School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
School of Mathematical Sciences, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.
Cancer. 2020 Sep 15;126(18):4220-4234. doi: 10.1002/cncr.33078. Epub 2020 Jul 10.
China's lung cancer (LC) burden plays a pivotal role in the global cancer epidemic. Comparing LC burden and population attributable fractions (PAFs) of risk factors between China and other countries/regions is essential to inform effective intervention. The Global Burden of Disease (GBD) study provides a unique opportunity for such comparisons.
We extracted the number of LC deaths, age-standardized death rates (ASDRs), age-standardized disability-adjusted life-year (DALY) rates, and PAFs of risk factors for LC deaths between 1990 and 2017 from GBD 2017. The annual percentage change (APC) was used to quantify the trends of LC ASDRs and age-standardized DALY rates. The relationship between the APC of LC ASDR and Socio-demographic Index was assessed among China and other countries.
Globally, the ASDR for LC decreased in men (APC, -0.66% [95% CI, -0.69 to -0.62]) but increased in women (APC, 0.31% [95% CI, 0.26 to 0.36]) from 1990 to 2017. The ASDRs in China increased both for men (APC, 1.12% [95% CI, 1.03 to 1.20]) and women (APC, 0.80% [95% CI, 0.70 to 0.89]). The increased LC death numbers among men (312,798) and women (139,115) in China accounted for 59.39% and 43.01% of global increases. LC years of life lost accounted for the majority of LC DALYs globally and in China. The risk factors with the highest PAFs of LC death in China were smoking and ambient particulate matter. The ASDRs for LC associated with ambient particulate matter in China ranked second globally.
The trends of LC ASDRs and age-standardized DALY rates and the PAFs of risk factors vary markedly by region, indicating a need for tailored measures to reduce LC burden and improve health equality. China's LC ASDRs are among the highest in the world, and the primary intervention priorities in China should be control of ambient particulate matter and tobacco usage.
中国肺癌（LC）负担在全球癌症流行中起着关键作用。比较中国与其他国家/地区的 LC 负担和危险因素的人群归因分数（PAF）对于制定有效的干预措施至关重要。全球疾病负担（GBD）研究为此提供了一个独特的比较机会。
我们从 GBD 2017 中提取了 1990 年至 2017 年期间 LC 死亡人数、年龄标准化死亡率（ASDR）、年龄标准化残疾调整生命年（DALY）率以及 LC 死亡危险因素的 PAF。使用年度百分比变化（APC）来量化 LC ASDR 和年龄标准化 DALY 率的趋势。评估了中国和其他国家之间 LC ASDR 的 APC 与社会人口指数之间的关系。
全球范围内，男性的 LC ASDR 呈下降趋势（APC，-0.66%[95%CI，-0.69 至-0.62]），而女性则呈上升趋势（APC，0.31%[95%CI，0.26 至 0.36]）。中国男性的 LC ASDR 呈上升趋势（APC，1.12%[95%CI，1.03 至 1.20]），女性的 LC ASDR 也呈上升趋势（APC，0.80%[95%CI，0.70 至 0.89]）。中国男性（312798 人）和女性（139115 人）的 LC 死亡人数增加占全球增加的 59.39%和 43.01%。全球和中国的 LC 生命年损失占 LC DALY 的大部分。中国 LC 死亡的 PAF 最高的危险因素是吸烟和环境颗粒物。中国与环境颗粒物相关的 LC ASDR 位居全球第二。
LC ASDR 趋势、年龄标准化 DALY 率和危险因素的 PAF 因地区而异，表明需要采取有针对性的措施来减轻 LC 负担和改善健康公平。中国的 LC ASDR 处于世界最高水平，中国的主要干预重点应该是控制环境颗粒物和烟草使用。
