55岁及以上老年人胰腺癌负担的不同轨迹：一项全球疾病负担研究（GBD）2021分析揭示中国老龄化与人口增长的双重流行（1990 - 2045年）

Divergent trajectories in pancreatic cancer burden among older adults (55+): a GBD 2021 analysis revealing China's dual epidemic of aging and population growth (1990-2045).

作者信息

Dong Hui, Wang Heng, Han Wenping, Niu Haigang

机构信息

Fenyang College of Shanxi Medical University, Fengyang, China.

Food Laboratory of Zhong Yuan, Luohe, China.

出版信息

Front Public Health. 2025 May 29;13:1600635. doi: 10.3389/fpubh.2025.1600635. eCollection 2025.

DOI:10.3389/fpubh.2025.1600635

PMID:40510574

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12158976/

Abstract

BACKGROUND

The global population aging trend has intensified concerns regarding pancreatic cancer (PC), a leading cause of cancer-related mortality with a 5-year survival rate of 13%. This study evaluates the global burden, temporal trends, and socioeconomic disparities of PC among individuals aged ≥55 years using the 2021 Global Burden of Disease (GBD) data.

METHODS

Age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analyzed across 204 countries. Joinpoint regression identified temporal trends (1990-2021), while Bayesian Age-Period-Cohort (BAPC) modeling projected future burden. Socioeconomic disparities were assessed via the Socio-demographic Index (SDI), and risk factor contributions were quantified using decomposition analysis.

RESULTS

In 2021, Finland, Germany, and Japan exhibited the highest age-standardized PC prevalence (ASPR: 64.42-66.17 per 100,000 population), contrasting sharply with Mozambique (ASPR: 2.85 per 100,000 population). Mortality peaked in Greenland (age-standardized death rate, ASDR: 81.85 per 100,000 population) and Monaco (ASDR: 71.75 per 100,000 population). Males showed elevated burden across incidence, prevalence, and mortality (peak age: 70-74 years), with global trends persistently rising (average annual percentage change, AAPC >0, 1990-2021). China experienced a transient mortality decline (AAPC = -0.93, 2011-2015), linked to healthcare reforms. High SDI regions (e.g., Japan) faced amplified burdens driven by aging and metabolic risks, while smoking (15.4-28.5% of deaths and years lived with disability, YLDs) and hyperglycemia (37.8% of YLDs in the U.S.) dominated modifiable risks. Projections diverge significantly: China's age-standardized incidence rate (ASIR) burden is projected to increase from 27.96 (95% uncertainty interval, UI: 25.76, 30.16) in 2022 to 36.94 (UI: 0, 79.46) by 2045. In contrast, the global ASIR is expected to decline from 31.07 (UI: 30.06, 32.08) to 27.11 (UI: 8.73, 45.57).

CONCLUSION

Persistent socioeconomic and gender disparities underscore the need for targeted interventions, including tobacco control, glycemic management, and lifestyle modifications. Prioritizing aging populations in high-SDI regions and addressing underreported risks in low-SDI areas are critical for mitigating the growing PC burden.

摘要

背景

全球人口老龄化趋势加剧了人们对胰腺癌（PC）的担忧，胰腺癌是癌症相关死亡的主要原因，5年生存率为13%。本研究利用2021年全球疾病负担（GBD）数据评估了全球55岁及以上人群中胰腺癌的负担、时间趋势和社会经济差异。

方法

对204个国家的年龄标准化发病率、患病率、死亡率和伤残调整生命年（DALYs）进行了分析。Joinpoint回归确定了时间趋势（1990 - 2021年），而贝叶斯年龄-时期-队列（BAPC）模型预测了未来负担。通过社会人口指数（SDI）评估社会经济差异，并使用分解分析量化风险因素的贡献。

结果

2021年，芬兰、德国和日本的年龄标准化胰腺癌患病率最高（每10万人中年龄标准化患病率：64.42 - 66.17），与莫桑比克形成鲜明对比（每10万人中年龄标准化患病率：2.85）。死亡率在格陵兰岛（年龄标准化死亡率，ASDR：每10万人中81.85）和摩纳哥（ASDR：每10万人中71.75）达到峰值。男性在发病率、患病率和死亡率方面的负担较高（峰值年龄：70 - 74岁），全球趋势持续上升（平均年度百分比变化，AAPC>0，1990 - 2021年）。中国经历了死亡率的短暂下降（AAPC = -0.93，2011 - 2015年），这与医疗改革有关。高SDI地区（如日本）由于老龄化和代谢风险面临更大的负担，而吸烟（占死亡和伤残调整生命年，YLDs的15.4 - 28.5%）和高血糖（在美国占YLDs的37.8%）是主要的可改变风险。预测结果差异显著：中国的年龄标准化发病率（ASIR）负担预计将从2022年的27.96（95%不确定区间，UI：25.76，30.16）增加到2045年的36.94（UI：0，79.46）。相比之下，全球ASIR预计将从31.07（UI：30.06，32.08）降至27.11（UI：8.73，45.57）。