国际肿瘤学杂志

国际肿瘤学杂志 ›› 2022, Vol. 49 ›› Issue (10): 586-591.doi: 10.3760/cma.j.cn371439-20220726-00116

• 论著 • 上一篇    下一篇

1990—2019年中国女性乳腺癌发病死亡趋势及年龄-时期-队列模型分析

段帅, 郭晨明, 李慧芳, 地力木拉提·艾斯木吐拉()   

  1. 新疆医科大学第一附属医院乳腺外科，乌鲁木齐 830054
  • 收稿日期:2022-07-26 修回日期:2022-09-12 出版日期:2022-10-08 发布日期:2022-12-01
  • 通讯作者: 地力木拉提·艾斯木吐拉 E-mail:mlt0306@sina.com

Trends in incidence and mortality of female breast cancer in China from 1990 to 2019 and age-period-cohort model analysis

Duan Shuai, Guo Chenming, Li Huifang, Dilimulati · Aisimutula()   

  1. Department of Breast Surgery， First Affiliated Hospital of Xinjiang Medical University， Urumqi 830054， China
  • Received:2022-07-26 Revised:2022-09-12 Online:2022-10-08 Published:2022-12-01
  • Contact: Dilimulati · Aisimutula E-mail:mlt0306@sina.com

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摘要：

目的 分析1990—2019年中国女性乳腺癌发病和死亡趋势及年龄-时期-队列（APC）对其的影响。方法 收集2019年全球疾病负担（GBD）中1990—2019年20~95岁中国女性乳腺癌发病和死亡数据，采用Joinpoint软件估算年龄标化发病率和死亡率的平均年度百分比变化率（AAPC），分析1990—2019年中国女性乳腺癌疾病负担变化趋势。运用美国国家癌症研究所研发的基于R语言的APC模型分析年龄、时期、队列对其变化的影响。结果 1990—2019年中国女性乳腺癌年龄标化发病率呈上升趋势，从1990年的17.07/10万上升至2019年的35.61/10万，平均每年上升2.59%（95%CI为2.45%~2.73%，P<0.001），且上升幅度高于全球水平（AAPC=0.47%，95%CI为0.31%~0.63%，P<0.001）；标化死亡率略呈下降趋势，从1990年的9.16/10万下降至2019年的9.01/10万，下降了0.05%（95%CI为-0.20%~0.09%，P=0.479），但差异无统计学意义。APC模型分析结果显示，女性乳腺癌发病率和死亡率随年龄的增长均呈上升趋势；随着时期的推移，1990—2019年发病率呈上升趋势，发病风险上升至2015—2019年时期的1.49（95%CI为1.42~1.57，P<0.001），死亡率呈下降趋势，死亡风险在1990—1994年时期组最高（RR=0.79，95%CI为0.74~0.83，P<0.001）；队列效应结果显示，出生越晚的女性发病风险越高，1995—1999年出生队列的女性发病风险最高（RR=3.12，95%CI为1.82~5.33，P<0.001），死亡风险呈单峰分布，呈先上升后下降的趋势，出生越晚的女性死亡风险越低，1950—1954年出生队列死亡风险最高（RR=1.04，95%CI为0.98~1.09，P<0.001），随后呈下降趋势，下降至1995—1999年出生队列的0.48（95%CI为0.19~1.24，P<0.001）。结论 1990—2019年中国女性乳腺癌发病率呈上升趋势，且明显高于全球上升幅度，死亡率趋于平稳。APC模型分析发现，发病率和死亡率随着年龄的增长呈上升趋势；时期和队列效应显示，随着时期和队列的推移我国女性乳腺癌发病风险逐渐增加；死亡率的时期效应呈下降趋势，队列效应呈单峰分布，呈先上升后下降的趋势。

关键词: 乳腺肿瘤, 死亡率, 发病率, 中国

Abstract:

Objective To analyze the incidence and mortality trends of female breast cancer in China from 1990 to 2019 and the impact of age-period-cohort （APC） on it. Methods The incidence and mortality of breast cancer of Chinese women aged 20-95 years from 1990 to 2019 were collected from the Global Burden of Disease （GBD） in 2019. Joinpoint software was used to estimate the average annual percentage change rate （AAPC） of age standardized incidence and mortality， and analyze the changing trend of disease burden of breast cancer in Chinese women from 1990 to 2019. The R language based APC model developed by the National Cancer Institute of the United States was used to analyze the impact of age， period and cohort on their changes. Results From 1990 to 2019， the age standardized incidence of female breast cancer in China showed an upward trend， from 17.07/100 000 in 1990 to 35.61/100 000 in 2019， with an average annual increase of 2.59% （95%CI： 2.45%-2.73%， P<0.001）， which was higher than the global level （AAPC=0.47%， 95%CI： 0.31%-0.63%， P<0.001）. The standardized mortality showed a slight downward trend， from 9.16/100 000 in 1990 to 9.01/100 000 in 2019， with a decrease of 0.05% （95%CI： -0.20%-0.09%， P=0.479）， but there was not a statistically significant difference. APC model results showed that the incidence and mortality of female breast cancer increased with age. With the passage of time， the incidence from 1990 to 2019 showed an upward trend， and the incidence risk rose to 1.49 in the 2015-2019 period （95%CI： 1.42-1.57， P<0.001）. The mortality showed a downward trend， and the death risk was the highest in the 1990-1994 period （RR=0.79， 95%CI： 0.74-0.83， P<0.001）. Cohort effect results showed that the later the women were born， the higher the risk of morbidity. The women born in the cohort from 1995 to 1999 had the highest risk （RR=3.12， 95%CI： 1.82-5.33， P<0.001）. The risk of death showed a unimodal distribution， showing a trend of first increasing and then decreasing， the later the women were born， the lower the risk of death. The birth cohort from 1950 to 1954 had the highest risk of death （RR=1.04， 95%CI： 0.98-1.09， P<0.001）， and then showed a downward trend， falling to 0.48 （95%CI： 0.19-1.24， P<0.001） in the birth cohort from 1995 to 1999. Conclusion From 1990 to 2019， the incidence of breast cancer in Chinese women shows an upward trend， which is significantly higher than the global increase， and the mortality tends to stabilize. APC model analysis finds that the incidence and mortality increase with age， and the period and cohort effects show that the incidence risk of breast cancer in Chinese women gradually increases with the passage of the period and cohort. The period effect of mortality shows a downward trend， and the cohort effect of mortality shows a unimodal distribution， showing a trend of first increasing and then decreasing.

Key words: Breast neoplasms, Mortality, Incidence, China