Wang D Z, Zhang S, Zhang H, Shen C F, Wang C, Xun L N, Zheng W L, Jiang G H
Department of Vital Statistics, Institution of Non-Communicable Disease Control and Prevention, Tianjin Centers for Diseases Control and Prevention, Tianjin300011,China.
Department of Cancer Registration, Institution of Non-Communicable Disease Control and Prevention, Tianjin Centers for Diseases Control and Prevention, Tianjin300011, China.
Zhonghua Zhong Liu Za Zhi. 2024 Nov 23;46(11):999-1008. doi: 10.3760/cma.j.cn112152-20240101-00001.
To explore the trends and distribution of liver cancer between sexes, ages, and urban-rural areas in Tianjin, China from 1999 to 2021, and provide data for targeted prevention and control strategies of liver cancer in Tianjin. Liver cancer mortality data of Tianjin during 1999-2021 were from the Tianjin population based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC), and the population data of permanent Tianjin residents were from Tianjin Municipal Public Security Bureau. Liver cancer mortality, years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALY) were calculated using the cause of death surveillance data collected by Tianjin Centers for Disease Control and Prevention. The distributions of these data among residents of different sexes, ages, and regions were analyzed. Segi's world standard population was used for standardization. Joinpoint regression was used for trend analysis on the mortality rate of liver cancer and the disease burden. The liver cancer mortality rate in Tianjin decreased by 46.75% from 1999 to 2021, with distinct phased characteristics. From 1999 to 2010, the age-sex-standardized mortality rate (SMR) decreased from 12.62/100 000 to 11.64/100 000 with an annual percent change (APC) of -1.32% (=0.003). From 2010 to 2021, the SMR decreased from 11.64/100 000 to 6.72/100 000 (APC=-3.89%, ＜0.001). The age-sex-standardized DALY rates(SDR) decreased by 50.63% from 1999 to 2021, also with distinct phased characteristics. From 1999 to 2010, the SDR decreased from 388.67/100 000 to 349.38/100 000 (APC=-1.35%, =0.002). From 2010 to 2021, the SDR decreased from 349.38/100 000 to 191.88/100 000 (APC=-4.43%, ＜0.001). The liver cancer mortality rate declined most rapidly in the age group under 45 years; the APC for those under 35 years was -5.07% (＜0.001), and for those aged 35-44 years, the APC was 0.63% (=0.707) and -8.21% (＜0.001) before and after 2007, respectively. Both SMR and SDR were significantly higher in males than in females (＜0.01). Both SMR and SDR were significantly higher in urban areas than in rural areas from 1999 to 2007 (＜0.05), but they became similar after 2008. Liver cancer DALY are predominantly YLL, accounting for 99%. The median age of liver cancer deaths in Tianjin during 1999-2021 was 64-68 years old, with males lower than females (＜0.05), and rural areas lower than urban areas (＜0.05), generally showing an increasing trend (1999-2014: APC=0.11%, =0.047; 2014-2021: APC=0.51%, =0.005). Liver cancer mortality rate and disease burden decreased from 1999 to 2021 in Tianjin, with an especially accelerated decline after 2010. Further efforts to reduce liver cancer mortality in Tianjin are needed, and special attention should be focused on the elderly, male, and rural residents.
为探究1999年至2021年中国天津市肝癌在性别、年龄和城乡之间的发病趋势及分布情况，为天津市肝癌的针对性防控策略提供数据支持。天津市1999 - 2021年的肝癌死亡数据来自天津市疾病预防控制中心维护的基于人群的死亡监测系统，天津市常住人口数据来自天津市公安局。利用天津市疾病预防控制中心收集的死因监测数据计算肝癌死亡率、寿命损失年（YLL）、失能生存年（YLD）和伤残调整寿命年（DALY）。分析了这些数据在不同性别、年龄和地区居民中的分布情况。采用Segi世界标准人口进行标准化。采用Joinpoint回归对肝癌死亡率和疾病负担进行趋势分析。1999年至2021年天津市肝癌死亡率下降了46.75%，具有明显的阶段性特征。1999年至2010年，年龄性别标准化死亡率（SMR）从12.62/10万降至11.64/10万，年变化百分比（APC）为 -1.32%（=0.003）。2010年至2021年，SMR从11.64/10万降至6.72/10万（APC = -3.89%，＜0.001）。1999年至2021年年龄性别标准化DALY率（SDR）下降了50.63%，也具有明显的阶段性特征。1999年至2010年，SDR从388.67/10万降至349.38/10万（APC = -1.35%，=0.002）。2010年至2021年，SDR从349.38/10万降至191.88/10万（APC = -4.43%，＜0.001）。肝癌死亡率在45岁以下年龄组下降最为迅速；35岁以下人群的APC为 -5.07%（＜0.001），35 - 44岁人群在2007年前后的APC分别为0.63%（=0.707）和 -8.21%（＜0.001）。男性的SMR和SDR均显著高于女性（＜0.01）。1999年至2007年城市地区的SMR和SDR均显著高于农村地区（＜0.05），但2008年后两者趋于相似。肝癌DALY主要为YLL，占99%。1999 - 2021年天津市肝癌死亡的中位年龄为64 - 68岁，男性低于女性（＜0.05），农村地区低于城市地区（＜0.05），总体呈上升趋势（1999 - 2014年：APC = 0.11%，=0.047；2014 - 2021年：APC = 0.51%，=0.005）。1999年至2021年天津市肝癌死亡率和疾病负担下降，2010年后下降尤其加速。天津市需要进一步努力降低肝癌死亡率，应特别关注老年人、男性和农村居民。
