Wang Xiao, Li Ying, Luo Yujie, Song Xin
Department of Otorhinolaryngology, Head and Neck Surgery, Ziyang Central Hospital, Ziyang, China.
Department of Ophthalmology, Ziyang Central Hospital, Ziyang, China.
Front Public Health. 2025 Jun 12;13:1614389. doi: 10.3389/fpubh.2025.1614389. eCollection 2025.
Nasopharyngeal cancer (NPC) poses a considerable global health burden, with behavioral risk factors such as smoking and high alcohol use contributing to disparities across sociodemographic groups. The growing aging population faces heightened vulnerability to NPC due to prolonged exposure to these modifiable risks, yet comprehensive analyses of aging-specific burden patterns remain limited.
Utilizing the Global Burden of Disease 2021 data, we conducted a systematic evaluation of NPC burden attributable to smoking and alcohol use across 204 countries from 1990 to 2021. Age-stratified analyses focused on older adults (≥60 years), incorporating three analytical dimensions: Sociodemographic Index (SDI) quintiles, sex-specific disparities, and geospatial heterogeneity. Age-standardized mortality (ASMR) and age-standardized DALY rates (ASDRs) were calculated with 95% uncertainty intervals. Temporal trends were quantified via estimated annual percentage changes (EAPCs). Bayesian age-period-cohort modeling projected disease burden through 2050.
From 1990 to 2021, smoking and high alcohol use contributed substantially to the NPC burden globally, with older adults exhibiting distinct risk profiles. Decline in smoking-related burden in global ASDR was observed, yet older adults in low and middle SDI regions retained disproportionately high rates. Rise in alcohol-related burden in certain regions (e.g., Southeast Asia and Caribbean) was particularly pronounced among older age groups. Middle and high-middle SDI regions consistently exhibited the highest ASDR for both risk factors, with older adults contributing a significant share of disability-adjusted life years (DALYs). Older males faced the highest DALY burdens, with extreme older male-to-female disparities persisting across age groups. Population aging will amplify absolute DALY burdens among older adults by 2050.
Behavioral risk factors such as tobacco and alcohol use remain key contributors to the burden of nasopharyngeal cancer in older persons, with significant regional, gender, and demographic differences. There is an urgent need to develop targeted public health policies focusing on smoking cessation and alcohol control that take into account the health needs of older persons.
鼻咽癌给全球带来了相当大的健康负担，吸烟和大量饮酒等行为风险因素导致不同社会人口群体之间存在差异。由于长期暴露于这些可改变的风险因素，老龄化人口对鼻咽癌的易感性增加，但针对老龄化特定负担模式的综合分析仍然有限。
利用《2021年全球疾病负担》数据，我们对1990年至2021年期间204个国家因吸烟和饮酒导致的鼻咽癌负担进行了系统评估。年龄分层分析聚焦于老年人（≥60岁），纳入三个分析维度：社会人口指数（SDI）五分位数、性别差异和地理空间异质性。计算了年龄标准化死亡率（ASMR）和年龄标准化伤残调整生命年率（ASDRs），并给出95%的不确定性区间。通过估计年度百分比变化（EAPCs）对时间趋势进行量化。贝叶斯年龄-时期-队列模型预测了到2050年的疾病负担。
1990年至2021年期间，吸烟和大量饮酒在全球鼻咽癌负担中占很大比例，老年人呈现出不同的风险特征。观察到全球ASDR中与吸烟相关的负担有所下降，但低和中等SDI地区的老年人仍保持着不成比例的高发病率。在某些地区（如东南亚和加勒比地区），与饮酒相关的负担上升在老年人群体中尤为明显。中等和高中等SDI地区在这两种风险因素下的ASDR一直最高，老年人在伤残调整生命年（DALYs）中占很大比例。老年男性面临着最高的DALY负担，各年龄组中老年男性与女性之间存在极端差异。到2050年，人口老龄化将加剧老年人的绝对DALY负担。
烟草和酒精使用等行为风险因素仍然是老年人鼻咽癌负担的主要贡献因素，存在显著的地区、性别和人口差异。迫切需要制定有针对性的公共卫生政策，重点关注戒烟和酒精控制，并考虑到老年人的健康需求。
