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BACKGROUND

As global aging intensifies, urological cancers pose increasing health and economic burdens. In China, home to one-fifth of the world's population, monitoring the distribution and determinants of these cancers and simulating the effects of health interventions are crucial for global and national health.

METHODS

With Global Burden of Disease (GBD) China database, the present study analyzed age-sex-specific patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in China and its 34 provinces as well as the association between gross domestic product per capita (GDPPC) and these patterns. Importantly, a multi-attentive deep learning pipeline (iTransformer) was pioneered to model the spatiotemporal patterns of urological cancers, risk factors, GDPPC, and population, to provide age-sex-location-specific long-term forecasts of urological cancer burdens, and to investigate the impacts of risk-factor-directed interventions on their future burdens.

FINDINGS

From 1990 to 2021, the incidence and prevalence of urological cancers in China has increased, leading to 266,887 new cases (95% confidence interval: 205,304-346,033) and 159,506,067 (12,236,0000-207,447,070) cases in 2021, driven primarily by males aged 55+ years. In 2021, Taiwan, Beijing, and Zhejiang had the highest age-standardized incidence rate (ASIR) and age-standardized prevalence rates of urological cancer in China, highlighting significant regional disparities in the disease burden. Conversely, the national age-standardized mortality rate (ASMR) has declined from 6.5 (5.1-7.8) per 100,000 population in 1990 to 5.6 (4.4-7.2) in 2021, notably in Jilin [-166.7% (-237 to -64.6)], Tibet [-135.4% (-229.1 to 4.4)], and Heilongjiang [-118.5% (-206.5 to -4.6)]. Specifically, the national ASMR for bladder and testicular cancers reduced by -32.1% (-47.9 to 1.9) and -31.1% (-50.2 to 7.2), respectively, whereas prostate and kidney cancers rose by 7.9% (-18.4 to 43.6) and 9.2% (-12.2 to 36.5). Age-standardized DALYs, YLDs, and YLLs for urological cancers were consistent with ASMR. Males suffered higher burdens of urological cancers than females in all populations, except those aged <5 years. Regionally and provincially, high GDPPC provinces have the highest burden of prostate cancer, while the main burden in other provinces is bladder cancer. The main risk factors for urological cancers in 2021 are smoking [accounting for 55.1% (42.7-67.4)], high body mass index [13.9% (5.3-22.4)], and high fasting glycemic index [5.9% (-0.8 to 13.4)] for both males and females, with smoking remarkably affecting males and high body mass index affecting females. Between 2022 and 2040, the ASIR of urological cancers increased from 10.09 (9.19-10.99) to 14.42 (14.30-14.54), despite their ASMR decreasing. Notably, prostate cancer surpassed bladder cancer as the primary subcategory, with those aged 55+ years showing the highest increase in ASIR, highlighting the aging-related transformation of the urological cancer burden. Following the implementation of targeted interventions, smoking control achieved the greatest reduction in urological cancer burden, mainly affecting male bladder cancer (-45.8% decline). In females, controlling smoking and high fasting plasma glucose reduced by 5.3% and 5.8% ASMR in urological cancers. Finally, the averaged mean-square-Percentage-Error, absolute-Percentage-Error, and root-mean-square Logarithmic-Error of the forecasting model are 0.54 ± 0.22, 1.51 ± 1.26, and 0.15 ± 0.07, respectively, indicating that the model performs well.

INTERPRETATION

Urological cancers exhibit an aging trend, with increased incidence rates among the population aged 55+ years, making prostate cancer the most burdensome subcategory. Moreover, urological cancer burden is imbalanced by age, sex, and province. Based on our findings, authorities and policymakers could refine or tailor population-specific health strategies, including promoting smoking cessation, weight reduction, and blood sugar control.

FUNDING

Bill & Melinda Gates Foundation.

背景

随着全球老龄化加剧，泌尿系统癌症带来的健康和经济负担日益加重。中国拥有全球五分之一的人口，监测这些癌症的分布及决定因素，并模拟健康干预措施的效果，对全球和国家健康至关重要。

方法

本研究利用中国全球疾病负担（GBD）数据库，分析了中国及其34个省份泌尿系统癌症发病率、患病率、死亡率、伤残调整生命年（DALY）、带病生存年数（YLD）和寿命损失年数（YLL）的年龄性别特异性模式，以及人均国内生产总值（GDPPC）与这些模式之间的关联。重要的是，率先采用了多注意力深度学习管道（iTransformer）对泌尿系统癌症、风险因素、GDPPC和人口的时空模式进行建模，以提供特定年龄、性别和地区的泌尿系统癌症负担长期预测，并研究针对风险因素的干预措施对其未来负担的影响。

结果

1990年至2021年，中国泌尿系统癌症的发病率和患病率有所上升，2021年新增266,887例病例（95%置信区间：205,304 - 346,033），病例数达159,506,067例（122360000 - 207,447,070），主要由55岁及以上男性驱动。2021年，台湾、北京和浙江的泌尿系统癌症年龄标准化发病率（ASIR）和年龄标准化患病率在中国最高，凸显了疾病负担的显著地区差异。相反，全国年龄标准化死亡率（ASMR）从1990年的每10万人6.5（5.1 - 7.8）降至2021年的5.6（4.4 - 7.2），特别是在吉林[-166.7%（-237至-64.6）]、西藏[-135.4%（-229.1至4.4）]和黑龙江[-118.5%（-206.5至-4.6）]。具体而言，全国膀胱癌和睾丸癌的ASMR分别下降了-32.1%（-47.9至1.9）和-31.1%（-50.2至7.2），而前列腺癌和肾癌分别上升了7.9%（-18.4至43.6）和9.2%（-12.2至36.5）。泌尿系统癌症的年龄标准化DALY、YLD和YLL与ASMR一致。除5岁以下人群外，所有人群中男性的泌尿系统癌症负担均高于女性。在地区和省级层面，GDPPC高的省份前列腺癌负担最高，而其他省份的主要负担是膀胱癌。2021年泌尿系统癌症的主要风险因素是吸烟[占55.1%（42.7 - 67.4）]、高体重指数[13.9%（5.3 - 22.4）]和高空腹血糖指数[5.9%（-0.8至13.4）]，吸烟对男性影响显著，高体重指数对女性影响较大。2022年至2040年，泌尿系统癌症的ASIR从10.09（9.19 - 10.99）增至14.42（14.30 - 14.54），尽管其ASMR有所下降。值得注意的是，前列腺癌超过膀胱癌成为主要亚型，55岁及以上人群的ASIR增幅最大，凸显了泌尿系统癌症负担与老龄化相关的转变。实施针对性干预措施后，控烟对泌尿系统癌症负担的降低效果最为显著，主要影响男性膀胱癌（下降45.8%）。在女性中，控烟和控制高空腹血糖使泌尿系统癌症的ASMR分别降低了5.3%和5.8%。最后，预测模型的平均均方百分比误差、绝对百分比误差和均方根对数误差分别为0.54±0.22、1.51±1.26和0.15±0.07，表明该模型表现良好。