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Article(id=1322191147410247774, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322191025829953744, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202504096, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745337600000, receivedDateStr=2025-04-23, revisedDate=1748620800000, revisedDateStr=2025-05-31, acceptedDate=null, acceptedDateStr=null, onlineDate=1793164534666, onlineDateStr=2026-10-28, pubDate=1753804800000, pubDateStr=2025-07-30, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793164534666, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793164534666, creator=13701087609, updateTime=1793164534666, updator=13701087609, issue=Issue{id=1322191025829953744, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='14', pageStart='1557', pageEnd='1684', issueExtLink='null', onlineDate='null', pubDate='1753804800000', pubDateStr='2025-07-30', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793164505679, creator='13701087609', updateTime=1793164547848, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322191202804420934, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322191025829953744, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322191202804420935, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322191025829953744, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1652, endPage=1659, ext={EN=ArticleExt(id=1322191147838066783, articleId=1322191147410247774, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Trend of thyroid cancer incidence in China, 1992-2021: a Joinpoint regression and age-period-cohort analysis, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective‍

To analyze the temporal trend of thyroid cancer incidence in China from 1992 to 2021 and evaluate the impact of age, period and cohort on the incidence.

Methods‍

Based on the Global Burden of Disease 2021, the trend changes of age-standardized incidence rate (ASIR) of thyroid cancer in China from the period were analyzed, and the obtained data were further analyzed with Joinpoint regression and age-period-cohort analysis. Auto regressive integrated moving average (ARIMA) model was applied to predict the incidence of thyroid cancer in China in the next 20 years.

Results‍

The ASIR of thyroid cancer among males was increased from 0.70/100 000 to 2.11/100 000 between 1992 and 2021, with an average annual percent change (AAPC) of 3.93% (95%CI: 3.86%~4.00%, P<0.001); For the females, the ASIR was elevated from 1.91/100 000 to 2.87/100 000 in the time, with an AAPC of 1.43% (95%CI: 1.36%~1.50%, P<0.001). On the age effect, the overall variation in ASIR among the females was minor, and that in the males reached its peak in the ≥85-years-old group, with a rate of 230.51/100 000. Regarding the period effect, the risk of thyroid cancer incidence in the males and females changed with the period and exhibited a temporal increase, and the incidence risk was consistently higher in the males than the females across different periods. Taking the incidence risk during 1992 and 1996 as a reference (RR=1), the males (RR=2.94, 95%CI: 2.78~3.11) and the females (RR=1.37, 95%CI: 1.32~1.42) had the highest risk of thyroid cancer in the period from 2017 to 2021. On the cohort effect, the risk of thyroid cancer in both sexes showed an increasing trend with cohort change. When taking the cohort during 1992 and 1996 as a reference (RR=1), the females in the pre-1986 cohort exhibited a higher risk of incidence than the males, but in the post-1996 cohort, the males demonstrated a greater risk of incidence than the females. The males in the 2012-2016 cohort had the highest risk of thyroid cancer when compared to the reference group (RR=2.54, 95%CI: 1.80~3.57), and the females in the cohort from 1992 to 2016 had higher risk of thyroid cancer than the reference group, though no statistical differences were observed. The ARIMA model prediction analysis found that the ASIR of thyroid cancer in males and females in China would continue to increase from 2022 to 2041, and the ASIR of thyroid cancer in males would reach 2.79/100 000 (95% CI: 1.96~3.61), and the ASIR of thyroid cancer in females would reach 3.54/100 000 (95% CI: 3.02~4.06) by 2041.

Conclusion‍

Between 1992 and 2021, the ASIR of thyroid cancer in China has exhibited a consistent upward trend, with the females having a higher ASIR than the males. However, the risk of developing thyroid cancer is higher in men who are older and those who were born more recently. In the next 20 years, the incidence of thyroid cancer among both men and women in China is projected to continue to rise, and the situation for prevention and control will be challenging.

