Study on the disease burden and changing trends of trachea, bronchus, and lung cancer attributable to air pollution in China from 1990 to 2021
-
摘要:
目的 探讨1990―2021年中国因空气污染导致的气管、支气管和肺癌疾病负担及其变化趋势，为制定和优化预防及控制策略提供科学依据。 方法 从2021年全球疾病负担(Global Burden of Disease, GBD)数据库中提取1990―2021年中国因空气污染导致的气管、支气管和肺癌死亡及伤残调整生命年(disability-adjusted life years, DALYs)数据，采用Joinpoint 5.0.2软件对死亡人数、年龄标化死亡率(age-standardized mortality rate, ASMR)和年龄标化DALYs率(age-standardized DALYs rate, ASDR)变化趋势进行分析，运用年龄-时期-队列模型对死亡风险的年龄、时期和队列效应进行探讨；构建贝叶斯年龄-时期-队列模型预测2022―2036年ASMR和ASDR的变化趋势。 结果 1990―2021年，中国因空气污染导致的气管、支气管和肺癌死亡人数从10.847万人增长至21.137万人[平均年度变化百分比(average annual percent change, AAPC)=2.140%, P＜0.001]；ASMR从13.558/10万下降至10.106/10万(AAPC=-0.972%, P＜0.001)；ASDR从336.299/10万下降至226.502/10万(AAPC=-1.299%, P＜0.001)。年龄-时期-队列模型分析揭示了不同年龄组、时期和出生队列人群的结局存在统计学意义(P＜0.001)。贝叶斯年龄-时期-队列模型预测2022―2036年，总人群和男性的ASMR和ASDR呈持续下降趋势，而女性则相反。 结论 2004年后中国全人群空气污染归因的气管、支气管和肺癌的ASMR和ASDR呈下降趋势，但预测模型提示女性指标可能会出现上升。应进一步加强空气污染治理并实施针对性的健康干预措施，提高对女性的关注。 Abstract:Objective This study aims to investigate the disease burden and temporal trends of tracheal, bronchus, and lung (TBL) cancer attributable to air pollution in China from 1990 to 2021, providing a scientific foundation for optimizing prevention and control strategies. Methods Data on TBL cancer-related deaths and disability-adjusted life years (DALYs) caused by air pollution in China (1990-2021) were retrieved from the Global Burden of Disease database (GBD 2021). Joinpoint 5.0.2 regression analysis was applied to assess trends in the number of deaths, age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). Age-period-cohort (APC) models were used to explore age, period, and cohort effects on mortality risk, while a Bayesian age-period-cohort (BAPC) model was developed to project ASMR and ASDR trends from 2022 to 2036. Results The annual death toll increased from 108.470 thousand in 1990 to 211.370 thousand in 2021 [average annual percent change (AAPC)=2.140%, P < 0.001]. However, ASMR declined from 13.558 to 10.106 per 100 000 (AAPC=-0.972%, P<0.001), and ASDR decreased from 336.299 to 226.502 per 100 000 (AAPC=-1.299%, P<0.001). APC analysis demonstrated statistically significant variations in mortality outcomes across age groups, periods, and birth cohorts (P < 0.001). The BAPC model projected a sustained decline in ASMR and ASDR for the total population and males from 2022 to 2036, whereas an upward trend was predicted for females. Conclusions Analysis reveals that after 2004, China′s ASMR and ASDR for TBL cancer attributable to air pollution among the entire population show a continuous downward trend. However, predictive models indicate that these indicators for women may begin to rise. Enhanced air pollution mitigation and health interventions are imperative, with prioritized attention to female populations. -
Key words:
- Tracheal cancer /
- Bronchus cancer /
- Lung cancer /
- Burden of disease /
- Disability-adjusted life years
-
图 1 1990―2021年中国归因于空气污染的气管、支气管和肺癌的疾病负担变化情况
A~C：依次表示1990―2021年中国不同人群归因大气污染气管、支气管和肺癌的死亡人数、标化死亡率、标化DALYs率变化趋势; ASMR：年龄标化死亡率；ASDR：年龄标化伤残调整生命年率; APC: 年度变化百分比; a：P＜0.05。
Figure 1. Changes in the disease burden of tracheal, bronchus, and lung cancer attributable to air pollution in China from 1990 to 2021
A-C: represent the trends from 1990 to 2021 in China for death numbers, ASMR and ASDR of tracheal, bronchus, and lung cancer attributable to atmospheric pollution in the overall population, males, and females, respectively; ASMR: age-standardized mortality rate; ASDR: age-standardized disability-adjusted life years rate; APC: annual percent change; a: P < 0.05.
