1992—2021年基于年龄-时期-队列模型的中国宫颈癌发病和死亡分析

doi:10.12280/gjfckx.20240828

摘要/Abstract

摘要：

目的：分析1992—2021年中国宫颈癌的发病和死亡情况，并探讨年龄、时期和队列因素对宫颈癌发病和死亡的影响。方法：利用全球疾病负担（Global Burden of Disease，GBD）2021数据库，分析1992—2021年中国宫颈癌的发病和死亡情况，应用Joinpoint软件分析宫颈癌年龄标化发病率和年龄标化死亡率的时间变化趋势。构建年龄-时期-队列模型，分析年龄、时期和出生队列因素对宫颈癌发病及死亡趋势变化的影响。结果：2021年中国宫颈癌发病率为19.12/10万，死亡率为7.18/10万，比1992年分别升高了91.58%和33.46%。1992—2021年，中国宫颈癌年龄标化发病率有升高趋势，平均每年升高0.70%，中国宫颈癌年龄标化死亡率有降低趋势，平均每年下降1.20%，变化趋势有统计学意义（均P<0.05）。年龄效应结果显示，1992—2021年，中国宫颈癌的发病率在15~59岁呈升高趋势，60岁之后呈波动性降低趋势；死亡率随着年龄的升高呈升高趋势。时期效应结果显示，1992—2021年，中国宫颈癌发病风险呈升高趋势，2017—2021年发病风险最高（RR=1.06）；宫颈癌死亡风险呈下降趋势，1992—1996年死亡风险最高（RR=1.07）。队列效应结果显示，出生越晚的人，发病风险越高，死亡风险越低。结论：1992—2021年，宫颈癌的标化发病率上升，但随着医学治疗手段的进步，标化死亡率有所降低。中青年女性发病率较高，老年群体死亡率增加。越晚出生的人群发病风险越高，提示在预防与健康教育方面仍需持续改进，以应对我国宫颈癌带来的公共健康挑战。

关键词: 宫颈肿瘤, 发病率, 死亡率, 队列研究, 年龄-时期-队列模型

Abstract:

Objective: To analyze the incidence and mortality of cervical cancer in China from 1992 to 2021, and to explore the effects of age, period, and cohort factors on these trends. Methods: Using the Global Burden of Disease (GBD) 2021 database, we analysed cervical cancer incidence and mortality from 1992 to 2021, employing Joinpoint software to assess the time trends of age-standardized incidence and mortality rates. An age-period-cohort model was constructed to analyse the influence of age, period, and birth cohort on the trends of incidence and mortality trends. Results: In 2021, the incidence rate of cervical cancer in China was 19.12 /100 000, and the mortality rate was 7.18 /100 000, representing increases of 91.58% and 33.46% respectively since 1992. From 1992 to 2021, the age-standardized incidence showed a rising trend, averaging an increase of 0.70% per year, while the age-standardized mortality rate exhibited a declining trend, averaging a decrease of 1.20% per year, with statistical significance (both P<0.05). The age effect indicated that from 1992 to 2021, incidence rates increased among women aged 15 to 59 years old, while showing a fluctuating decreasing trend after age 60 years old; mortality rates increased with age. The period effect revealed a rising risk of incidence from 1992 to 2021, with the highest risk observed from 2017 to 2021 (RR=1.06); the risk of death showed a decreasing trend, peaking from 1992 to 1996 (RR=1.07). The cohort effect demonstrated that those born later had higher incidence risks but lower mortality risks. Conclusions: From 1992 to 2021, the age-standardized incidence of cervical cancer has risen, but due to advancements in medical treatment, the mortality rate has decreased. The incidence is higher among middle-aged women, while mortality increases in older populations. Individuals born later have higher incidence risks, highlighting the need for ongoing improvements in prevention and health education to address the public health challenge posed by cervical cancer in China.

Key words: Uterine cervical neoplasms, Incidence, Mortality, Cohort studies, Age-period-cohort model

魏金花, 祁玉超, 沈晓亚. 1992—2021年基于年龄-时期-队列模型的中国宫颈癌发病和死亡分析[J]. 国际妇产科学杂志, 2024, 51(6): 664-668.

WEI Jin-hua, QI Yu-chao, SHEN Xiao-ya. Analysis on the Incidence and Mortality of Cervical Cancer in China Based on the Age-Period-Cohort Model from 1992 to 2021[J]. Journal of International Obstetrics and Gynecology, 2024, 51(6): 664-668.

