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Article(id=1322165002002354336, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322164984558243894, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.01.003, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1739548800000, receivedDateStr=2025-02-15, revisedDate=1763481600000, revisedDateStr=2025-11-19, acceptedDate=null, acceptedDateStr=null, onlineDate=1793158301115, onlineDateStr=2026-10-28, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793158301115, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793158301115, creator=13701087609, updateTime=1793158301115, updator=13701087609, issue=Issue{id=1322164984558243894, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='1', pageStart='1', pageEnd='176', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158296955, creator='13701087609', updateTime=1793158296955, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=21, endPage=26, ext={EN=ArticleExt(id=1322165002371453089, articleId=1322165002002354336, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Age-period-cohort model and decomposition analysis of colorectal cancer mortality trends in China and the United States from 1992 to 2021, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To compare the long-term trends in colorectal cancer(CRC) mortality rates in China and the United States(U.S.) from 1992 to 2021 and to provide scientific evidence for CRC prevention and control in China.

Methods

Based on data from the GBD2021 database,CRC mortality burden data for China and the U.S.from 1992 to 2021 were extracted.The Age-Period-Cohort(APC) model was used to evaluate the independent effects of age,period,and cohort,while decomposition analysis quantified the contributions of aging,population growth,and epidemiological changes to CRC mortality.

Results

From 1992 to 2021,colorectal cancer deaths increased in both China and the United States.However,the age-standardized mortality rate(ASMR) declined in both countries,with males consistently bearing a higher mortality burden than females.According to the age-period-cohort(APC) model,colorectal cancer mortality rose sharply with age in both countries,particularly among individuals aged 50 years and older.In China,the overall mortality rate increased from 0.53 per 100 000 to 236.50 per 100 000,while in the United States it rose from 0.11 per 100 000 to 171.02 per 100 000. The period effect demonstrated a downward trend in both countries,with the period rate ratio decreasing from 1.10 to 0.91 in China and from 1.07 to 0.85 in the United States.The cohort effect also showed a continuous decline,with China's cohort rate ratio decreasing from 1.34 to 0.46 and the U.S.declining from 2.54 to 0.74.Although the U.S.exhibited higher cohort risks,its reduction was more pronounced.Decomposition analysis further indicated that the rise in colorectal cancer deaths in China was primarily driven by population aging and population growth,whereas the mortality changes in the United States were predominantly attributable to improvements in epidemiological factors.

Conclusions

From 1992 to 2021,the ASMR for CRC declined in both China and the U.S.;however,CRC mortality changes in China were primarily driven by aging and population growth,highlighting the need for enhanced screening and intervention for older males.Epidemiological improvements had more pronounced effect in the U.S.,emphasizing the need for China to strengthen CRC prevention and screening efforts for the aging population and further to improve the impact of epidemiological changes.

, authors=Tian TIAN, Xueqin GAO, Rongrong WANG, authorsList=Tian TIAN, Xueqin GAO, Rongrong WANG, authorCompany=null, correspAuthors=Xueqin GAO, authorNote=null, correspAuthorsNote=
GAO Xueqin, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322165004095312042, articleId=1322165002002354336, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=1992—2021年中美两国结直肠癌死亡趋势的年龄-时期-队列模型及分解分析, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

分析1992—2021年中国与美国结直肠癌死亡率的长期变化趋势，为中国结直肠癌防控工作提供依据。

方法

基于全球疾病负担研究（GBD）2021数据库，提取1992—2021年中美结直肠癌死亡负担数据，采用年龄-时期-队列（APC）模型评估其年龄、时期及队列效应的独立影响，同时通过分解分析量化老龄化、人口增长以及流行病学变化对结直肠癌死亡人数的影响。

结果

1992—2021年，中、美结直肠癌死亡人数均增加，然而，年龄标准化死亡率则下降，男性死亡负担均高于女性。根据APC模型结果显示，中美两国结直肠癌死亡率均随年龄增长显著上升，50岁及以上人群增幅尤为明显，中国结直肠癌死亡率总人口从0.53/10万上升至236.50/10万，美国从0.11/10万上升至171.02/10万；时期效应显示，中美两国死亡率的时期率比均呈下降趋势，中国总人口结直肠癌死亡率比从1.10下降至0.91，美国从1.07下降至0.85；队列效应显示，中国总人口结直肠癌死亡的队列率比从1.34下降至0.46，美国从2.54下降至0.74，美国队列效应高于中国，但下降幅度更大。中国结直肠癌死亡人数的上升主要受老龄化和人口增长驱动，而美国死亡变化则主要由流行病学改善所主导。

