摘要: Global, Regional, and National Cancer Incidence,Mortality, Years of Life Lost, Years Lived With Disability,and Disability-Adjusted Life-Years for 29 Cancer Groups,1990 to 2017A Systematic Analysis for ...
Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017 A Systematic Analysis for the Global Burden of Disease Study
IMPORTANCE Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. OBJECTIVE To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. EVIDENCE REVIEW We used the GBD study estimation methods to describe cancer incidence,mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate.We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. FINDINGS In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority ofcancer DALYs came from years of life lost (97%), and only 3%came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). CONCLUSIONS AND RELEVANCE The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
重要性 癌症和其他非传染性疾病(NCD)现在被广泛认为是对全球发展的威胁。联合国非传染性疾病最新高级别会议重申了这一观点,并强调了在实现2011年《关于预防和控制非传染性疾病的政治宣言》和第三个可持续发展目标方面进展缓慢。缺乏情况分析,确定优先重点和预算是实现这些目标的主要障碍。所有这些共同点在于,它们需要有关当地癌症流行病学的信息。全球疾病负担(GBD)研究具有独特的优势,可以提供这些关键数据。 目的 描述1990年至2017年间195个国家的29个癌症组的癌症负担,以提供癌症控制规划所需的数据。 证据审查 我们使用GBD研究估算方法来描述癌症发生率,死亡率,残障生存年限,生命损失年限以及残障调整生命年(DALYs)。结果在国家一级以及社会人口统计学指数(SDI)上进行显示,该指标是收入,教育程度和总生育率的综合指标。我们还分析了流行病学与人口学转变对癌症发病率的影响。 发现 2017年,全球有2450万例癌症事件(1680万例无非黑色素瘤皮肤癌[NMSC])和960万例癌症死亡。大多数癌症DALY来自失去生命的岁月(97%),只有3%来自患有残疾的岁月。男女患低SDI的几率最低(七分之一),高SDI的几率最高(二分之一)。2017年,男性最常见的事件癌症是NMSC(430万起事件);气管,支气管和肺癌(TBL)(150万起事故);和前列腺癌(130万起事件)。男性最常见的癌症死亡和DALY原因是TBL癌(130万死亡和2840万DALY),肝癌(572 000死亡和1520万DALY)和胃癌癌症(542 000例死亡和1220万DALYs)。对于2017年的女性而言,最常见的事件癌症是NMSC(330万事件),乳腺癌(190万事件)和大肠癌(819 000事件)。女性癌症死亡和DALY的主要原因是乳腺癌(601 000例死亡和1740万DALYs),TBL癌(596 000例死亡和1260万DALYs)和结直肠癌(414 000例死亡和830DALYs)。 结论与关联 全国癌症流行病学概况 GBD研究显示出巨大的异质性,这反映了不同的风险因素,经济环境,生活方式以及获得医疗和筛查的机会。政策制定者和其他利益相关者可以使用GBD研究来制定和改善国家和地方癌症控制,以实现全球目标并提高癌症治疗的公平性。Cancer is nowwidely recognized as a global problem that unfortunately lacks a global solution. The latest United Nations high-level meeting on noncommunicable diseases (NCDs) exemplified this conundrum. Despite global commitment to reducing the risk of and disability from NCDs,including cancer, implementation of knownsolutions is inadequate to reach the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases(25% reduction in premature mortality from NCDs by 2025) and the third Sustainable Development Goal (by 2030 reduce by onethird premature mortality from NCDs through prevention and treatment, and promote mental health and well-being).To reduce cancer burden, identifying the scope of the problem and mapping out implementation of solutions is best done in National Cancer Control Plans (NCCPs). However, a recent review showed that only 29% of low-income countries had a NCCP, and even if NCCPs existed, cost, financing, monitoring,and expansion of information systems was often inadequate.Many highly effective prevention and treatment strategies exist for cancer.However, they are often very specific (eg,vaccination forhumanpapillomavirus and hepatitisBvirus for prevention of cervical and liver cancer, or tyrosine kinase inhibitors for cancerswith targetablemutations). Effective NCCPs therefore require detailed knowledge about the local burden of cancer and associated risk factors. We herein present results from the Global Burden of Disease (GBD) 2017 study describing cancer incidence, mortality, years of life lost (YLLs), years livedwith disability (YLDs), and disability-adjusted lifeyears (DALYs) for 195 countries from1990 through 2017, which can inform cancer control through policy, resource allocation,and health system planning.癌症已被广泛认为是一个全球性问题,但不幸的是缺乏全球性解决方案。最近的联合国非传染性疾病高级别会议就是这一难题的例证。尽管全球致力于降低包括癌症在内的非传染性疾病的风险和致残性,但已知解决方案的实施仍不足以达成2011年《关于预防和控制非传染性疾病的政治宣言》(到2025年使非传染性疾病的过早死亡减少25%)和第三次可持续发展。发展目标(到2030年,通过预防和治疗将非传染性疾病的过早死亡率降低三分之一,并促进心理健康和福祉)。减少癌症负担,确定问题的范围并规划解决方案的实施最好在国家癌症中心控制计划(NCCP)。然而,最近的一项审查表明,只有29%的低收入国家拥有NCCP,即使存在NCCP,信息系统的成本,融资,监控和扩展也常常不足。许多有效的癌症预防和治疗策略存在但是,它们通常非常具体(例如,人乳头瘤病毒和乙型肝炎病毒的疫苗接种,以预防子宫颈癌和肝癌,或酪氨酸激酶抑制剂用于具有可靶向突变的癌症)。因此,有效的NCCP需要有关癌症局部负担和相关风险因素的详细知识。我们在此提供了2017年全球疾病负担(GBD)研究的结果,该研究描述了1990年至2017年间195个国家的癌症发病率,死亡率,生命损失年限(YLLs),残疾寿命年限(YLDs)和残疾调整生命年(DALYs)。可以通过政策,资源分配和卫生系统规划来告知癌症控制。