Qiu Zijian, Huang Yitong, Qiu Zhaoqi, Guo Zeying, Wang Liejiong, Xu Maoyi, Xuan Feng
Department of Radiation Oncology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
Department of Internal Medicine, Zhuji Maternal and Child Health Hospital, Shaoxing, China.
J Glob Health. 2025 Jun 2;15:04161. doi: 10.7189/jogh.15.04161.
Cancer poses a significant challenge to society and public health. Our objective was to systematically quantify the effect of disease severity changes on cancer-related disability-adjusted life years (DALYs), thereby enabling cross-regional, temporal, and cancer-type comparisons.
This secondary analysis obtained data on prevalence, DALYs, and population size from 1990 to 2021 from the Global Burden of Disease 2021. Unlike conventional analyses, a four-factor decomposition analysis was applied to attribute DALY changes to population growth, aging, prevalence shifts, and disease severity changes from 1990 to each subsequent year. We focused on the absolute and relative contributions of disease severity changes to DALY variations. Comparative analyses were subsequently stratified by region, sociodemographic index (SDI), sex, and cancer type.
Between 1990 and 2021, a reduction in neoplasms-related DALYs attributed to disease severity changes was observed globally for both sexes combined, with a total decrease of 81 963.31 thousand (52.68%) by 2021. Significantly, males (n = -56 172.28 thousand; -62.73%) exhibited greater absolute and relative contributions than females (n = -28 558.95 thousand; -42.35%). High (n = -30 317.14 thousand; -67.01%) and middle SDI (n = -32 958.22 thousand; -80.36%) regions showed a more pronounced decline than low-middle SDI (n = -5869.18 thousand; -37.48%) and low SDI (n = -2881.96 thousand; -41.62%) regions. Nationally, China (n = -44 306.96 thousand) demonstrated the largest absolute contribution, while Qatar (-337.34%) exhibited the highest relative proportion. Globally, absolute contributions were greatest for lung (n = -12 228.72 thousand), colorectal (n = -9334.10 thousand), and gastric (n = -8504.91 thousand) cancers. The highest relative proportions were for testicular (-80.81%), thyroid (-75.28%), and nasopharyngeal (-75.11%) cancers. Notably, mesothelioma saw an increase in DALYs due to disease severity changes.
Variations in cancer-related DALYs attributed to disease severity changes exhibited substantial heterogeneity. These findings could offer valuable insights for policy makers to develop and improve cancer control, with the vision of a world where cancer in preventable and every survivor remains healthy.
癌症对社会和公众健康构成重大挑战。我们的目标是系统地量化疾病严重程度变化对癌症相关伤残调整生命年（DALYs）的影响，从而实现跨地区、跨时间和癌症类型的比较。
这项二次分析从《2021年全球疾病负担》中获取了1990年至2021年的患病率、DALYs和人口规模数据。与传统分析不同，我们应用了四因素分解分析，将1990年至随后各年的DALY变化归因于人口增长、老龄化、患病率变化和疾病严重程度变化。我们关注疾病严重程度变化对DALY变化的绝对和相对贡献。随后按地区、社会人口指数（SDI）、性别和癌症类型进行了比较分析。
1990年至2021年期间，全球两性合计因疾病严重程度变化导致的肿瘤相关DALYs有所减少，到2021年总计减少了8196.331万（52.68%）。值得注意的是，男性（n = -5617.228万；-62.73%）的绝对和相对贡献均高于女性（n = -2855.895万；-42.35%）。高SDI地区（n = -3031.714万；-67.01%）和中等SDI地区（n = -3295.822万；-80.36%）的下降比低中SDI地区（n = -586.918万；-37.48%）和低SDI地区（n = -288.196万；-41.62%）更为明显。在国家层面，中国（n = -4430.696万）的绝对贡献最大，而卡塔尔（-337.34%）的相对比例最高。在全球范围内，肺癌（n = -1222.872万）、结直肠癌（n = -933.410万）和胃癌（n = -850.491万）的绝对贡献最大。相对比例最高的是睾丸癌（-80.81%）、甲状腺癌（-75.28%）和鼻咽癌（-75.11%）。值得注意的是，间皮瘤因疾病严重程度变化导致DALYs增加。
因疾病严重程度变化导致的癌症相关DALYs变化存在显著异质性。这些发现可为政策制定者制定和改进癌症控制提供有价值的见解，以期实现一个可预防癌症且每个幸存者都保持健康的世界。