结论

1992—2021年，中美两国结直肠癌总标化死亡率均下降，但中国结直肠癌变化受老龄化和人口增长驱动明显，需加强老年男性人群筛查和疾病干预。流行病学改善在美国效果更为显著，中国应加强老龄化人群的防控与筛查，进一步提升流行病学改善成效。

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田田，主管护师，本科

, correspAuthorsNote=
高雪琴，E-mail：
GAO Xueqin, E-mail:
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articleId=1322165002002354336, language=EN, label=Table 1, caption=

Number of deaths, ASMR and changes in colorectal cancer in China and the United States in 1992 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
国家时间男性女性总体
死亡（例）ASMR（/10万）死亡（例）ASMR（/10万）死亡（例）ASMR（/10万）
中国1992年69 74318.4854 89412.98124 63715.32
2021年174 40018.95100 7299.34275 12913.64
变化率(%)150.062.5483.50-28.04120.74-10.97
美国1992年33 16324.4634 47816.8167 64119.97
2021年39 37615.1635 71110.7475 08712.79
变化率(%)18.73-38.023.58-36.1111.01-35.95
), ArticleFig(id=1322529722848887430, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322165002002354336, language=CN, label=表1, caption=

1992年和2021年中美两国结直肠癌死亡例数、ASMR及变化情况

, figureFileSmall=null, figureFileBig=null, tableContent=
国家时间男性女性总体
死亡（例）ASMR（/10万）死亡（例）ASMR（/10万）死亡（例）ASMR（/10万）
中国1992年69 74318.4854 89412.98124 63715.32
2021年174 40018.95100 7299.34275 12913.64
变化率(%)150.062.5483.50-28.04120.74-10.97
美国1992年33 16324.4634 47816.8167 64119.97
2021年39 37615.1635 71110.7475 08712.79
变化率(%)18.73-38.023.58-36.1111.01-35.95
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1992—2021年中美两国结直肠癌死亡趋势的年龄-时期-队列模型及分解分析
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田田 , 高雪琴 *, * , 王榕榕
护理研究 | 科研论著 2026,40(1): 21-26
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护理研究 |科研论著 2026 , 40 (1) : 21 -26
1992—2021年中美两国结直肠癌死亡趋势的年龄-时期-队列模型及分解分析
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田田, 高雪琴*, * , 王榕榕
作者信息
  • 1南京中医药大学第二附属医院，江苏 210017
通讯作者:
高雪琴，E-mail：
GAO Xueqin, E-mail:
作者简介:

田田，主管护师，本科

Age-period-cohort model and decomposition analysis of colorectal cancer mortality trends in China and the United States from 1992 to 2021
Tian TIAN, Xueqin GAO , Rongrong WANG
Affiliations
  • 1The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu 210017 China
    • Corresponding Author:
    GAO Xueqin, E-mail:
出版时间: 2026-01-10 doi: 10.12102/j.issn.1009-6493.2026.01.003
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摘要
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目的

分析1992—2021年中国与美国结直肠癌死亡率的长期变化趋势，为中国结直肠癌防控工作提供依据。

方法

基于全球疾病负担研究（GBD）2021数据库，提取1992—2021年中美结直肠癌死亡负担数据，采用年龄-时期-队列（APC）模型评估其年龄、时期及队列效应的独立影响，同时通过分解分析量化老龄化、人口增长以及流行病学变化对结直肠癌死亡人数的影响。

