基于年龄-时期-队列模型的1992—2021年中国胰腺癌发病和死亡分析

摘要/Abstract

摘要：

目的分析1992—2021年中国胰腺癌的发病和死亡情况，并探讨年龄、时期和队列对胰腺癌发病和死亡的影响。方法利用全球疾病负担研究（GBD）2021数据库，分析1992—2021年中国胰腺癌发病和死亡情况，应用Joinpoint软件分析标化发病率和标化死亡率的时间变化趋势，计算平均年度变化百分比。构建年龄-时期-队列模型，分析年龄、时期和出生队列对胰腺癌发病及死亡趋势变化的影响。分析胰腺癌死亡归因于高血糖和吸烟危险因素的疾病负担。结果2021年，中国胰腺癌发病率为8.34/10万，死亡率为8.41/10万，比1992年（3.33/10万和3.43/10万）分别升高了150.45%和145.19%。从性别看，2021年男性胰腺癌发病率（9.93/10万）和死亡率（9.91/10万）均高于女性（6.68/10万和6.83/10万）。1992—2021年，中国胰腺癌标化发病率和标化死亡率均有升高趋势，分别平均每年升高0.80%和0.62%，趋势均有统计学意义（均P<0.001）。年龄效应结果显示，中国胰腺癌的发病率总体呈升高趋势，15~49岁年龄组胰腺癌发病率呈平稳升高趋势，在50岁以后胰腺癌发病率呈明显升高趋势，85岁以上年龄组达到高峰，为68.64/10万；死亡率在15~79岁年龄组呈缓慢升高趋势，在80~84岁年龄组呈明显升高趋势并达到高峰，为196.51/10万。时期效应结果显示，中国胰腺癌发病率的时期变化RR值总体呈升高趋势，以2002—2006年为参考组（RR=1），2017—2021年发病风险最高，发病风险RR=1.09（95%CI为1.05~1.13，P=0.012）；胰腺癌死亡率的时期变化RR值变化趋势呈波动性，以2002—2006年为参考组（RR=1），2012—2016年死亡风险最高，死亡风险RR=1.60（95%CI为1.07~2.38，P=0.021）。队列效应结果显示，中国胰腺癌发病和死亡风险均总体随年份的增加呈升高趋势，以1952—1956年出生队列为参考队列（RR=1），1987—1991年出生队列的发病和死亡风险均最高（RR=1.18，95%CI为0.99~1.40，P=0.032；RR=1.63，95%CI为0.12~11.53，P=0.042），1992—1996年出生队列以后均呈下降趋势。胰腺癌死亡归因于高血糖占比有升高趋势，归因于吸烟有降低趋势。结论1992—2021年，中国胰腺癌的标化发病率和标化死亡率均呈上升趋势，男性的发病率和死亡率均高于女性。年龄、时期和队列均对胰腺癌的发病和死亡趋势产生显著影响。胰腺癌死亡归因于高血糖的危险呈升高趋势。

关键词:胰腺肿瘤,中国,发病率,死亡率

Abstract:

