Lancet Oncol. 2019 Sep;20(9):1211-1225. doi: 10.1016/S1470-2045(19)30339-0. Epub 2019 Jul 29.
Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs).
Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0-19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals.
Globally, in 2017, there were 11·5 million (95% uncertainty interval 10·6-12·3) DALYs due to childhood cancer, 97·3% (97·3-97·3) of which were attributable to YLLs and 2·7% (2·7-2·7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82·2% (82·1-82·2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50·3% (50·3-50·3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26·5% (26·5-26·5) of global childhood cancer DALYs.
The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern.
Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation.
准确的儿童癌症负担数据对于资源规划和卫生政策优先事项至关重要。由于在许多国家癌症监测数据稀缺或不存在，因此需要基于模型的估计。尽管已经有了全球发病率和死亡率的估计，但之前没有关于用残疾调整生命年（DALYs）表示的全球儿童癌症负担的分析。
使用全球疾病、伤害和危险因素研究（GBD）2017 年方法，通过使用人口登记系统数据、死因推断数据和基于人群的癌症登记发病率数据，对儿童（0-19 岁）癌症死亡率进行了估计，这些数据通过建模死亡率与发病率比（MIR）转化为死亡率估计值。儿童癌症发病率是通过死亡率估计值和相应的 MIR 进行估计的。通过使用 MIR 来模拟生存率来计算患病率估计值，然后将其乘以残疾权重以获得残疾生活年（DALY）。通过将特定年龄的癌症死亡人数乘以死亡年龄与参考预期寿命之间的差值来计算生命损失年（YLL）。DALY 计算为 YLL 和 DALY 的总和。最终点估计值报告了 95%的置信区间。
在全球范围内，2017 年，儿童癌症导致 1150 万（95%置信区间为 1060-1230）个 DALY，其中 97.3%（97.3-97.3）归因于 YLL，2.7%（2.7-2.7）归因于 YLD。儿童癌症是全球癌症总负担的第六大主要原因，也是全球儿童疾病负担的第九大主要原因。全球儿童癌症 DALY 的 82.2%（82.1-82.2）发生在低、低中、中和中社会人口指数地区，而 50.3%（50.3-50.3）的成人癌症 DALY 发生在这些相同的地区。目前 GBD 框架中未分类的癌症占全球儿童癌症 DALY 的 26.5%（26.5-26.5）。
GBD 2017 年的结果引起了人们对全球儿童癌症负担的关注，这种负担不成比例地影响了资源有限环境中的人群。使用 DALY 估计值对于证明儿童癌症负担是一个重要的全球癌症和儿童健康问题至关重要。
比尔及梅林达·盖茨基金会、美国黎巴嫩叙利亚人协会（ALSAC）和圣巴多罗买会。