结果

1992—2021年，中、美结直肠癌死亡人数均增加，然而，年龄标准化死亡率则下降，男性死亡负担均高于女性。根据APC模型结果显示，中美两国结直肠癌死亡率均随年龄增长显著上升，50岁及以上人群增幅尤为明显，中国结直肠癌死亡率总人口从0.53/10万上升至236.50/10万，美国从0.11/10万上升至171.02/10万；时期效应显示，中美两国死亡率的时期率比均呈下降趋势，中国总人口结直肠癌死亡率比从1.10下降至0.91，美国从1.07下降至0.85；队列效应显示，中国总人口结直肠癌死亡的队列率比从1.34下降至0.46，美国从2.54下降至0.74，美国队列效应高于中国，但下降幅度更大。中国结直肠癌死亡人数的上升主要受老龄化和人口增长驱动，而美国死亡变化则主要由流行病学改善所主导。

结论

1992—2021年，中美两国结直肠癌总标化死亡率均下降，但中国结直肠癌变化受老龄化和人口增长驱动明显，需加强老年男性人群筛查和疾病干预。流行病学改善在美国效果更为显著，中国应加强老龄化人群的防控与筛查，进一步提升流行病学改善成效。

结直肠癌  /  死亡率  /  年龄  /  老龄化  /  流行病学
Objective

To compare the long-term trends in colorectal cancer(CRC) mortality rates in China and the United States(U.S.) from 1992 to 2021 and to provide scientific evidence for CRC prevention and control in China.

Methods

Based on data from the GBD2021 database,CRC mortality burden data for China and the U.S.from 1992 to 2021 were extracted.The Age-Period-Cohort(APC) model was used to evaluate the independent effects of age,period,and cohort,while decomposition analysis quantified the contributions of aging,population growth,and epidemiological changes to CRC mortality.

Results

From 1992 to 2021,colorectal cancer deaths increased in both China and the United States.However,the age-standardized mortality rate(ASMR) declined in both countries,with males consistently bearing a higher mortality burden than females.According to the age-period-cohort(APC) model,colorectal cancer mortality rose sharply with age in both countries,particularly among individuals aged 50 years and older.In China,the overall mortality rate increased from 0.53 per 100 000 to 236.50 per 100 000,while in the United States it rose from 0.11 per 100 000 to 171.02 per 100 000. The period effect demonstrated a downward trend in both countries,with the period rate ratio decreasing from 1.10 to 0.91 in China and from 1.07 to 0.85 in the United States.The cohort effect also showed a continuous decline,with China's cohort rate ratio decreasing from 1.34 to 0.46 and the U.S.declining from 2.54 to 0.74.Although the U.S.exhibited higher cohort risks,its reduction was more pronounced.Decomposition analysis further indicated that the rise in colorectal cancer deaths in China was primarily driven by population aging and population growth,whereas the mortality changes in the United States were predominantly attributable to improvements in epidemiological factors.

Conclusions

From 1992 to 2021,the ASMR for CRC declined in both China and the U.S.;however,CRC mortality changes in China were primarily driven by aging and population growth,highlighting the need for enhanced screening and intervention for older males.Epidemiological improvements had more pronounced effect in the U.S.,emphasizing the need for China to strengthen CRC prevention and screening efforts for the aging population and further to improve the impact of epidemiological changes.

