAFs were calculated using the smoking impact ratio and Monte Carlo uncertainty analyses were conducted.
For 2008, lung cancer incidence and mortality estimates were 10 871 cases and 9871 deaths respectively. Lung cancer accounted for an estimated 267 787 DALYs lost, 99% of which were due to years of life lost. Overall, the PAF of smoking was 65% and a total of 173 103 DALYs were smoking-attributable. There were increasing trends in incidence, mortality and DALY rates with age. The majority of incidence (72%), mortality (71%) and disease burden (72%) occurred among men, who also had higher PAF estimates.
Considerable health gains could be achieved if smoking exposure were reduced in the Philippines. Strong enforcement of measures like increasing taxation to the WHO-endorsed rate, expanding smoke-free environments, and requiring large graphic warnings within a comprehensive tobacco control programme is recommended.
在菲律宾，吸烟极为普遍，烟草控制政策未能充分落实世界卫生组织《烟草控制框架公约》的规定。为助力政策变革、干预措施实施、监测与评估，本研究旨在提供菲律宾以下各项首个内部一致且最新的估计数据：因肺癌导致的伤残调整生命年（DALYs）；吸烟的人群归因分数（PAFs）；以及吸烟归因的肺癌伤残调整生命年。
本研究将全球疾病负担和比较风险评估框架应用于二手数据，并辅以专家意见。使用DISMOD II对疾病流行病学进行了全面的内部一致评估，并将疾病影响量化为伤残调整生命年。使用吸烟影响比率计算人群归因分数，并进行蒙特卡洛不确定性分析。
2008年，肺癌发病率和死亡率估计分别为10871例和9871例死亡。肺癌估计导致267787个伤残调整生命年损失，其中99%是由于寿命损失年数。总体而言，吸烟的人群归因分数为65%，共有173103个伤残调整生命年可归因于吸烟。发病率、死亡率和伤残调整生命年率随年龄呈上升趋势。大多数发病率（72%）、死亡率（71%）和疾病负担（72%）发生在男性中，男性的人群归因分数估计也更高。
如果菲律宾减少吸烟暴露，可实现可观的健康收益。建议在全面的烟草控制计划中大力实施各项措施，如将税收提高到世界卫生组织认可的水平、扩大无烟环境以及要求使用大幅图形警示。