图 2 1990-2021年中国归因于空气污染的气管、支气管和肺癌死亡情况年龄-时期-队列模型分析
A1~3:依次表示总体、女性、男性纵向年龄曲线; B1~3:表示时期相对风险; C1~3:表示出生队列相对风险。
Figure 2. Analysis of air polution-attributable tracheal, bronchus, and lung cancer deaths in China from 1990 to 2021 using an age-period-cohort model
A1-3: ongitudinal age curve foroverallpopuation, fcmales, males respecively; B-3: peiod relative risk for overalpopulation, femalcs, males respectiveh; C-3: hinh cohortrelaliveriskforoveral populalion, females, males respectively.
图 3 2022―2036年中国归因于空气污染的气管、支气管和肺癌疾病负担预测
A1~2：依次表示总体人群的ASMR、ASDR预测值；B1~2：依次表示女性人群的ASMR、ASDR预测值；C1~2：依次表示男性人群的ASMR、ASDR预测值; DALYs，伤残调整生命年；ASMR，标化死亡率；ASDR，标化伤残调整生命年率。
Figure 3. Prediction of the disease burden of tracheal, bronchus, and lung cancer attributable to air pollution in China from 2022 to 2036
A1-2: predicted values of ASMR and ASDR for the overall population, respectively; B1-2: predicted values of ASMR and ASDR for females, respectively; C1-2: predicted values of ASMR and ASDR for males, respectively; DALYs, disability-adjusted life years; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years rate.
表 1 1990―2021年中国归因于空气污染的气管、支气管和肺癌死亡和DALYs变化情况
Table 1. Changes in tracheal, bronchus, and lung cancer deaths and DALYs attributed to air pollution in China from 1990 to 2021
变量
Variable组别
Group1990年year
(95% UI)2021年year
(95% UI)AAPC/%
(95% CI)P值
value死亡人数 Number of deaths/10 000 总人群 Total population 10.847(7.332~14.392) 21.137(13.208~29.994) 2.140(1.888~2.392) ＜0.001 女性 Female 3.486(2.225~4.820) 7.067(4.331~10.155) 2.270(2.039~2.502) ＜0.001 男性 Male 7.361(4.805~10.015) 14.070(8.457~20.674) 2.083(1.765~2.401) ＜0.001 ASMR/100 000-1 总人群 Total population 13.558(9.167~17.967) 10.106(6.323~14.394) -0.972(-1.268~-0.675) ＜0.001 女性 Female 8.495(5.483~11.737) 6.420(3.935~9.226) -1.077(-1.191~-0.962) ＜0.001 男性 Male 19.681(13.023~26.480) 14.532(8.814~21.200) -0.992(-1.356~-0.627) ＜0.001 ASDR/100 000-1 总人群 Total population 336.299(227.451~446.203) 226.502(141.638~320.618) -1.299(-1.566~-1.031) ＜0.001 女性 Female 212.044(134.954~293.310) 144.656(88.759~206.604) -1.272(-1.475~-1.069) ＜0.001 男性 Male 470.225(308.404~640.573) 316.413(189.385~465.012) -1.294(-1.619~-0.969) ＜0.001 注：DALYs，伤残调整生命年；ASMR，年龄标化死亡率；ASDR，年龄标化伤残调整生命年率；UI, 不确定性区间；AAPC，平均年度变化百分比。
Note: DALYs, disability-adjusted life years; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; UI, uncertainty interval; AAPC, average annual percent change.