ObjectiveTo analyze the incidence and mortality of pancreatic cancer in China from 1992 to 2021，and to explore the effects of age，period，and cohort on pancreatic cancer incidence and mortality.MethodsData from the Global Burden of Disease Study （GBD） 2021 database were used to analyze the incidence and mortality of pancreatic cancer in China from 1992 to 2021. The Joinpoint software was applied to analyze the time trends of standardized incidence and mortality rates，and to calculate the average annual percentage change. An age-period-cohort model was constructed to analyze the effects of age，period，and birth cohort on the trends of pancreatic cancer incidence and mortality. The disease burden of pancreatic cancer deaths attributed to risk factors such as hyperglycemia and smoking was analyzed.ResultsIn 2021，the incidence of pancreatic cancer in China was 8.34/100 000，and the mortality rate was 8.41/100 000，representing increases of 150.45% and 145.19%，respectively，compared to 1992 （3.33/100 000 and 3.43/100 000）. By sex，the incidence （9.93/100 000） and mortality （9.91/100 000） rates in males in 2021 were higher than those in females （6.68/100 000 and 6.83/100 000）. From 1992 to 2021，the standardized incidence and mortality rates of pancreatic cancer in China showed upward trends，with average annual increases of 0.80% and 0.62%，respectively，both of which were statistically significant （bothP<0.001）. Age effect results indicated a general increasing trend in pancreatic cancer incidence，with a steady rise in the 15-49 age group，a sharp increase after the age of 50，and a peak in the over 85 age group at 68.64/100 000. The mortality rate showed a slow increase in the 15-79 age group，with a marked rise and peak in the 80-84 age group at 196.51/100 000. Period effect results showed an overall upward trend in the period relative risk （RR） for pancreatic cancer incidence，with the highest risk in 2017-2021 （RR=1.09，95%CI：1.05-1.13，P=0.012），compared to the reference period 2002-2006 （RR=1）. TheRRfor pancreatic cancer mortality showed a fluctuating trend，with the highest risk in 2012-2016 （RR=1.60，95%CI：1.07-2.38，P=0.021），compared to the reference period 2002-2006 （RR=1）. The results of cohort effect showed that the incidence and mortality risk of pancreatic cancer in China generally increased with the increase of years. With the 1952-1956 birth cohort as the reference cohort （RR=1），the incidence （RR=1.18，95%CI：0.99-1.40，P=0.032） and mortality （RR=1.63，95%CI：0.12-11.53，P=0.042） risk of pancreatic cancer were the highest in the 1987-1991 birth cohort, and showed decreasing trends after the 1992-1996 birth cohort. The proportion of pancreatic cancer deaths attributable to high blood glucose showed an increasing trend，while those attributable to smoking showed a decreasing trend.ConclusionsFrom 1992 to 2021，the standardized incidence and mortality rates of pancreatic cancer in China have continued to rise，with males having higher incidence and mortality rates than females. Age，period，and cohort all significantly influence the trends in pancreatic cancer incidence and mortality. The trend in pancreatic cancer deaths attributable to high blood glucose is increasing.

Key words:Pancreatic neoplasms,China,Incidence,Mortality

胡嘉宝, 华莎, 陈微, 马丽娜. 基于年龄-时期-队列模型的1992—2021年中国胰腺癌发病和死亡分析[J]. 国际肿瘤学杂志, 2025, 52(4): 217-223.

Hu Jiabao, Hua Sha, Chen Wei, Ma Lina. Analysis of pancreatic cancer incidence and mortality in China from 1992 to 2021 based on the age-period-cohort model[J]. Journal of International Oncology, 2025, 52(4): 217-223.

图/表7

表1

1992年和2021年中国胰腺癌发病和死亡情况"

指标	男性	女性	合计
发病例数
1992年（万）	2.40	1.61	4.01
2021年（万）	7.23	4.64	11.86
变化率（%）	201.25	188.20	195.76
发病率
1992年（1/10万）	3.86	2.77	3.33
2021年（1/10万）	9.93	6.68	8.34
变化率（%）	157.25	141.16	150.45
死亡例数
1992年（万）	2.45	1.69	4.13
2021年（万）	7.22	4.74	11.96
变化率（%）	194.69	180.47	189.59
死亡率
1992年（1/10万）	3.92	2.90	3.43
2021年（1/10万）	9.91	6.83	8.41
变化率（%）	152.81	135.52	145.19

表1

指标	年份	APC（%）	95%CI（%）	P值	AAPC（%）	95%CI（%）	P值
标化发病率	1992—2012	0.79	0.73~0.86	0.023
	2012—2015	-0.76	-3.19~1.72	0.478	0.80	0.52~1.02	<0.001
	2015—2021	1.47	1.04~1.89	0.013
标化死亡率	1992—2011	0.67	0.58~0.75	0.012
	2011—2015	-0.80	-2.22~0.63	0.232	0.62	0.46~0.82	<0.001
	2015—2021	1.28	0.79~1.77	0.026

表2

指标	发病率
总年龄偏差=0	1 983.63	<0.001	42.99	<0.001
时期RR值=1	10.76	0.029	14.93	0.004
队列RR值=1	100.83	<0.001	37.85	0.004

表3

图1

图2

图3

图4

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