全球、区域和国家结直肠癌及其危险因素负担，1990-2019 年：2019 年全球疾病负担研究的系统分析。

BACKGROUND

Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades.

METHODS

Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer.

FINDINGS

Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019.

INTERPRETATION

The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions.

FUNDING

Bill & Melinda Gates Foundation.

背景

结直肠癌是全球癌症死亡的第三大主要原因。鉴于全球结直肠癌发病率呈上升趋势，最新的结直肠癌负担信息可以指导筛查、早期发现和治疗策略，并有助于有效分配资源。我们研究了过去 30 年来全球 204 个国家和地区结直肠癌的全球、区域和国家负担及其危险因素的时间模式。

方法

作为全球疾病、伤害和危险因素研究（GBD）2019 年的一部分，通过年龄、性别和地理位置，估算了 1990 年至 2019 年期间结直肠癌的发病率、死亡率和伤残调整生命年（DALY）。死亡率估计使用死因综合模型得出。我们还计算了归因于与结直肠癌有因果关系的危险因素的 DALY。

结果

全球范围内，1990 年至 2019 年，结直肠癌的发病病例增加了一倍以上，从 842098 例（95%不确定性区间[UI]为 810408-868574）增加到 217 万例（2000000-2134000），死亡人数从 518126 例（493682-537877）增加到 109 万例（1020000-1150000）。全球年龄标准化发病率从 22.2 每 100000 人（95% UI 为 21.3-23.0）上升到 26.7 每 100000 人（24.6-28.9），而年龄标准化死亡率从 14.3 每 100000 人（13.5-14.9）下降到 13.7 每 100000 人（12.6-14.5），年龄标准化 DALY 率从 308.5 每 100000 人（294.7-320.7）下降到 295.5 每 100000 人（275.2-313.0）。台湾（中国省份；62.0[48.9-80.0]每 100000 人）、摩纳哥（60.7[48.5-73.6]每 100000 人）和安道尔（56.6[42.8-71.9]每 100000 人）的年龄标准化发病率最高，而格陵兰（31.4[26.0-37.1]每 100000 人）、文莱（30.3[26.6-34.1]每 100000 人）和匈牙利（28.6[23.6-34.0]每 100000 人）的年龄标准化死亡率最高。1990 年至 2019 年，年轻人（年龄<50 岁）的发病率显著上升，尤其是在高社会人口指数（SDI）国家。全球范围内，低牛奶（15.6%）、吸烟（13.3%）、低钙（12.9%）和饮酒（9.9%）的饮食是 2019 年结直肠癌 DALY 的主要原因。