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目的

分析1992-2021年我国甲状腺癌发病变化趋势，并评估年龄、时期及队列对甲状腺癌发病率的影响。

方法

利用2021年全球疾病负担数据，分析1992-2021年我国甲状腺癌年龄标准化发病率（age-standardized incidence rate，ASIR）的变化趋势，使用Joinpoint回归模型及年龄-时期-队列模型进行分析。利用差分自回归移动平均模型（auto regressive integrated moving average，ARIMA）预测未来20年中国甲状腺癌发病情况。

结果

1992-2021年，我国男性甲状腺癌ASIR从0.70/10万上升到2.11/10万，平均年度变化百分比（average annual percent change，AAPC）为3.93%（95%CI：3.86%~4.00%，P<0.001）；女性ASIR从1.91/10万上升到2.87/10万，AAPC为1.43%（95%CI：1.36%~1.50%，P<0.001）。年龄效应上，女性ASIR整体波动不大，男性ASIR在≥85岁组达到峰值，为230.51/10万。时期效应上，男性、女性甲状腺癌发病风险随时期变化呈上升趋势，男性发病风险大于女性。以1992-1996年为参照组（RR=1），2017-2021年男性、女性（RR男性=2.94，95%CI：2.78~3.11；RR女性=1.37，95%CI：1.32~1.42）的发病风险最高。队列效应上，男性、女性甲状腺癌发病风险随队列变化呈上升趋势。以1992-1996年为对照组（RR=1），同一队列中，1986年前的队列，女性发病风险大于男性，但1996年后的队列，男性发病风险大于女性。男性2012-2016年（RR=2.54，95%CI：1.80~3.57）发病风险最大，女性在1992-2016年发病风险均大于对照组，但差异无统计学意义。ARIMA模型预测分析发现，2022-2041年中国男性、女性甲状腺癌ASIR持续上升，到2041年，男性甲状腺癌ASIR达到2.79/10万（95%CI：1.96~3.61），女性甲状腺癌ASIR达到3.54/10万（95%CI：3.02~4.06）。

结论

1992-2021年，我国甲状腺癌的ASIR呈上升趋势，女性高于男性，但男性年龄越大、出生越晚，甲状腺癌的发病风险越高。未来20年，中国男性、女性的甲状腺癌发病率将持续上升，防控形式严峻。

