Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
Department of Obstetrics and Gynecology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020, China.
Int J Clin Pract. 2022 Sep 30;2022:3356431. doi: 10.1155/2022/3356431. eCollection 2022.
Cervical cancer, especially in underdeveloped areas, poses a great threat to human health. In view of this, we stratified the age and social demographic index (SDI) based on the epidemiological development trend and attributable risk of cervical cancer in countries and regions around the world.
According to the data statistics of the global burden of disease database (GBD) in the past 30 years, we adopted the annual percentage change (EAPCs) to evaluate the incidence trend of cervical cancer, that is, incidence rate, mortality, and disability adjusted life expectancy (DALY). Meanwhile, we investigated the potential influence of SDI on cervical cancer's epidemiological trends and relevant risk factors for cervical cancer-related mortality.
In terms of incidence rate and mortality, the high SDI areas were significantly lower than those of low SDI areas. The incidence and mortality in women aged 20 to 39 were relatively stable, whereas an upward trend existed in patients aged 40 to 59. The global cervical cancer incidence rate increased from 335642 in 1990 to 565541 in 2019 (an increase of 68.50%, with an average annual growth rate of 2.28%), while the age-standardized incidence rate (ASIR) showed a slight downward trend of 14.91/100000 people (95% uncertainty interval [UI], 13.37-17.55) in 1990 to 13.35/100,000 persons (95% UI, 11.37-15.03) in 2019. The number of annual deaths at a global level increased constantly and there were 184,527 (95% UI, 164,836-218,942) deaths in 1990 and 280,479 (95% UI, 238,864-313,930) deaths in 2019, with an increase of 52.00%(average annual growth rate: 1.73%). The annual age-standardized disability adjusted annual life rate showed a downward trend (decline range: 0.95%, 95% confidence interval [CI], from -1.00% to - 0.89%). In addition, smoking and unsafe sex were the main attributable hazard factors in most GBD regions.
In the past three decades, the increase in the global burden of cervical cancer is mainly concentrated in underdeveloped regions (concentrated in low SDI). On the contrary, in countries with high sustainable development index, the burden of cervical cancer tends to be reduced. Alarmingly, ASIR in areas with low SDI is on the rise, which suggests that policy makers should pay attention to the allocation of public health resources and focus on the prevention and treatment of cervical cancer in underdeveloped areas, so as to reduce its incidence rate, mortality, and prognosis.
宫颈癌，尤其是在欠发达地区，对人类健康构成了巨大威胁。鉴于此，我们根据全球各国和地区宫颈癌的流行病学发展趋势和归因风险，对年龄和社会人口指数（SDI）进行了分层。
根据过去 30 年全球疾病负担数据库（GBD）的数据统计，我们采用年度百分比变化（EAPCs）来评估宫颈癌的发病趋势，即发病率、死亡率和伤残调整生命年（DALY）。同时，我们研究了 SDI 对宫颈癌流行病学趋势的潜在影响，以及与宫颈癌相关死亡率相关的风险因素。
就发病率和死亡率而言，高 SDI 地区明显低于低 SDI 地区。20-39 岁女性的发病率和死亡率相对稳定，而 40-59 岁患者的发病率呈上升趋势。全球宫颈癌发病率从 1990 年的 335642 例增加到 2019 年的 565541 例（增长 68.50%，平均年增长率为 2.28%），而年龄标准化发病率（ASIR）则从 1990 年的 13.37/100000 人（95%置信区间[CI]，11.37-15.55）呈轻微下降趋势至 2019 年的 13.35/100000 人（95%CI，11.37-15.03）。全球每年死亡人数持续增加，1990 年为 184527 人（95%CI，164836-218942），2019 年为 280479 人（95%CI，238864-313930），增长 52.00%（平均年增长率：1.73%）。每年的年龄标准化伤残调整生命年呈下降趋势（下降幅度：0.95%，95%置信区间[CI]，从-1.00%至-0.89%）。此外，吸烟和不安全的性行为是大多数 GBD 地区主要的归因危险因素。
在过去的 30 年中，全球宫颈癌负担的增加主要集中在欠发达地区（集中在低 SDI 地区）。相反，在可持续发展指数较高的国家，宫颈癌负担趋于减少。令人担忧的是，低 SDI 地区的 ASIR 呈上升趋势，这表明决策者应关注公共卫生资源的分配，并注重欠发达地区宫颈癌的防治，以降低其发病率、死亡率和预后。
