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RSS中国和全球早发性肺癌的疾病负担及相关风险因素分析
Disease Burden and Associated Risk Factors of Early-Onset Lung Cancer in China and Worldwide
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摘要:目的 评估全球和中国早发性肺癌(诊断肺癌时患者年龄为15~49岁)疾病负担流行现状和主要风险因素。方法 基于GLOBOCAN 2022数据集和全球疾病负担(Global Burden of Disease, GBD)2021数据集, 按年龄、性别、地理位置和人类发展指数(human development index, HDI)评估全球和中国早发性肺癌疾病负担和相关风险因素, 主要观察指标为年龄标化发病率(age-standardized incidence rate, ASIR)、年龄标化死亡率(age-standardized mortality rate, ASMR)及伤残调整生命年(disability adjusted life years, DALYs)损失贡献率。结果 2022年全球早发性肺癌新增病例137 705例, 死亡病例72 646例, ASIR和ASMR分别为3.43/10万人和1.82/10万人, 男性早发性肺癌疾病负担高于女性(ASIR: 3.72/10万人比3.14/10万人, ASMR: 2.31/10万人比1.33/10万人)。高HDI地区早发性肺癌的ASIR(5.51/10万人)和ASMR(2.57/10万人)高于其他水平HDI地区; 健康不平等性分析发现, 早发性肺癌疾病负担主要集中于高HDI地区。中国是全球早发性肺癌疾病负担最为严重的国家, 2022年中国早发性肺癌新增和死亡病例分别占全球总数的48.69%和35.77%, ASIR和ASMR分别为8.21/10万人和3.17/10万人, 男性早发性肺癌发病负担低于女性(ASIR: 7.67/10万人比8.78/10万人), 但死亡负担高于女性(ASMR: 4.01/10万人比2.29/10万人)。吸烟和室外颗粒物污染是早发性肺癌最主要的风险因素, 其DALYs损失贡献率在全球范围内分别为42.01%和15.62%, 在中国分别为46.78%和20.84%。全球范围内, 早发性肺癌的第三大风险因素为室内空气污染, 在中国则为二手烟, 室内空气污染降至第五位。不同年龄组中, 早发性肺癌的风险因素构成存在明显差异, 其中在15~24岁年龄组中, 可控风险因素所致的疾病负担相对较低。结论 早发性肺癌疾病负担在不同性别、区域和HDI水平之间呈现明显差异, 中国的早发性肺癌负担较为严重。政策制订者应根据疾病负担差异, 考虑公平分配卫生资源, 并采取针对性干预措施, 特别是在烟草控制和空气污染方面, 应进一步采取措施控制吸烟率和降低空气污染, 以提升癌症防治整体成效。Abstract:Objective To assess the global and Chinese disease burden of early-onset lung cancer(diagnosed in patients aged 15-49 years) and its major risk factors.Methods Based on the GLOBOCAN 2022 and Global Burden of Disease(GBD) 2021 datasets, we evaluated the disease burden and associated risk factors of early-onset lung cancer globally and in China, stratified by age, sex, geographic location, and human development index(HDI). Key indicators included age-standardized incidence rate(ASIR), age-standardized mortality rate(ASMR), and disability adjusted life years(DALYs) attributable to risk factors.Results In 2022, there were 137 705 new cases and 72 646 deaths from early-onset lung cancer globally, with ASIR and ASMR of 3.43 per 100 000 and 1.82 per 100 000 population, respectively. The disease burden was higher in males than in females(ASIR: 3.72 per 100 000 vs. 3.14 per 100 000; ASMR: 2.31 per 100 000 vs. 1.33 per 100 000). High-HDI regions exhibited the highest ASIR(5.51 per 100 000) and ASMR(2.57 per 100 000), with health inequality analysis revealing a concentration of disease burden in higher-HDI areas. China bore the heaviest burden, accounting for 48.69% of global new cases and 35.77% of deaths. China's ASIR(8.21 per 100 000) and ASMR(3.17 per 100 000) exceeded global averages, with incidence higher in females(8.78 per 100 000 vs. 7.67 per 100 000) but mortality higher in males(4.01 per 100 000 vs. 2.29 per 100 000). Smoking and ambient particulate matter pollution were the leading risk factors globally(DALYs contribution: 42.01% and 15.62%) and in China(DALYs contribution: 46.78% and 20.84%). Globally, household air pollution ranked third, whereas in China, secondhand smoke replaced it as the third leading risk factor, with household air pollution dropping to fifth. Risk factor profiles varied significantly across age groups, with modifiable risks contributing less to disease burden in the 15-24 age group.Conclusions The burden of early-onset lung cancer varies markedly by sex, region, and HDI, with China facing a disproportionately high burden. Policymakers should prioritize equitable resource allocation and targeted interventions, particularly in tobacco control and air pollution mitigation, to enhance cancer prevention and control efforts.
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