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杨 英，E-mail：
YANG Ying，E-mail：
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Analysis of age-period-cohort effect for incidence trend of hepatitis C incidence in Chinese residents from 2006 to 2020［J］.Health Econ Res，2024，41（7）：6-8，14., articleTitle=Analysis of age-period-cohort effect for incidence trend of hepatitis C incidence in Chinese residents from 2006 to 2020, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322191153726869616, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, xref=1, ext=[AuthorCompanyExt(id=1322191153743646833, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, companyId=1322191153726869616, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Breast and Thyroid Surgery，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing，China), AuthorCompanyExt(id=1322191153756229746, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, companyId=1322191153726869616, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1陆军军医大学（第三军医大学）第一附属医院乳腺甲状腺外科，重庆)])], figs=[ArticleFig(id=1322191160890740883, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=EN, label=null, caption=null, figureFileSmall=TrIobi1kzDwykCiwL0AQEQ==, figureFileBig=63vwL3Sn8zSj2DMEC5Pcdg==, tableContent=null), ArticleFig(id=1322191161251451028, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=CN, label=图1, caption=1992-2021年不同性别甲状腺癌发病率情况, figureFileSmall=TrIobi1kzDwykCiwL0AQEQ==, figureFileBig=63vwL3Sn8zSj2DMEC5Pcdg==, tableContent=null), ArticleFig(id=1322191161721213077, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=EN, label=null, caption=null, figureFileSmall=2ZnwEkU9DCbqfW4kCnTjtw==, figureFileBig=ZqKf2jdRJ+ML/I0nPQh+0A==, tableContent=null), ArticleFig(id=1322191161792516246, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=CN, label=图2, caption=1992-2021年中国男性和女性甲状腺癌ASIR的纵向年龄曲线, figureFileSmall=2ZnwEkU9DCbqfW4kCnTjtw==, figureFileBig=ZqKf2jdRJ+ML/I0nPQh+0A==, tableContent=null), ArticleFig(id=1322191162077728919, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=EN, label=null, caption=null, figureFileSmall=0dCsNfTbPIMcjyS0t11bgw==, figureFileBig=9NgKkcFZFHk55W6bd0i8zg==, tableContent=null), ArticleFig(id=1322191162140643481, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=CN, label=图3, caption=1992-2021年中国男性和女性甲状腺癌ASIR的时期变化趋势, figureFileSmall=0dCsNfTbPIMcjyS0t11bgw==, figureFileBig=9NgKkcFZFHk55W6bd0i8zg==, tableContent=null), ArticleFig(id=1322191162442633370, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=EN, label=null, caption=null, figureFileSmall=6tRgp7baxdOMQotEqASP2Q==, figureFileBig=fK7MGoMeikPsBtyPunzcyQ==, tableContent=null), ArticleFig(id=1322191162513936539, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=CN, label=图4, caption=1992-2021年中国男性和女性甲状腺癌ASIR的队列变化趋势, figureFileSmall=6tRgp7baxdOMQotEqASP2Q==, figureFileBig=fK7MGoMeikPsBtyPunzcyQ==, tableContent=null), ArticleFig(id=1322191162862063772, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=EN, label=null, caption=null, figureFileSmall=tl3JZaUfztyrafH8C/4N0g==, figureFileBig=rpuVxCst/xK+iI00h24K6w==, tableContent=null), ArticleFig(id=1322191164380401822, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=CN, label=图5, caption=2022-2041年中国甲状腺癌年龄标准化发病率的预测结果, figureFileSmall=tl3JZaUfztyrafH8C/4N0g==, figureFileBig=rpuVxCst/xK+iI00h24K6w==, tableContent=null), ArticleFig(id=1322191164535591071, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
变量年份APC（%）95%CIPAAPC（%）95%CIP
男性3.933.86~4.00<0.001
1992-19963.182.58~4.36<0.001
1996-20022.331.77~6.71<0.001
2002-20066.915.84~7.94<0.001
2006-20127.841.31~8.35<0.001
2012-20211.501.24~1.830.007
女性1.431.36~1.50<0.001
1992-19961.961.46~2.56<0.001
1996-2003-0.29-0.53~-0.090.014
2003-20112.812.61~3.80<0.001
2011-20160.38-0.61~0.890.276
2016-20212.301.78~3.34<0.001
全人群2.262.10~2.41<0.001
1992-19962.141.49~2.80<0.001
1996-20030.590.26~0.920.002
2003-20114.664.36~4.97<0.001
2011-20211.581.37~1.79<0.001
), ArticleFig(id=1322191164619477152, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322191147410247774, language=CN, label=表1, caption=

