Cancer Institute, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
Department of Breast Surgery, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
BMJ Open. 2019 Oct 7;9(10):e028461. doi: 10.1136/bmjopen-2018-028461.
Disparities in the global burden of breast cancer have been identified. We aimed to investigate recent patterns and trends in the breast cancer incidence and associated mortality. We also assessed breast cancer-related health inequalities according to socioeconomic development factors.
An observational study based on the Global Burden of Diseases.
Estimates of breast cancer incidence and mortality during 1990-2016 were obtained from the Global Health Data Exchange database. Subsequently, data obtained in 2016 were described using the age-standardised and age-specific incidence, mortality and mortality-to-incidence (MI) ratios according to sociodemographic index (SDI) levels. Trends were assessed by measuring the annual percent change using the joinpoint regression. The Gini coefficients and concentration indices were used to identify between-country inequalities.
Countries with higher SDI levels had worse disease incidence burdens in 2016, whereas inequalities in the breast cancer incidence had decreased since 1990. Opposite trends were observed in the mortality rates of high and low SDI countries. Moreover, the decreasing concentration indices, some of which became negative, among women aged 15-49 and 50-69 years suggested an increase in the mortality burdens in undeveloped regions. Conversely, inequality related to the MI ratio increased. In 2016, the MI ratios exhibited distinct gradients from high to low SDI regions across all age groups.
The patterns and trends in breast cancer incidence and mortality closely correlated with the SDI levels. Our findings highlighted the primary prevention of breast cancer in high SDI countries with a high disease incidence and the development of cost-effective diagnostic and treatment interventions for low SDI countries with poor MI ratios as the two pressing needs in the next decades.
已经确定了全球乳腺癌负担的差异。我们旨在研究乳腺癌发病率和相关死亡率的最新模式和趋势。我们还根据社会经济发展因素评估了与乳腺癌相关的健康不平等。
基于全球疾病负担的观察性研究。
从全球健康数据交换数据库中获取 1990 年至 2016 年乳腺癌发病率和死亡率的估计值。随后，根据社会人口指数 (SDI) 水平，使用年龄标准化和特定年龄的发病率、死亡率和死亡率与发病率（MI）比来描述 2016 年获得的数据。通过使用连接点回归测量年度百分比变化来评估趋势。基尼系数和集中指数用于确定国家间的不平等。
SDI 水平较高的国家在 2016 年的疾病发病率负担更高，而自 1990 年以来，乳腺癌发病率的不平等有所减少。高 SDI 和低 SDI 国家的死亡率趋势则相反。此外，15-49 岁和 50-69 岁女性的死亡率集中指数下降，其中一些变为负值，表明欠发达地区的死亡率负担增加。相反，与 MI 比相关的不平等增加。2016 年，所有年龄组的 MI 比都表现出从高 SDI 地区到低 SDI 地区的明显梯度。
乳腺癌发病率和死亡率的模式和趋势与 SDI 水平密切相关。我们的研究结果强调了在高 SDI 国家中以高疾病发病率为重点的乳腺癌一级预防，以及在 MI 比值较差的低 SDI 国家中制定具有成本效益的诊断和治疗干预措施，这是未来几十年的两个紧迫需求。
