1990年至2021年中国归因于二手烟的气管、支气管和肺癌疾病负担趋势及未来预测分析

Trends and future predictions of the burden of tracheal, bronchus, and lung cancer attributed to secondhand smoke in China from 1990 to 2021

    摘要
  • 摘要:
    目的 整合分析1990～2021年中国归因于二手烟的气管、支气管和肺癌（tracheal，bronchus，and lung cancer，TBL）疾病负担趋势并行未来预测分析，以期为中国TBL的防治提供数据支持。
    方法 基于全球疾病负担（global burden of disease，GBD）2021数据库，以二手烟为危险因素，以ICD-10疾病分类为C33，C34-C34.92的TBL为研究对象，提取1990～2021年中国归因于二手烟的TBL死亡率和伤残调整寿命年（disability-adjusted life year，DALY）相关数据，并进一步年龄标准化处理。运用Joinpoint 4.7.1回归分析模型计算年度变化百分比（annual percentage change，APC）和平均年度变化百分比（average annual percentage change，AAPC），Hiplot软件绘制不同年龄与性别的疾病负担数据图，R 4.3.1软件构建灰色模型GM(1,1)预测2022～2031年中国归因于二手烟的TBL疾病负担预测值与变化趋势图。
    结果 1990～2021年中国归因于二手烟的TBL死亡率、年龄标化死亡率、DALY率从1990年的1.76/10万例、2.63/10万例、49.43/10万例升高至2021年的4.08/10万例、2.80/10万例、95.57/10万例；增长幅度分别为131.18%、6.45%、93.34%；年龄标化DALY率从1990年的65.04/10万降低至2021年的63.32/10万例；下降幅度为2.65%。Joinpoint回归分析结果显示，1990～2021年中国归因于二手烟的TBL，其死亡率、年龄标化死亡率、DALY率的AAPC（95%CI）值分别为2.75（2.58～2.93）%、0.16（0.11～0.21）%、2.15（2.11～2.18）%，总体呈上升趋势；年龄标化DALY率的AAPC（95%CI）值为−0.14（−0.40～0.12）%，总体呈波动不变趋势；男性均高于女性。1990年与2021年，中国归因于二手烟的TBL死亡率随年龄的增长均呈逐渐上升趋势，DALY率随着年龄的增长均呈先上升后变缓的趋势，老年及男性为疾病负担的主要群体。灰色预测模型GM(1,1)显示，2022～2031年中国归因于二手烟的TBL年龄标化死亡率呈缓慢上升趋势，2031年预测值将上升至2.95/10万例；年龄标化DALY呈缓慢下降趋势，2031年预测值将下降至63.83/10万例。
    结论 1990～2021年中国归因于二手烟的TBL死亡率、年龄标化死亡率、DALY率均呈上升趋势，年龄标化DALY率呈下降趋势；男性和老年人群是中国归因于二手烟的TBL疾病负担的主要人群，应按不同性别和年龄构成制定适宜措施以减少二手烟的暴露与接触，并加强二手烟的防控与健康教育的宣传。

     

    Abstract:
    Objective  To integrate and analyze the trend of the disease burden of tracheal, bronchus, and lung cancer (TBL) attributable to secondhand smoke in China from 1990 to 2021 and to analyze future projections, aiming to provide data support for the prevention and treatment of TBL in China.
    Methods  Based on the global burden of disease (GBD) 2021 database, TBL with ICD-10 disease classification C33, C34-C34.92 was studied. Using secondhand smoke as a risk factor, the data on TBL mortality and disability-adjusted life year (DALY) due to secondhand smoke in China from 1990 to 2021 were further age-standardized. Using Joinpoint 4.7.1 regression analysis model to calculate annual percentage change (APC) and average annual percentage change (AAPC), Hiplot software was used to plot disease burden data for different ages and genders, and R 4.3.1 software was used to construct a grey model GM (1,1) to predict the predicted value and trend of TBL disease burden attributed to secondhand smoke in China from 2022 to 2031.
    Results From 1990 to 2021, the TBL mortality rate, age-standardized mortality rate, and DALY rate attributed to secondhand smoke in China increased from 1.76/100 000, 2.63/100 000, and 49.43/100 000 to 4.08/100 000, 2.80/100 000, and 95.57/100 000, respectively; the growth was 131.18%, 6.45%, and 93.34%; the age-standardized DALY rate decreased from 65.04/100 000 to 63.32/100 000 with the reduction of 2.65%. The results of the Joinpoint regression showed that the AAPC (95% CI) of mortality, age-standardized mortality rate, and DALY rate for TBL were 2.75(2.58-2.93)%, 0.16(0.11-0.21)%, and 2.15(2.11-2.18)%, respectively, with an overall increasing trend; the AAPC (95% CI) of age-standardized DALY rate was −0.14(−0.40-0.12)%, with an overall fluctuating and unchanged trend and it was higher in males than in females. In both 1990 and 2021, the TBL mortality rate attributable to secondhand smoke in China gradually increased with age, and the DALY rate first increased and then slowed down with age. The main groups of the burden of disease were the elderly and males. The grey prediction model GM(1,1) showed that the age-standardized mortality rate of TBL attributable to secondhand smoke from 2022 to 2031 showed a slow increasing trend, and the predicted value in 2031 would increase to 2.95/100 000. The age-standardized DALY showed a slow decreasing trend, and the predicted value in 2031 would decrease to 63.83/100 000.
    Conclusions From 1990 to 2021, the TBL mortality, age-standardized mortality, and DALY rates attributable to secondhand smoke in China increased, and the age-standardized DALY rate decreased. Men and the elderly are the main groups affected by TBL. Appropriate measures should be formulated to reduce exposure to and contact with secondhand smoke, taking into account gender and age differences. Additionally, efforts should be made to strengthen secondhand smoke prevention and public health education.

     

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