1992-2021年中国男性和女性甲状腺癌ASIR的Joinpoint回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年份APC（%）95%CIPAAPC（%）95%CIP
男性3.933.86~4.00<0.001
1992-19963.182.58~4.36<0.001
1996-20022.331.77~6.71<0.001
2002-20066.915.84~7.94<0.001
2006-20127.841.31~8.35<0.001
2012-20211.501.24~1.830.007
女性1.431.36~1.50<0.001
1992-19961.961.46~2.56<0.001
1996-2003-0.29-0.53~-0.090.014
2003-20112.812.61~3.80<0.001
2011-20160.38-0.61~0.890.276
2016-20212.301.78~3.34<0.001
全人群2.262.10~2.41<0.001
1992-19962.141.49~2.80<0.001
1996-20030.590.26~0.920.002
2003-20114.664.36~4.97<0.001
2011-20211.581.37~1.79<0.001
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1992-2021年中国甲状腺癌发病率变化趋势：Joinpoint回归及年龄-时期-队列模型分析
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熊丹 , 苏小君 , 方燕梅 , 杨英
陆军军医大学学报 | 临床医学 2025,47(14): 1652-1659
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陆军军医大学学报 |临床医学 2025 , 47 (14) : 1652 -1659
1992-2021年中国甲状腺癌发病率变化趋势：Joinpoint回归及年龄-时期-队列模型分析
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熊丹, 苏小君, 方燕梅, 杨英
作者信息
  • 1陆军军医大学（第三军医大学）第一附属医院乳腺甲状腺外科，重庆
通讯作者:
杨 英，E-mail：
YANG Ying，E-mail：
Trend of thyroid cancer incidence in China, 1992-2021: a Joinpoint regression and age-period-cohort analysis
Dan XIONG, Xiaojun SU, Yanmei FANG, Ying YANG
Affiliations
  • 1Department of Breast and Thyroid Surgery，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing，China
出版时间: 2025-07-30 doi: 10.16016/j.2097-0927.202504096
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摘要
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目的

分析1992-2021年我国甲状腺癌发病变化趋势，并评估年龄、时期及队列对甲状腺癌发病率的影响。

方法

利用2021年全球疾病负担数据，分析1992-2021年我国甲状腺癌年龄标准化发病率（age-standardized incidence rate，ASIR）的变化趋势，使用Joinpoint回归模型及年龄-时期-队列模型进行分析。利用差分自回归移动平均模型（auto regressive integrated moving average，ARIMA）预测未来20年中国甲状腺癌发病情况。

结果

1992-2021年，我国男性甲状腺癌ASIR从0.70/10万上升到2.11/10万，平均年度变化百分比（average annual percent change，AAPC）为3.93%（95%CI：3.86%~4.00%，P<0.001）；女性ASIR从1.91/10万上升到2.87/10万，AAPC为1.43%（95%CI：1.36%~1.50%，P<0.001）。年龄效应上，女性ASIR整体波动不大，男性ASIR在≥85岁组达到峰值，为230.51/10万。时期效应上，男性、女性甲状腺癌发病风险随时期变化呈上升趋势，男性发病风险大于女性。以1992-1996年为参照组（RR=1），2017-2021年男性、女性（RR男性=2.94，95%CI：2.78~3.11；RR女性=1.37，95%CI：1.32~1.42）的发病风险最高。队列效应上，男性、女性甲状腺癌发病风险随队列变化呈上升趋势。以1992-1996年为对照组（RR=1），同一队列中，1986年前的队列，女性发病风险大于男性，但1996年后的队列，男性发病风险大于女性。男性2012-2016年（RR=2.54，95%CI：1.80~3.57）发病风险最大，女性在1992-2016年发病风险均大于对照组，但差异无统计学意义。ARIMA模型预测分析发现，2022-2041年中国男性、女性甲状腺癌ASIR持续上升，到2041年，男性甲状腺癌ASIR达到2.79/10万（95%CI：1.96~3.61），女性甲状腺癌ASIR达到3.54/10万（95%CI：3.02~4.06）。

结论

1992-2021年，我国甲状腺癌的ASIR呈上升趋势，女性高于男性，但男性年龄越大、出生越晚，甲状腺癌的发病风险越高。未来20年，中国男性、女性的甲状腺癌发病率将持续上升，防控形式严峻。

甲状腺癌  /  年龄标准化发病率  /  趋势  /  预测
Objective‍

To analyze the temporal trend of thyroid cancer incidence in China from 1992 to 2021 and evaluate the impact of age, period and cohort on the incidence.

