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Analysis of Disease Burden and Attributable Risk Factors of Early-onset Female Breast Cancer in China and Globally from 1990 to 2021
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摘要: 目的 分析1990—2021年中国与全球早发女性乳腺癌的疾病负担、变化趋势及归因风险因素。方法 从2021年全球疾病负担（ Global Burden of Disease，GBD） 2021数据库提取1990—2021年中国与全球早发女性乳腺癌（诊断年龄<50岁）的发病、死亡和伤残调整寿命年（ disability adjusted life year，DALY）的绝对数和粗率，提取5种风险因素（吸烟、饮酒、运动不足、高红肉饮食、高空腹血糖）和全部风险因素的DALY归因占比数据。采用Joinpoint回归模型以年度变化百分比（ annual percentage change，APC）和平均年度变化百分比（ average annual percentage change，AAPC）分析标化率的变化趋势。结果 1990—2021年，中国和全球早发女性乳腺癌标化发病率均呈整体上升趋势（中国： AAPC=2.25%；全球： AAPC=0.64%；成对比较，P < 0.001），标化死亡率（中国： AAPC=-0.82%；全球： AAPC=-0.26%；成对比较，P < 0.001）和标化DALY率（中国： AAPC=-0.63%；全球： AAPC=-0.18%；成对比较，P=0.004）均呈整体下降趋势。中国标化死亡率（ APC=0.78%）和标化DALY率（ APC=1.38%）分别在2014年和2015年呈逐渐上升趋势。2021年，中国（ 13.55%）与全球（ 11.20%）早发女性乳腺癌DALY归因于高红肉饮食的比例均相对最高。结论 1990—2021年，中国和全球早发女性乳腺癌的标化发病率均呈整体上升趋势，标化死亡率和标化DALY率均呈整体下降趋势。中国标化发病率正向全球整体水平靠近，标化死亡率和标化DALY率在近十余年均呈上升趋势，中国早发女性乳腺癌防治形势依然严峻。未来应进一步扩大乳腺癌筛查项目的推广范围，优化乳腺癌筛查方案，提高居民对癌症防治知识的认知，将有助于减轻中国日益增长的早发女性乳腺癌疾病负担。Abstract: Objective To analyze the disease burden， trends， and attributable risk factors of early-onset female breast cancer in China and globally from 1990 to 2021. Methods Data on the number and crude rates of incidence， death， and disability adjusted life year (DALY)， and attributable proportion for DALY of five specific risk factors (tobacco， alcohol use， low physical activity， diet high in red meat， and high fasting plasma glucose) and all risk factors were extracted from the Global Burden of Disease 2021 (GBD 2021). The Joinpoint regression model was used to analyze the trends through annual percentage change (APC) and average annual percentage change (AAPC) on the trends of age-standardized rates. Results From 1990 to 2021， the age-standardized incidence rates in China and globally showed an overall upward trend (China: AAPC = 2.25%； Globally: AAPC = 0.64%; Pairwise comparison， P < 0.001). The age-standardized mortality rates (China: AAPC = -0.82%; Globally: AAPC = -0.26%; Pairwise comparison， P < 0.001) and agestandardized DALY rates (China: AAPC = -0.63%; Globally: AAPC = -0.18%; Pairwise comparison， P = 0.004) showed an overall downward trend. The age-standardized mortality rates (APC = 0.78%) and age-standardized DALY rates (APC = 1.38%) in China have shown a gradually upward trend since 2014 and 2015， respectively. The proportion of DALY attributed to diet high in red meat was relatively highest in China (13.55%) and globally (11.20%). Conclusion From 1990 to 2021， the age-standardized incidence rates of early-onset female breast cancer in China and globally showed an overall upward trend， and the age-standardized mortality rates and age-standardized DALY rates showed an overall downward trend. The age-standardized incidence rates in China was approaching to the global level， and the age-standardized mortality rates and age-standardized DALY rates have shown an upward trend in the past decade. The prevention and treatment of early-onset female breast cancer in China is in a serious situation. In the future， further expanding the promotion scope of female breast cancer screening programs， optimizing the female breast cancer screening programs， and improving residents' awareness of cancer prevention and treatment knowledge will help reduce the growing disease burden of early-onset female breast cancer in China.
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Keywords:
- early-onset female breast cancer /
- disease burden /
- attributable risk factors /
- China /
- global
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