colorectal cancer  /  mortality rate  /  age  /  aging  /  epidemiology
田田, 高雪琴, 王榕榕. 1992—2021年中美两国结直肠癌死亡趋势的年龄-时期-队列模型及分解分析. 护理研究, 2026 , 40 (1) : 21 -26 . DOI: 10.12102/j.issn.1009-6493.2026.01.003
Tian TIAN, Xueqin GAO, Rongrong WANG. Age-period-cohort model and decomposition analysis of colorectal cancer mortality trends in China and the United States from 1992 to 2021[J]. Chinese Nursing Research, 2026 , 40 (1) : 21 -26 . DOI: 10.12102/j.issn.1009-6493.2026.01.003
正文
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结直肠癌（colorectal cancer,CRC）是全球最常见的恶性肿瘤之一，近年来其发病率和死亡率持续升高，给公共卫生带来沉重负担[1]，根据全球癌症统计报告，2020年有近190万例结直肠癌新发病例和93.5万例死亡病例，约占癌症病例和死亡病例的1/10[2]。根据中国癌症统计数据，2022年中国结直肠癌新发病例约51.71万例，位居中国恶性肿瘤发病率的第2位，而其死亡病例接近24.00万例，位居死亡率的第4位[3]。美国2022年结直肠癌新发病例约14.95万例，是发病第3位的癌症，死亡病例约5.30万例，排名第2位[4]。结直肠癌与多种因素密切相关，包括人口老龄化、城市化进程加快、饮食习惯的西化以及生活方式的改变[5]。相关研究表明，高脂肪、高蛋白和低膳食纤维的饮食模式可能增加结直肠癌的发病风险[6]。此外，吸烟、饮酒、体力活动不足和肥胖等行为和代谢危险因素也是结直肠癌的重要影响因素[7]。尽管中国近年来在结直肠癌的早期筛查、诊断和治疗方面取得了一定进展，但病人的5年生存率仍相对较低，仅约为55.70%[8]，美国结直肠癌病人5年生存率为65%[9]，中国明显低于一些高收入国家。目前，关于结直肠癌死亡趋势以及不同文化和生活习惯国家之间的对比研究仍较为匮乏，因此，本研究通过对比中国和美国结直肠癌死亡率的时间变化，旨在揭示两国在风险模式上的差异，以全面了解中国结直肠癌的疾病负担及其影响因素，对于制定科学、有效的防控策略具有重要意义。
1　资料与方法
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1.1　数据来源
本研究的结直肠癌死亡数据均来自《全球疾病负担（Global Burden of Disease,GBD）2021》，是GBD系列的最新成果之一。这项研究由华盛顿大学健康指标与评估研究所（IHME）牵头，联合多个研究机构和学者共同完成。GBD的目标是通过系统和全面的分析，量化全球范围内各类疾病、伤害及其危险因素对人类健康的影响。2021年，GBD估计了204个国家和地区的371种疾病和伤害[10]。本研究采用的数据均可以从https://ghdx.healthdata.org/gbd-2021/sources免费获取。
1.2　年龄-时期-队列（age-period-cohort,APC）模型
APC模型是一种统计分析方法，用于研究某一现象或结果（如疾病发病率、死亡率等）随年龄、时期和出生队列变化的规律及其相互作用。该模型广泛应用于流行病学、人口学、社会学和公共健康领域[11]。采用APC模型对结直肠癌的死亡率进行趋势分析。APC模型通过分离年龄、时期和队列效应，量化其对结直肠癌死亡率变化的独立贡献。模型的构建基于以下公式：
            ln Rijk=ln yijnij=u+αi+βj+γr+ε。
式中：αi为结直肠癌死亡的年龄效应，βj为时期效应，γr为出生队列效应，ε为随机误差项。
1.3　分解分析
本研究采用Das Gupta[12]提出的分解分析方法，用于将某个整体变化或差异分解为多个可解释的组成部分（效应或因素，即人口老龄化、人口增长和流行病学变化），从而明确每个因素对整体变化的相对贡献。这种方法广泛用于公共卫生、经济学和社会科学领域，帮助研究者理解复杂现象背后的驱动因素[13]。
2　结果
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2.1　1992—2021年中美两国结直肠癌死亡负担及变化情况