Methods Methods have remained similar to the GBD 2016 study.Detailed descriptions of the methods can be found in theGBD 2017 publications as well as in the eAppendix, eFigures, and eTables in the Supplement.For eachGBDstudy, the entire time series is re-estimated. This study therefore supersedes prior GBD iterations. The GBD study is compliant with the Guidelines forAccurate and TransparentHealth EstimatesReporting statement (eTable 1 in the Supplement). Compared with the prior GBD study (GBD 2016), the neoplasms category for GBD 2017 also includes benign and in situ neoplasms (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] codes D00-D49). Because disability associatedwithbenign neoplasms is most often very small,we only estimated disability for the new cause:myelodysplastic, myeloproliferative, and other hematopoietic neoplasms.The terms malignant neoplasms or cancer in this article only include ICD-10 codes C00 through C96. Other changes since GBD 2016 are the addition of new data sources(eTable 3 in the Supplement) for GBD 2017 and improvements in the way we estimated cancer survival by using the mortality-to-incidence ratio (MIR). In this study, estimates are presented for 29 cancer categories and 195 countries and territories.Estimates for benign neoplasms as well as selected subnational estimates are available online (https://vizhub. healthdata.org/gbd-compare/ andhttp://ghdx.healthdata.org/ gbd-results-tool). All rates are reported per 100000 personyears. The GBD world population standard was used for the calculation of age-standardized rates.9 We report 95% uncertainty intervals for all estimates.方法 方法仍与GBD 2016研究相似,有关方法的详细说明可在GBD 2017出版物以及增刊中的eAppendix,eFigures和eTables中找到。对于每个GBD研究,将重新估算整个时间序列。因此,本研究取代了先前的GBD迭代。GBD研究符合《准确和透明的健康估计报告指南》声明(补编中的表1)。与之前的GBD研究(GBD 2016)相比,GBD 2017的肿瘤类别还包括良性和原位肿瘤(《国际疾病和相关健康问题统计分类》,第十次修订[ICD-10]代码D00-D49)。因为与良性肿瘤相关的残疾通常很小,我们仅估计新病因的残疾:骨髓增生异常,骨髓增生性和其他造血肿瘤。本文中的术语“恶性肿瘤或癌症”仅包括ICD-10代码C00至C96。自GBD 2016以来的其他变化是为GBD 2017添加了新的数据源(补编中的表3),并通过使用死亡率与发病率(MIR)来估计癌症存活率的方式有所改进。在这项研究中,给出了针对195个国家和地区的29种癌症类别的估计值,有关良性肿瘤的估计值以及部分国家以下估计值可在线获得(https:// vizhub.healthdata.org/gbd-compare/和http://ghdx.healthdata.org/gbd-results-tool)。所有费率均按每100000人年报告。GBD世界人口标准用于计算年龄标准化率。9我们报告所有估计的不确定性区间为95%。
Estimation Framework The GBD cancer estimation process starts with mortality.Mortality estimates are made based on vital registration system(83% of data), cancer registry (16% of data) (eTable 3 in the Supplement), and verbal autopsy data (1% of data) using an ensemble model approach.9,10 Predictive covariates used in the model can be found in the eAppendix (eTable 8 in the Supplement). Single-cause mortality estimates are scaled into the separately estimated all-cause estimate.9 To estimate cancer incidence, mortality estimates are divided by a separately estimated MIR for each cancer type, sex, 5-year age group, location, and year; additional information regarding incidence and MIR estimation can be found in the eAppendix and eFigure2 inthe Supplement.Data sources used for estimatingMIRs are described in eTable 2 in the Supplement. MIRs allowfor a uniform method to estimate incidence. Other cancer estimation frameworks11,12 have set a precedent for using MIRs for decades and have detailed its benefits, including greater representativeness, especially in settings that lack quality or complete population-based cancer registry systems. By determining incidence using mortality, we are able to account for uncaptured incident cases and, if mortality and incidence are determined correctly, estimating incidence based on MIRs should result in the similar results if using incidence directly. The correlation between survival data and the MIR is used to estimate 10-year cancer prevalence. Total prevalence is partitioned into 4 sequelae: (1) diagnosis/treatment, (2) remission,(3) metastatic/disseminated, and (4) terminal phase.Each sequela prevalence is multiplied by a disability weight to estimate YLDs. Lifetime prevalence of procedure-related disability is estimated for larynx, breast, colorectal, bladder, and prostate cancers. A standard life expectancy is used to estimate years of life lost (YLLs).9 DALYs are the sum of YLDs and YLLs. To determine the contribution of population aging,population growth, and change in age-specific rates on the change in incident cases between 2007 and 2017, we use hypothetical demographic scenarios holding 2 of these 3 components constant. Results are stratified by quintiles of Sociodemographic Index (SDI), which is a composite indicator including fertility, education, and income.