下载: 导出CSV
表 2 1990―2021年中国不同年龄组人群归因于空气污染的气管、支气管和肺癌死亡和DALYs变化情况
Table 2. Changes in tracheal, bronchus, and lung cancer deaths and DALYs attributable to air pollution across different age groups
变量
Variable年龄组/岁
Age group/years1990年year
(95% UI)2021年year
(95% UI)AAPC/%
(95% CI)P值
value死亡率 Mortality rate/100 000-1 25~＜30 0.437(0.288~0.586) 0.256(0.156~0.372) -1.805(-2.446~-1.160) ＜0.001 30~＜35 1.082(0.718~1.467) 0.616(0.388~0.891) -1.870(-2.688~-1.046) ＜0.001 35~＜40 2.461(1.643~3.301) 1.280(0.820~1.837) -2.198(-2.599~-1.794) ＜0.001 40~＜45 5.535(3.618~7.477) 2.798(1.775~4.041) -2.313(-3.060~-1.560) ＜0.001 45~＜50 9.601(6.445~12.905) 4.919(3.112~6.943) -2.137(-2.712~-1.558) ＜0.001 50~＜55 19.783(13.213~26.535) 10.214(6.399~14.778) -2.215(-2.460~-1.970) ＜0.001 55~＜60 32.431(21.680~43.523) 17.445(10.567~25.240) -2.030(-2.330~-1.730) ＜0.001 60~＜65 47.347(31.595~63.538) 30.129(18.626~43.035) -1.488(-1.836~-1.138) ＜0.001 65~＜70 67.547(45.331~90.923) 46.801(29.147~66.749) -1.211(-1.556~-0.864) ＜0.001 70~＜75 89.941(61.414~119.836) 72.632(45.299~104.688) -0.710(-0.962~-0.458) ＜0.001 75~＜80 104.540(70.194~138.615) 95.754(60.397~135.210) -0.297(-0.634~0.040) 0.084 ≥80 117.683(78.329~156.100) 125.321(79.317~174.432) 0.121(-0.510~0.756) 0.708 DALYs率 DALYs rate/100 000-1 25~＜30 27.576(18.185~37.014) 16.100(9.796~23.408) -1.818(-2.458~-1.173) ＜0.001 30~＜35 62.614(41.593~84.945) 35.742(22.525~51.611) -1.870(-2.653~-1.080) ＜0.001 35~＜40 130.701(87.281~175.376) 68.158(43.691~97.995) -2.189(-2.573~-1.802) ＜0.001 40~＜45 266.794(174.525~360.310) 134.759(85.529~194.679) -2.290(-2.990~-1.585) ＜0.001 45~＜50 414.945(278.789~557.846) 212.343(134.368~299.588) -2.149(-2.683~-1.611) ＜0.001 50~＜55 759.371(507.223~1 019.686) 392.880(246.417~568.313) -2.204(-2.446~-1.961) ＜0.001 55~＜60 1 095.332(733.400~1 466.818) 591.187(358.449~855.527) -2.019(-2.308~-1.728) ＜0.001 60~＜65 1 378.576(920.588~1 848.698) 876.604(543.533~1 252.230) -1.491(-1.822~-1.159) ＜0.001 65~＜70 1 655.088(1 112.442~2 226.568) 1 148.180(715.440~1 640.115) -1.206(-1.547~-0.865) ＜0.001 70~＜75 1 815.077(1 240.425~2 417.742) 1 469.338(916.320~2 116.630) -0.707(-0.950~-0.463) ＜0.001 75~＜80 1 694.027(1 136.393~2 247.555) 1 549.625(978.057~2 190.476) -0.302(-0.631~0.028) 0.072 ≥80 1 379.778(920.591~1 842.570) 1 416.363(895.743~1 974.889) 0.007(-0.625~0.643) 0.983 注：DALYs，伤残调整生命年；UI, 不确定性区间；AAPC，平均年度变化百分比。
Note: DALYs, disability-adjusted life years; UI, uncertainty interval; AAPC, average annual percent change.
