Department of Thoracic Surgery, Sichuan Cancer Hospital & Research Institute, School of Medicine, University of Electronic Science and Technology of China (UESTC), Chengdu 610041, China; Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Cancer Epidemiol. 2024 Aug;91:102583. doi: 10.1016/j.canep.2024.102583. Epub 2024 May 29.
Understanding the current status and future trends of cancer burdens by systems provides important information for specialists, policymakers, and specific risk populations.
The aim of this study was to compare the current and future cancer burdens of the gastrointestinal (GI) and respiratory tracts in terms of their magnitude and distribution. Data from a total of eight cancers of the digestive and respiratory tracts in the Global Burden of Disease (GBD) database were collected. The age-standardized incidence/death rates (ASIR/ASDRs), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) were analyzed. Future trends were predicted with Bayesian age-period-cohort (BAPC) and NORDPRED models.
In 2019, there was a significant increase in DALY for both digestive and respiratory tract cancers compared to 1990. Meanwhile, ASIR increased slightly and ASDR decreased notably. In 2019, the global cancer burdens of respiratory and digestive tracts were 38568363.53 and 66912328.72 in DALY, 34.28 and 55.32 in ASIR, and 656.82 and 808.22 in ASDR per 100,000 population with changes of +54.63% and +43.93%, +2.92% and +5.65%, and -17.39% and -26.83% compared to those in 1990, respectively. Significant cross-regional differences in the cancer burdens were observed among the regions. Compared to four representative chronic diseases, the burden of cancers showed less remission and greater global inequalities. The burdens of both digestive and respiratory tract cancers were higher in males than in females in terms of the ASIR, ASDR, and DALY. The incidence and mortality rates of respiratory tract cancers were up to 3-4 times higher in males than in females, whereas the difference between male and female rates of digestive tract cancers was relatively smaller. The main risk factor associated with all kinds of digestive and respiratory tract cancers is tobacco, leading to 18.5 in ASDR and 3.38×10 in DALY for respiratory tract cancers; 8.29 in ASDR and 1.60×10 in DALY for digestive tract cancers, in 2019. Additionally, alcohol use contributes to most digestive and respiratory tract cancers (1.23/1.03 in ASDR and 1.60×10/2.57×10 in DALY for respiratory tract cancers; 4.19/3.82 in ASDR and 4.49×10/8.06×10 in DALY for digestive tract cancers), except for stomach cancer and tracheal, bronchus, and lung cancer. The cancer burdens of respiratory and digestive tracts are likely to decrease substantially between 2020 and 2044. For most metrics, except for the ASIR and male-to-female ratios of ASDR and ASDALY in digestive tract cancers, the worldwide variances of burden metrics have been decreasing in the past decades and will possibly maintain stable trends in the future.
The epidemiology of respiratory and GI tract cancers has common features and individual characteristics that are reflected in geography, age characteristics, and risk factors. Current epidemiological status, future trends, and the globalization of these disease burdens are important factors for making scientific planning of resources to minimize the cancer burden metrics and their cross-regional inequalities.
通过系统了解癌症负担的当前状况和未来趋势，可为专家、政策制定者和特定风险人群提供重要信息。
本研究旨在比较胃肠道（GI）和呼吸道癌症的当前和未来癌症负担，包括其规模和分布。从全球疾病负担（GBD）数据库中收集了总计 8 种消化系统和呼吸系统癌症的数据。分析了年龄标准化发病率/死亡率（ASIR/ASDR）、残疾调整生命年（DALY）和估计的年百分比变化（EAPC）。使用贝叶斯年龄-时期-队列（BAPC）和 NORDPRED 模型预测未来趋势。
与 1990 年相比，2019 年消化道和呼吸道癌症的 DALY 均显著增加。与此同时，ASIR 略有增加，ASDR 显著下降。2019 年，全球呼吸道和消化道癌症负担分别为 DALY 的 38568363.53 和 66912328.72，ASIR 为 34.28 和 55.32，ASDR 为 656.82 和 808.22/每 10 万人，变化率分别为+54.63%和+43.93%，+2.92%和+5.65%，-17.39%和-26.83%。观察到各区域之间癌症负担存在显著的跨区域差异。与四种代表性的慢性病相比，癌症负担的缓解幅度较小，全球不平等程度更高。在 ASIR、ASDR 和 DALY 方面，男性的消化道和呼吸道癌症负担均高于女性。男性呼吸道癌症的发病率和死亡率高达女性的 3-4 倍，而消化道癌症的男女发病率差异相对较小。与所有消化道和呼吸道癌症相关的主要风险因素是烟草，导致 2019 年呼吸道癌症的 ASDR 为 18.5，DALY 为 3.38×10；ASDR 为 8.29，DALY 为 1.60×10。此外，酒精使用是大多数消化道和呼吸道癌症的主要原因（ASDR 为 1.23/1.03，DALY 为 1.60×10/2.57×10；ASDR 为 4.19/3.82，DALY 为 4.49×10/8.06×10），除了胃癌和气管、支气管和肺癌。呼吸道和消化道癌症的负担预计将在 2020 年至 2044 年之间大幅下降。除了消化道癌症的 ASIR 和 ASDR 以及 ASDALY 的男性与女性比值外，过去几十年中，除了胃癌和气管、支气管和肺癌外，大多数指标的全球差异都在减小，未来可能会保持稳定的趋势。
呼吸道和胃肠道癌症的流行病学具有共同特征和个体特征，反映在地理、年龄特征和危险因素方面。当前的流行病学状况、未来趋势以及这些疾病负担的全球化是制定科学资源规划以最大程度降低癌症负担指标及其跨区域不平等的重要因素。
