Chen Xiangyu, Hao Xuexue, Wu Jinhao, Liu Xiaoqiang
Department of Urology, Tianjin Medical University General Hospital, Tianjin, China.
Tob Induc Dis. 2025 May 23;23. doi: 10.18332/tid/204299. eCollection 2025.
Smoking increases the risk of bladder and kidney cancers and is associated with a poorer prognosis in prostate cancer (PCa) patients, which poses a significant health and socioeconomic burden. Understanding the epidemiologic trends of urological cancers attributable to smoking is critical to developing targeted prevention strategies. This study examines global trends in the three urological cancers attributable to smoking from 1990 to 2021 and projects future trends over the next two decades.
Data were obtained from the Global Burden of Disease (GBD) 2021. Metrics included deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR), with uncertainty intervals (UIs). Burden comparisons were stratified by sex, age, and sociodemographic index (SDI). Temporal trends were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average annual percentage change (AAPC), with 95% confidence intervals (CIs). Future trends were predicted using the autoregressive integrated moving average (ARIMA) model.
Compared with 1990, the number of deaths of bladder cancer, kidney cancer and PCa attributable to smoking increased by 43%, 67%, and 31%, and the number of DALYs increased by 31%, 52%, and 29% in 2021. However, the corresponding age-standardized rates showed a downward trend (AAPC, -1.53; AAPC, -1.68; AAPC, -0.89; AAPC, -1.11; AAPC, -2.10; AAPC, -1.97). The burden was higher among males than females, with the highest burden observed in high-SDI regions. The ASMR and ASDR were found to have a non-linear positive correlation with SDI (RASMR of bladder cancer=0.574, p<0.001; R=0.580, p<0.001; R=0.792, p<0.001; R=0.783, p<0.001; R=0.417, p<0.001; R=0.436, p<0.001), although the greatest improvements over the past three decades were observed in high-SDI regions. Joinpoint regression analysis indicated a downward trend in global deaths and DALYs burden, and the ARIMA model predicted that the burden of related diseases will continue to decline through 2041 (ASMR=0.44; ASDR=8.56; ASMR=0.13; ASDR=2.82; ASMR=0.28; ASDR=4.28).
Smoking has imposed a substantial disease burden on urological cancers over the past three decades. While overall ASDR and ASMR are declining, the disease burden remains high among men, especially those in high-SDI areas. This emphasizes the need for increased tobacco control for these populations or regions.
吸烟会增加患膀胱癌和肾癌的风险，并且与前列腺癌（PCa）患者较差的预后相关，这带来了重大的健康和社会经济负担。了解归因于吸烟的泌尿系统癌症的流行病学趋势对于制定有针对性的预防策略至关重要。本研究调查了1990年至2021年归因于吸烟的三种泌尿系统癌症的全球趋势，并预测了未来二十年的趋势。
数据来自《2021年全球疾病负担》（GBD 2021）。指标包括死亡人数、伤残调整生命年（DALYs）、年龄标准化死亡率（ASMR）和年龄标准化DALY率（ASDR），以及不确定性区间（UIs）。负担比较按性别、年龄和社会人口指数（SDI）进行分层。使用Joinpoint回归分析时间趋势，以计算年度百分比变化（APC）和平均年度百分比变化（AAPC），并给出95%置信区间（CIs）。使用自回归积分移动平均（ARIMA）模型预测未来趋势。
与1990年相比，2021年归因于吸烟的膀胱癌、肾癌和前列腺癌死亡人数分别增加了43%、67%和31%，DALYs数量分别增加了31%、52%和29%。然而，相应的年龄标准化率呈下降趋势（AAPC，-1.53；AAPC，-1.68；AAPC，-0.89；AAPC，-1.11；AAPC，-2.10；AAPC，-1.97）。男性的负担高于女性，高SDI地区的负担最高。发现ASMR和ASDR与SDI呈非线性正相关（膀胱癌的RASMR = 0.574，p < 0.001；R = 0.580，p < 0.001；R = 0.792，p < 0.001；R = 0.783，p < 0.001；R = 0.417，p < 0.001；R = 0.436，p < 0.001），尽管在过去三十年中高SDI地区的改善最为显著。Joinpoint回归分析表明全球死亡和DALYs负担呈下降趋势，ARIMA模型预测相关疾病的负担将持续下降至2041年（ASMR = 0.44；ASDR = 8.56；ASMR = 0.13；ASDR = 2.82；ASMR = 0.28；ASDR = 4.