下载: 导出CSV
表 3 2022―2036年中国归因于空气污染的气管、支气管和肺癌疾病负担预测值
Table 3. The predicted values of the disease burden of tracheal, bronchus, and lung cancer attributable to air pollution in China from 2022 to 2036
年份
Year标化死亡率预测值
Predicted standardized mortality rate/100 000-1标化DALYs率预测值
Predicted standardized DALYs rate/100 000-1总人群 Total population 女性 Female 男性 Male 总人群 Total population 女性 Female 男性 Male 2022 9.979 6.394 14.264 220.840 140.735 303.920 2023 9.982 6.480 14.123 220.677 142.085 298.653 2024 9.981 6.563 13.978 220.465 143.421 293.408 2025 9.978 6.646 13.831 220.227 144.739 288.221 2026 9.972 6.727 13.682 219.961 146.031 283.093 2027 9.959 6.805 13.526 219.630 147.275 277.977 2028 9.943 6.881 13.366 219.268 148.507 272.912 2029 9.924 6.957 13.205 218.894 149.735 267.929 2030 9.904 7.032 13.045 218.528 150.960 263.053 2031 9.883 7.105 12.887 218.177 152.177 258.292 2032 9.859 7.177 12.726 217.820 153.371 253.620 2033 9.832 7.247 12.565 217.496 154.575 249.077 2034 9.805 7.317 12.405 217.214 155.799 244.673 2035 9.779 7.387 12.248 216.976 157.037 240.405 2036 9.753 7.457 12.095 216.789 158.290 236.275 注：DALYs，伤残调整生命年。
Note: DALYs, disability-adjusted life years.
下载: 导出CSV
-
[1] GBD 2019 Respiratory Tract Cancers Collaborators. Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Respir Med, 2021, 9(9): 1030-1049. DOI: 10.1016/S2213-2600(21)00164-8. [2] 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. [3] Kuang ZY, Wang JX, Liu KX, et al. Global, regional, and national burden of tracheal, Bronchus, and lung cancer and its risk factors from 1990 to 2021: findings from the Global Burden of Disease Study 2021[J]. EClinicalMedicine, 2024, 75: 102804. DOI: 10.1016/j.eclinm.2024.102804. [4] Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263. DOI: 10.3322/caac.21834. [5] Veith M, McAlarney D, Xue XN, et al. Characterizing trends in lung cancer mortality attributable to airborne environmental carcinogens[J]. Int J Environ Res Public Health, 2021, 18(24): 13162. DOI: 10.3390/ijerph182413162. [6] GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2162-2203. DOI: 10.1016/S0140-6736(24)00933-4. [7] 覃胜林, 赵金华, 邓萍, 等. Joinpoint回归模型在2005―2023年青海省流行性感冒发病趋势的应用[J]. 中华疾病控制杂志, 2024, 28(11): 1295-1300. DOI: 10.16462/j.cnki.zhjbkz.2024.11.009.Qin SL, Zhao JH, Deng P, et al. Application of Joinpoint regression analysis in the trend of influenza incidence in Qinghai Province from 2005 to 2023[J]. Chin J Dis Control Prev, 2024, 28(11): 1295-1300. DOI: 10.16462/j.cnki.zhjbkz.2024.11.009. [8] 卓凌云, 曹洪, 杜柯楠, 等. 2013―2022年自贡市结核病患者就诊延迟情况及影响因素分析[J]. 中华疾病控制杂志, 2024, 28(11): 1281-1286. DOI: 10.16462/j.cnki.zhjbkz.2024.11.007.Zhuo LY, Cao H, Du KN, et al. Delay on care-seeking and related influencing factors among tuberculosis patients in Zigong, 2013-2022[J]. Chin J Dis Control Prev, 2024, 28(11): 1281-1286. DOI: 10.16462/j.cnki.zhjbkz.2024.11.007. [9] 张越, 张英英, 丁玲, 等. 基于Joinpoint回归及年龄-时期-队列模型分析中国肾功能损伤所致心血管病死亡率变化趋势[J]. 