Ma Jun, Song Ying-da, Bai Xiao-Ming
Department of Thoracic Surgery, Shanxi Provincial People's Hospital, Taiyuan, China.
Fifth Clinical Medical College, Shanxi Medical University, Taiyuan, People's Republic of China.
Thorac Cancer. 2024 Mar;15(8):601-613. doi: 10.1111/1759-7714.15227. Epub 2024 Feb 1.
Tracheal, bronchus, and lung cancer (TBL) is one of the main cancer health problems worldwide, but data on the burden and trends of early-onset tracheal, bronchus, and lung cancer (EO-TBL) are sparse. The aim of the present study was to provide the latest and the most comprehensive burden estimates of the EO-TBL cancer from 1990 to 2019.
Overall, we used data from the Global Burden of Disease (GBD) study in EO-TBL cancer from 1990 to 2019. Evaluation metrics included incidence, mortality, and disability-adjusted life years (DALYs). The joinpoint regression model was used to analyze the temporal trends. Decomposition analysis was employed to analyze the driving factors for EO-TBL cancer burden alterations. Bayesian age-period-cohort (BAPC) analysis was used to estimate trends in the next 20 years.
The global age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) for EO-TBL cancer decreased significantly from 3.95 (95% uncertainty interval [UI]: 3.70-4.24), 3.41 (95% UI: 3.19-3.67), 158.68 (95% UI: 148.04-170.92) in 1990 to 2.82 (95% UI: 2.54-3.09), 2.28 (95% UI: 2.07-2.49), 106.47 (95% UI: 96.83-116.51) in 2019 with average annual percent change (AAPC) of -1.14% (95% confidence interval [CI]: -1.32 to -0.95), -1.37% (95% CI: -1.55 to -1.18), and - 1.35% (95% CI: -1.54 to -1.15) separately. The high and high-middle sociodemographic index (SDI) region had a higher burden of EO-TBL cancer but demonstrated a downward trend. The most prominent and significant upward trends were Southeast and South Asia, Africa, and women in the low SDI and low-middle SDI quintiles. At the regional and national level, there were significant positive correlations between ASDR, ASIR, ASMR, and SDI. Decomposition analysis showed that population growth and aging have driven the increase in the number of incidence, mortality, and DALYs in the global population, especially among the middle SDI quintile and the East Asia region. The BAPC results showed that ASDR, ASIR, and ASMR in women would increase but the male population remained relatively flat over the next 20 years.
Although global efforts have been the most successful and effective in reducing the burden of EO-TBL cancer over the past three decades, there was strong regional and gender heterogeneity. EO-TBL cancer need more medical attention in the lower SDI quintiles and in the female population.
气管、支气管和肺癌（TBL）是全球主要的癌症健康问题之一，但关于早发性气管、支气管和肺癌（EO-TBL）负担及趋势的数据较为匮乏。本研究的目的是提供1990年至2019年EO-TBL癌症最新且最全面的负担估计。
总体而言，我们使用了1990年至2019年全球疾病负担（GBD）研究中EO-TBL癌症的数据。评估指标包括发病率、死亡率和伤残调整生命年（DALYs）。采用连接点回归模型分析时间趋势。运用分解分析来分析EO-TBL癌症负担变化的驱动因素。采用贝叶斯年龄-时期-队列（BAPC）分析来估计未来20年的趋势。
EO-TBL癌症的全球年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）和年龄标准化DALYs率（ASDR）从1990年的3.95（95%不确定区间[UI]：3.70 - 4.24）、3.41（95% UI：3.19 - 3.67）、158.68（95% UI：148.04 - 170.92）显著下降至2019年的2.82（95% UI：2.54 - 3.09）、2.28（95% UI：2.07 - 2.49）、106.47（95% UI：96.83 - 116.51），平均年变化百分比（AAPC）分别为-1.14%（95%置信区间[CI]：-1.32至-0.95）、-1.37%（95% CI：-1.55至-1.18）和-1.3 %（95% CI：-1.54至-1.15）。高社会人口学指数（SDI）地区和高中等SDI地区的EO-TBL癌症负担较高，但呈下降趋势。最显著的上升趋势出现在东南亚、南亚、非洲以及低SDI和低中等SDI五分位数的女性群体中。在区域和国家层面，ASDR、ASIR、ASMR与SDI之间存在显著正相关。分解分析表明，人口增长和老龄化推动了全球人口中发病率、死亡率和DALYs数量的增加，尤其是在中等SDI五分位数群体和东亚地区。BAPC结果显示，在未来20年中，女性的ASDR、ASIR和ASMR将会增加，而男性人口相对保持平稳。
尽管在过去三十年中全球在减轻EO-TBL癌症负担方面取得了最成功和有效的成果，但仍存在强烈的区域和性别异质性。EO-TBL癌症在较低SDI五分位数群体和女性人群中需要更多的医疗关注。
