Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Cancer Prevention, Hunan Cancer Hospital, Changsha, Hunan 410006, China.
Chin Med J (Engl). 2021 Jul 7;134(16):1941-1951. doi: 10.1097/CM9.0000000000001619.
Globally, colorectal cancer (CRC) imposes a substantial burden on healthcare systems and confers considerable medical expenditures. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.
We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index (HDI). Trends of age-standardized rates of incidence and mortality in 60 countries (2000-2019) were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019. The association between exposure to country-level lifestyle, metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.
CRC incidence and mortality varied greatly in the 60 selected countries, and much higher incidence and mortality were observed in countries with higher HDIs, and vice versa. From 2000 to 2019, significant increases of incidence and mortality were observed for 33 countries (average annual percent changes [AAPCs], 0.24-3.82) and 18 countries (AAPCs, 0.41-2.22), respectively. A stronger increase in incidence was observed among males (AAPCs, 0.36-4.54) and individuals <50 years (AAPCs, 0.56-3.86). Notably, 15 countries showed significant decreases in both incidence (AAPCs, -0.24 to -2.19) and mortality (AAPCs, -0.84 to -2.74). A significant increase of incidence among individuals <50 years was observed in 30 countries (AAPCs, 0.28-3.62). Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking, higher level of cholesterol level, higher level of unemployment, and a poorer healthcare system.
Some high-HDI countries showed decreasing trends in CRC incidence and mortality, whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends, especially in males and populations ≥50 years, which require targeted preventive health programs.
结直肠癌（CRC）在全球范围内对医疗体系造成了沉重负担，并带来了巨大的医疗支出。我们旨在评估全球和地区 CRC 的发病和死亡负担以及与之相关的流行病学趋势和因素。
我们使用 GLOBOCAN 数据库的数据来估计 2020 年全球 CRC 的发病率和死亡率及其与人类发展指数（HDI）的关系。使用 2019 年全球疾病负担的数据，通过 Joinpoint 回归分析评估了 60 个国家（2000-2019 年）发病率和死亡率的年龄标准化率趋势。通过多变量线性回归，确定了从世界卫生组织全球卫生观测站和世界银行数据库获得的国家生活方式、代谢和社会经济因素暴露与 CRC 发病率和死亡率之间的关系。
在 60 个选定的国家中，CRC 的发病率和死亡率差异很大，在 HDI 较高的国家，发病率和死亡率也较高，反之亦然。从 2000 年到 2019 年，33 个国家（平均年变化百分比 [APC]，0.24-3.82）和 18 个国家（APC，0.41-2.22）的发病率和死亡率均呈显著上升趋势。男性（APC，0.36-4.54）和<50 岁的个体（APC，0.56-3.86）的发病率上升更为明显。值得注意的是，有 15 个国家的发病率（APC，-0.24 至-2.19）和死亡率（APC，-0.84 至-2.74）均呈显著下降趋势。30 个国家的<50 岁人群的发病率显著上升（APC，0.28-3.62）。发病率较高的国家更有可能有更高的饮酒率、更高的胆固醇水平、更高的失业率和更差的医疗保健系统。
一些高 HDI 国家的 CRC 发病率和死亡率呈下降趋势，而以前疾病负担较低的发展中国家的发病率和死亡率呈显著上升趋势，尤其是在男性和≥50 岁的人群中，这需要有针对性的预防保健计划。
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