1992—2021年，中国结直肠癌死亡人数显著增加，其中男性死亡人数从69 743例上升至174 400例（增加150.06%），女性从54 894例上升至100 729例（增加83.50%），总体死亡人数从124 637例增加至275 129例（增加120.74%）。然而，年龄标准化死亡率（ASMR）呈现不同趋势，男性略微增加了2.54%，女性减少了28.04%，总体下降了10.97%。美国在同一时间段内，结直肠癌死亡人数也有所增加，男性死亡人数从33 163例增加至39 376例（增加18.73%），女性从34 478例增加至35 711例（增加3.58%），总体从67 641例上升至75 087例（增加11.01%）。美国不同性别的结直肠癌ASMR均下降，男性下降了38.02%，女性下降了36.11%，总体下降了35.95%。中国尽管死亡人数显著增加，但总体ASMR略有下降，尤其是女性降幅较大。美国在同一时期死亡人数的增长幅度较小，且ASMR下降幅度较大。见表1。
2.2　年龄-时期-队列模型
2.2.1　年龄效应
从15~19岁至90~94岁，中美两国结直肠癌的死亡率均随年龄的增长而增长，尤其是在65岁及以上年龄段上升更为明显。这表明年龄是结直肠癌的重要影响因素。中国总人口死亡率从0.53/10万增至236.50/10万，美国总人口从0.11/10万增至171.02/10万；中国男性从0.49/10万增至535.58/10万，美国男性从0.13/10万增至185.66/10万；中国女性从0.70/10万增至120.88/10万，美国女性从0.09/10万增至159.52/10万。见图1。
2.2.2　时期效应
1992—2021年，中国总人口结直肠癌死亡的时期率比从1.10降至0.91，美国总人口从1.07降至0.85；中国男性从1.02降至0.99，美国男性从1.07降至0.84；中国女性从1.24降至0.78，美国女性从1.09降至0.84。见图2。
2.2.3　队列效应
在整个出生队列时期内，中国总人口结直肠癌死亡的队列率比从1.34降至0.46，美国总人口从2.54降至0.74；美国男性从2.76降至0.78，中国男性从1.01降至0.66；美国女性从2.57降至0.69，中国女性从1.96降至0.22。美国结直肠癌死亡的队列率高于中国，下降幅度高于中国。见图3。
2.3　分解分析
1992—2021 年，中国结直肠癌死亡人数的增加主要由人口老龄化和人口增长共同推动。其中，老龄化是最主要因素，对死亡人数的净增加贡献最大；人口增长为第二重要因素。相比之下，流行病学改变在中国发挥了抑制作用。美国的变化模式不同。尽管美国同样受到人口老龄化与人口增长的影响，但其结直肠癌死亡人数净变化更大程度上受到流行病学改变的主导性影响，该因素对死亡人数的减少贡献最为明显。见图4。
3　讨论
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1992—2021年，中美两国结直肠癌总死亡例数均呈上升趋势，然而ASMR呈下降趋势。从性别来看，只有中国男性的ASMR呈上升趋势。行为因素的差异可能是造成结直肠癌死亡负担性别差异的原因，如吸烟、饮酒、压力、生活方式等[14-15]。吸烟是结直肠癌的重要危险因素之一，男性的吸烟率较女性高[16]。此外，尽管近些年中国男性的生活方式有所改善，但饮食中高脂肪含量较高且蔬菜摄入量相对较低的情况仍然普遍存在[6]。因此，提高对风险因素的认识和管理对于缩小ASMR性别差距至关重要。
无论在中国还是美国，结直肠癌死亡率均随年龄增长显著升高，尤其在50岁及以上年龄段上升尤为明显。这表明年龄是影响结直肠癌发病和死亡的重要因素。值得注意的是，中国的年龄效应高峰值明显高于美国，反映出中国面临更为沉重的老年群体结直肠癌疾病负担。年龄效应的增长与多种生物学因素密切相关，例如老年人更容易出现营养不良，这可能进一步增加结直肠癌的死亡风险[17]。此外，老年群体通常伴有多种合并症，并且免疫功能较为低下，这些因素对其生存状况产生了重要影响[18]，这些原因可能是导致中国结直肠癌死亡率随年龄增长不断升高的主要因素。在老年女性群体中，特别是80岁以上的群体，美国女性的结直肠癌死亡率可能更高，这部分归因于较高的体质指数和糖尿病等并发症，这些因素可能增加治疗的复杂性和难度[19-20]。女性的肥胖率较高，这与结直肠癌的高死亡率密切相关。
