Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
JAMA Netw Open. 2020 Jun 1;3(6):e208759. doi: 10.1001/jamanetworkopen.2020.8759.
Thyroid cancer is the most pervasive endocrine cancer worldwide. Studies examining the association between thyroid cancer and country, sex, age, sociodemographic index (SDI), and other factors are lacking.
To examine the thyroid cancer burden and variation trends at the global, regional, and national levels using data on sex, age, and SDI.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, epidemiologic data were gathered using the Global Health Data Exchange query tool, covering persons of all ages with thyroid cancer in 195 countries and 21 regions from January 1, 1990, to December 31, 2017; data analysis was completed on October 1, 2019. All participants met the Global Burden of Disease Study inclusion criteria.
Outcomes included incidence, deaths, and disability-adjusted life-years (DALYs) of thyroid cancer. Measures were stratified by sex, region, country, age, and SDI. The estimated annual percentage changes (EAPCs) and age-standardized rates were calculated to evaluate the temporal trends.
Increases of thyroid cancer were noted in incident cases (169%), deaths (87%), and DALYs (75%). Age-standardized incidence rate (ASIR) showed an upward trend over time, with an EAPC of 1.59 (95% CI, 1.51-1.67); decreases were noted in EAPCs of age-standardized death rate (-0.15; 95% CI, -0.19 to -0.12) and age-standardized DALY rate (-0.11; 95% CI, -0.15 to -0.08). Almost half (41.73% for incidence, 50.92% for deaths, and 54.39% for DALYs) of the thyroid cancer burden was noted in Southern and Eastern Asia. In addition, females accounted for most of the thyroid cancer burden (70.22% for incidence, 58.39% for deaths, and 58.68% for DALYs) and increased by years in this population, although the ASIR of males with thyroid cancer (EAPC, 2.18; 95% CI, 2.07-2.28) increased faster than that of females (EAPC, 1.38; 95% CI, 1.30-1.46). A third (34%) of patients with thyroid cancer resided in countries with a high SDI, and most patients were aged 50 to 69 years, which was older than the age in other quintiles (high SDI quintile compared with all other quintiles, P<.05). The most common age at onset of thyroid cancer worldwide was 15 to 49 years in female individuals compared with 50 to 69 years in male individuals (P<.05). Death from thyroid cancer was concentrated in participants aged 70 years or older and increased by years (average annual percentage change, 0.10; 95% CI, 0.01-0.21; P<.05). Furthermore, people in lower SDI quintiles developed thyroid cancer and died from it earlier than those in other quintiles (high and high-middle SDI vs low and low-middle SDI, P<.05).
Data from this study suggest considerable heterogeneity in the epidemiologic patterns of thyroid cancer across sex, age, SDI, region, and country, providing information for governments that may help improve national and local cancer control policies.
甲状腺癌是全球最普遍的内分泌癌症。缺乏研究来检查甲状腺癌与国家、性别、年龄、社会人口指数 (SDI) 及其他因素之间的关联。
使用关于性别、年龄和 SDI 的数据，在全球、区域和国家各级检查甲状腺癌的负担和变化趋势。
设计、设置和参与者：在这项横断面研究中，使用全球卫生数据交换查询工具收集了流行病学数据，涵盖了 195 个国家和 21 个地区的所有年龄组患有甲状腺癌的患者，时间范围为 1990 年 1 月 1 日至 2017 年 12 月 31 日；数据分析于 2019 年 10 月 1 日完成。所有参与者均符合全球疾病负担研究的纳入标准。
结果包括甲状腺癌的发病率、死亡率和伤残调整生命年 (DALY)。按性别、地区、国家、年龄和 SDI 进行分层。计算了估计的年百分比变化 (EAPC) 和年龄标准化率，以评估时间趋势。
甲状腺癌的发病例数 (169%)、死亡例数 (87%) 和 DALY 数 (75%) 均有所增加。年龄标准化发病率 (ASIR) 呈上升趋势，EAPC 为 1.59(95%CI，1.51-1.67)；年龄标准化死亡率 (EAPC，-0.15；95%CI，-0.19 至-0.12) 和年龄标准化 DALY 率 (EAPC，-0.11；95%CI，-0.15 至-0.08) 的 EAPC 呈下降趋势。几乎一半 (发病率的 41.73%、死亡率的 50.92%和 DALY 的 54.39%) 的甲状腺癌负担发生在南亚和东亚。此外，女性占甲状腺癌负担的大部分 (发病率的 70.22%、死亡率的 58.39%和 DALY 的 58.68%)，并且随着时间的推移，这一人群中的发病率也在增加，尽管男性甲状腺癌的 ASIR (EAPC，2.18；95%CI，2.07-2.28) 的增长速度快于女性 (EAPC，1.38；95%CI，1.30-1.46)。三分之一 (34%) 的甲状腺癌患者居住在 SDI 较高的国家，大多数患者年龄在 50 至 69 岁之间，比其他五分位数(高 SDI 五分位数与所有其他五分位数相比，P<.05)的年龄大。全世界女性甲状腺癌发病的最常见年龄为 15 至 49 岁，而男性为 50 至 69 岁(P<.05)。甲状腺癌导致的死亡集中在 70 岁及以上的人群中，且随年龄增长而增加(平均年百分比变化，0.10；95%CI，0.01-0.21；P<.05)。此外，SDI 较低五分位数的人群比其他五分位数的人群更早地发展为甲状腺癌并死于该病(高和高中等 SDI 与低和低中等 SDI 相比，P<.05)。
这项研究的数据表明，甲状腺癌在性别、年龄、SDI、地区和国家方面存在相当大的流行病学模式异质性，为政府提供了信息，可能有助于改善国家和地方的癌症控制政策。