中华疾病控制杂志, 2024, 28(7): 764-769, 783. DOI: 10.16462/j.cnki.zhjbkz.2024.07.004.Zhang Y, Zhang YY, Ding L, et al. Joinpoint regression and age-period-cohort analysis of mortality trends of cardiovascular disease attributable to kidney dysfunction in China[J]. Chin J Dis Control Prev, 2024, 28(7): 764-769, 783. DOI: 10.16462/j.cnki.zhjbkz.2024.07.004. [10] harma R, Khubchandani J. Global, regional, and national burden of tracheal, Bronchus, and lung cancer in 2022: evidence from the GLOBOCAN study[J]. Epidemiologia, 2024, 5(4): 785-795. DOI: 10.3390/epidemiologia5040053. [11] Salerno PRVO, Palma Dallan LA, Rodrigues Pereira GT, et al. Trends in tracheal, bronchial and lung cancer attributed to smoking in South America: Global Burden of Disease analysis 1990-2019[J]. Rev Panam Salud Publica, 2024, 48: e30. DOI: 10.26633/RPSP.2024.30. [12] Li LJ, Zhang XX, Jiang AQ, et al. Disease burden of lung cancer attributable to metabolic and behavioral risks in China and globally from 1990 to 2021[J]. BMC Public Health, 2025, 25(1): 911. DOI: 10.1186/s12889-025-21941-y. [13] Deng YJ, Zhao P, Zhou LH, et al. Epidemiological trends of tracheal, Bronchus, and lung cancer at the global, regional, and national levels: a population-based study[J]. J Hematol Oncol, 2020, 13(1): 98. DOI: 10.1186/s13045-020-00915-0. [14] 丁璐璐, 朱健, 张永辉, 等. 1990-2019年中国归因于吸烟的肺癌疾病负担研究[J]. 现代肿瘤医学, 2024, 32(1): 141-146. DOI: 10.3969/j.issn.1672-4992.2024.01.026.Ding LL, Zhu J, Zhang YH, et al. Disease burden of lung cancer attributable to smoking in China from 1990 to 2019[J]. Journal of Modern Oncology, 2024, 32(1): 141-146. DOI: 10.3969/j.issn.1672-4992.2024.01.026. [15] Fuller R, Landrigan PJ, Balakrishnan K, et al. Pollution and health: a progress update[J]. Lancet Planet Health, 2022, 6(6): e535-e547. DOI: 10.1016/S2542-5196(22)00090-0. [16] Raza SA, da Costa WL, Thrift AP. Editorial: sex differences in cancer incidence, mortality, and survival: methodological perspectives[J]. Front Oncol, 2024, 14: 1441965. DOI: 10.3389/fonc.2024.1441965. [17] Shah R, Battisti NML, Brain E, et al. Updated cancer burden in oldest old: a population-based study using 2022 Globocan estimates[J]. Cancer Epidemiol, 2025, 95: 102716. DOI: 10.1016/j.canep.2024.102716. [18] Ren F, Liu G. Global, regional, and national burden and trends of air pollution-related neoplasms from 1990 to 2019: an observational trend study from the Global Burden of Disease Study 2019[J]. Ecotoxicol Environ Saf, 2024, 285: 117068. DOI: 10.1016/j.ecoenv.2024.117068. [19] 王文静, 丛舒, 樊静, 等. 2019年中国40岁及以上女性家庭烹饪油烟暴露状况分析[J]. 中华流行病学杂志, 2023, 44(12): 1899-1910. DOI: 10.3760/cma.j.cn112338-20230925-00187.Wang WJ, Cong S, Fan J, et al. Prevalence of exposure to household cooking oil fumes in women aged 40 years and older in China, 2019[J]. Chin J Epidemiol, 2023, 44(12): 1899-1910. DOI: 10.3760/cma.j.cn112338-20230925-00187. [20] 樊静, 方利文, 丛舒, 等. 2019-2020年中国40岁及以上人群二手烟暴露状况分析[J]. 中华流行病学杂志, 2024, 45(1): 95-104. DOI: 10.3760/cma.j.cn112338-20231031-00260.Fan J, Fang LW, Cong S, et al. Analysis on passive smoking exposure in adults aged 40 years and above in China, 2019-2020[J]. Chin J Epidemiol, 2024, 45(1): 95-104. DOI: 10.3760/cma.j.cn112338-20231031-00260. [21] 国家统计局. 《中国妇女发展纲要(2011-2020年)》终期统计监测报告[EB/OL]. (2021-12-21)[2025-05-11]. https://www.stats.gov.cn/sj/zxfb/202302/t20230203_1901316.html .[22] Lin K, Shao J, Cao Y, et al. The trend of lymphoma incidence in China from 2005 to 2017 and lymphoma incidence trend prediction from 2018 to 2035: a log-linear regression and Bayesian age-period-cohort analysis[J]. Front Oncol, 2024, 14: 1297405. DOI: 10.3389/fonc.2024.1297405. -
点击查看大图
图(3) / 表(3)
计量
- 文章访问数: 2
- HTML全文浏览量: 2
- PDF下载量: 0
- 被引次数: 0