图/表 5

参考文献 17

[1]	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J]. CA Cancer J Clin, 2021, 71(3):209-249. doi: 10.3322/caac.21660.
[2]	Nnaji CA, Ezenwankwo EF, Kuodi P, et al. Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review[J]. BMJ Open, 2022, 12(2):e057685. doi: 10.1136/bmjopen-2021-057685.
[3]	Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis[J]. Lancet Glob Health, 2020, 8(2):e191-e203. doi: 10.1016/S2214-109X(19)30482-6. pmid: 31812369
[4]	Kechagias KS, Kalliala I, Bowden SJ, et al. Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis[J]. BMJ, 2022, 378:e070135. doi: 10.1136/bmj-2022-070135.
[5]	Simms KT, Steinberg J, Caruana M, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study[J]. Lancet Oncol, 2019, 20(3):394-407. 10.1136/bmj-2022-070135. pmid: 30795950
[6]	Li S, Huang M, Zhu Y, et al. Temporal trends in incidence and mortality of cervical cancer in China from 1990 to 2019 and predictions for 2034[J]. Eur J Cancer Prev, 2024, 33(3):252-261. doi: 10.1097/CEJ.0000000000000849.
[7]	Yang M, Du J, Lu H, et al. Global trends and age-specific incidence and mortality of cervical cancer from 1990 to 2019: an international comparative study based on the Global Burden of Disease[J]. BMJ Open, 2022, 12(7):e055470. doi: 10.1136/bmjopen-2021-055470.
[8]	Zhang X, Zeng Q, Cai W, et al. Trends of cervical cancer at global, regional, and national level: data from the Global Burden of Disease study 2019[J]. BMC Public Health, 2021, 21(1):894. doi: 10.1186/s12889-021-10907-5. pmid: 33975583
[9]	Guo M, Xu J, Du J. Trends in cervical cancer mortality in China from 1989 to 2018: an age-period-cohort study and Joinpoint analysis[J]. BMC Public Health, 2021, 21(1):1329. doi: 10.1186/s12889-021-11401-8. pmid: 34229639
[10]	Li J, Chan NB, Xue J, et al. Time series models show comparable projection performance with joinpoint regression: A comparison using historical cancer data from World Health Organization[J]. Front Public Health, 2022, 10:1003162. doi: 10.3389/fpubh.2022.1003162.
[11]	Stumbar SE, Stevens M, Feld Z. Cervical Cancer and Its Precursors: A Preventative Approach to Screening, Diagnosis, and Management[J]. Prim Care, 2019, 46(1):117-134. doi: 10.1016/j.pop.2018.10.011. pmid: 30704652
[12]	Huang J, Deng Y, Boakye D, et al. Global distribution, risk factors, and recent trends for cervical cancer: A worldwide country-level analysis[J]. Gynecol Oncol, 2022, 164(1):85-92. doi: 10.1016/j.ygyno.2021.11.005.
[13]	Wang M, Jin Y, Zheng ZJ. The association of cervical cancer screening and quality of care: A systematic analysis of the Global Burden of Disease Study 2019[J]. J Glob Health, 2023, 13:04090. doi: 10.7189/jogh.13.04090. pmid: 37622720
[14]	Zhao M, Luo L, Zhang CH, et al. Healthy-related quality of life in patients with cervical cancer in Southwest China: a cross-sectional study[J]. BMC Health Serv Res, 2021, 21(1):841. doi: 10.1186/s12913-021-06723-7. pmid: 34412641
[15]	Abu-Rustum NR, Yashar CM, Arend R, et al. NCCN Guidelines^® Insights: Cervical Cancer, Version 1.2024[J]. J Natl Compr Canc Netw, 2023, 21(12):1224-1233. doi: 10.6004/jnccn.2023.0062.
[16]	蔡会龙, 原伟光. 全球及我国宫颈癌流行现状及防治策略[J]. 临床肿瘤学杂志, 2023, 28(1):90-93. doi: 10.3969/j.issn.1009-0460.2023.01.013.
[17]	李瑾, 王佳. 全程健康教育对改善宫颈癌手术患者自我效能及疾病认知水平的护理研究[J]. 黑龙江医学, 2024, 48(12):1495-1497. doi: 10.3969/j.issn.1004-5775.2024.12.026.

年份	发病（例）	发病率（/10万）	标化发病率（/10万）	死亡（例）	死亡率（/10万）	标化死亡率（/10万）
1992	58 201	9.98	11.23	31 380	5.38	6.53
2021	132 788	19.12	13.37	49 841	7.18	4.64
变化率（%）	128.15	91.58	19.06	58.83	33.46	-28.94

年份	发病（例）	发病率（/10万）	标化发病率（/10万）	死亡（例）	死亡率（/10万）	标化死亡率（/10万）
1992	58 201	9.98	11.23	31 380	5.38	6.53
2021	132 788	19.12	13.37	49 841	7.18	4.64
变化率（%）	128.15	91.58	19.06	58.83	33.46	-28.94

指标	趋势	年份	APC（%）	95%CI（%）
标化发病率（1/10万）	趋势1	1992—1999	-1.41*	-1.86~-0.96
	趋势2	1999—2004	3.93*	2.82~5.05
	趋势3	2004—2021	0.62*	0.50~0.74
	AAPC	1992—2021	0.70*	0.50~0.90
标化死亡率（1/10万）	趋势1	1992—1998	-3.07*	-4.32~-1.80
	趋势2	1998—2003	1.27	-1.16~3.77
	趋势3	2003—2021	-1.26*	-1.51~-1.02
	AAPC	1992—2021	-1.20*	-1.72~-0.76

指标	趋势	年份	APC（%）	95%CI（%）
标化发病率（1/10万）	趋势1	1992—1999	-1.41*	-1.86~-0.96
	趋势2	1999—2004	3.93*	2.82~5.05
	趋势3	2004—2021	0.62*	0.50~0.74
	AAPC	1992—2021	0.70*	0.50~0.90
标化死亡率（1/10万）	趋势1	1992—1998	-3.07*	-4.32~-1.80
	趋势2	1998—2003	1.27	-1.16~3.77
	趋势3	2003—2021	-1.26*	-1.51~-1.02
	AAPC	1992—2021	-1.20*	-1.72~-0.76