中国和美国的结直肠癌时期效应总体呈下降趋势，表明随着医疗技术的进步、政策干预（如癌症筛查项目的推广）以及生活水平的改善，结直肠癌相关死亡率有所降低。然而，在同一时间段内，美国的时期效应总体低于中国，且下降速度更快。近年来，美国等社会发展指数（SDI）较高的国家通过一系列健康促进措施，如推行控烟限酒政策、增加膳食纤维摄入、鼓励体力活动以及积极管理代谢相关疾病等，有效减少了由多种因素导致的结直肠癌相关死亡率[21]。这些国家实施的结直肠癌治疗和管理方法，如粪便免疫化学检测、CT结肠造影、结直肠癌筛查、早期病变切除等，也有利于降低结直肠癌死亡率[22-23]。美国早在1998年就开始将结直肠癌筛查纳入保险覆盖范围[24]，其结直肠癌多协会工作组（MSTF）制定并定期更新结直肠癌筛查计划[25]，这反映了美国更早期和更系统的防控措施起到了长期效果。在中国，由于经济快速转型，工业化、城镇化、全球化等因素，生活方式、饮食结构发生较大变化，吸烟和代谢性疾病增多，结直肠癌发病率和死亡率明显上升。同时，各地筛查预防措施不完善也是导致结直肠癌发病率和死亡率上升的因素[26-27]。中国虽然整体趋势在改善，但其初始时期效应较高，下降趋势相对更晚，提示进一步加强结直肠癌防控力度的重要性。中国在过去20年中逐步加强了公共健康的管理，但由于地区间发展不平衡，其效果仍有提升空间。
中国结直肠癌死亡风险在较早的出生队列中相对较低，可能与早期医疗条件不足，诊断和登记系统不完善，导致对结直肠癌死亡率的低估有关[28]。这一时期主要以低脂、高纤维的传统饮食为主，相关危险因素暴露有限[29]，早期人口的寿命较短，可能在未到达结直肠癌高发年龄前因其他疾病去世。此外，中药因其在癌症临床治疗中不可或缺的作用而闻名，在过去的几十年中在世界范围内的应用日益广泛[30]。此外，中药已被证明可有效延缓癌症复发和抑制转移，并可改善癌症病人的生活质量[31]，这可能也是原因之一。美国在早期出生群体结直肠癌死亡的队列效应较高，随后经历快速下降，直到1947—1956年出生队列趋于稳定或略微下降。美国较早的出生队列效应可能因高吸烟率、不健康饮食习惯等导致较高的结直肠癌风险。首先，美国早期队列经历了长期的高脂肪、高蛋白、低膳食纤维饮食以及较高的肥胖率，这种西化饮食均是结直肠癌的重要危险因素[5]。此外，美国人群的吸烟率和饮酒率较高，尤其在早期出生的队列中，这些不良生活方式的累积效应增加了癌症发生风险[32-33]。在现代队列（如1960年及以后），中美两国的队列效应逐渐趋于接近，表明随着生活方式的改变和全球化的影响，中国可能经历了与美国类似的风险因素暴露模式。对于中国而言，未来的队列可能因饮食西化和生活方式改变而逐渐显现更高的结直肠癌死亡风险，提示公共卫生政策需提前干预。
根据分解分析的结果，在中国人口老龄化是结直肠癌死亡人数增加的主要驱动因素，人口老龄化的影响远大于美国，这与中国快速老龄化的人口结构一致，中国的人口增长效应高于美国，这与中国过去几十年的人口基数较大且增长迅速有关[34]。中国的流行病学变化对死亡人数的负面贡献较小，表明癌症筛查和治疗的改善正在发挥作用，但效果尚不如美国显著。美国的流行病学变化负面贡献最大，这反映了其在癌症筛查（如结肠镜检查普及）、早期诊断和治疗技术（如靶向药物、免疫治疗）方面的领先地位[2]。中国的主要驱动因素是人口老龄化和人口增长，流行病学改善效果尚需加强。美国的主要变化得益于流行病学改善，但人口老龄化仍是不可忽视的挑战。这一分析为优化防控政策提供了量化依据，同时凸显了老龄化背景下疾病防控策略的重要性。
4　小结
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1992—2021年，中美两国结直肠癌总标化死亡率均下降，但中国结直肠癌变化受老龄化和人口增长驱动明显，需加强50岁及以上老年男性人群的干预。流行病学改变在美国效果更为明显，未来中国应在持续应对老龄化挑战的同时，加强高危人群的精准防控与筛查，并进一步提高筛查可及性与流行病学干预成效，以实现结直肠癌死亡风险的有效控制。

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2026年第40卷第1期
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doi: 10.12102/j.issn.1009-6493.2026.01.003
  • 接收时间：2025-02-15
  • 首发时间：2026-10-28
  • 出版时间：2026-01-10
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  • 收稿日期：2025-02-15
  • 修回日期：2025-11-19
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    1南京中医药大学第二附属医院，江苏 210017

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高雪琴，E-mail：
GAO Xueqin, E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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