Methods‍

Based on the Global Burden of Disease 2021, the trend changes of age-standardized incidence rate (ASIR) of thyroid cancer in China from the period were analyzed, and the obtained data were further analyzed with Joinpoint regression and age-period-cohort analysis. Auto regressive integrated moving average (ARIMA) model was applied to predict the incidence of thyroid cancer in China in the next 20 years.

Results‍

The ASIR of thyroid cancer among males was increased from 0.70/100 000 to 2.11/100 000 between 1992 and 2021, with an average annual percent change (AAPC) of 3.93% (95%CI: 3.86%~4.00%, P<0.001); For the females, the ASIR was elevated from 1.91/100 000 to 2.87/100 000 in the time, with an AAPC of 1.43% (95%CI: 1.36%~1.50%, P<0.001). On the age effect, the overall variation in ASIR among the females was minor, and that in the males reached its peak in the ≥85-years-old group, with a rate of 230.51/100 000. Regarding the period effect, the risk of thyroid cancer incidence in the males and females changed with the period and exhibited a temporal increase, and the incidence risk was consistently higher in the males than the females across different periods. Taking the incidence risk during 1992 and 1996 as a reference (RR=1), the males (RR=2.94, 95%CI: 2.78~3.11) and the females (RR=1.37, 95%CI: 1.32~1.42) had the highest risk of thyroid cancer in the period from 2017 to 2021. On the cohort effect, the risk of thyroid cancer in both sexes showed an increasing trend with cohort change. When taking the cohort during 1992 and 1996 as a reference (RR=1), the females in the pre-1986 cohort exhibited a higher risk of incidence than the males, but in the post-1996 cohort, the males demonstrated a greater risk of incidence than the females. The males in the 2012-2016 cohort had the highest risk of thyroid cancer when compared to the reference group (RR=2.54, 95%CI: 1.80~3.57), and the females in the cohort from 1992 to 2016 had higher risk of thyroid cancer than the reference group, though no statistical differences were observed. The ARIMA model prediction analysis found that the ASIR of thyroid cancer in males and females in China would continue to increase from 2022 to 2041, and the ASIR of thyroid cancer in males would reach 2.79/100 000 (95% CI: 1.96~3.61), and the ASIR of thyroid cancer in females would reach 3.54/100 000 (95% CI: 3.02~4.06) by 2041.

Conclusion‍

Between 1992 and 2021, the ASIR of thyroid cancer in China has exhibited a consistent upward trend, with the females having a higher ASIR than the males. However, the risk of developing thyroid cancer is higher in men who are older and those who were born more recently. In the next 20 years, the incidence of thyroid cancer among both men and women in China is projected to continue to rise, and the situation for prevention and control will be challenging.

thyroid cancer  /  age-standardized incidence rate  /  trend  /  prediction
熊丹, 苏小君, 方燕梅, 杨英. 1992-2021年中国甲状腺癌发病率变化趋势：Joinpoint回归及年龄-时期-队列模型分析. 陆军军医大学学报, 2025 , 47 (14) : 1652 -1659 . DOI: 10.16016/j.2097-0927.202504096
Dan XIONG, Xiaojun SU, Yanmei FANG, Ying YANG. Trend of thyroid cancer incidence in China, 1992-2021: a Joinpoint regression and age-period-cohort analysis[J]. Journal of Army Medical University, 2025 , 47 (14) : 1652 -1659 . DOI: 10.16016/j.2097-0927.202504096
正文
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甲状腺癌（thyroid cancer，TC）是一种淋巴结转移发生率较高的内分泌恶性肿瘤［1］。2021年，全球TC发病数为249 538例，年龄标准化发病率（age-standardized incidence rate，ASIR）为2.91/10万［2］。据估计到2030年，全球男性和女性的TC发病率将持续上升［3］。2018年，我国甲状腺癌发病率位于居民癌症发病谱第8位，占全部新增癌症的5.41%［4］。2019年，全球约有233 846例新发病例和45 575例死亡病例与TC相关，其中中国分别占16.71%和15.88%［5］。中国TC新发病例从1990年的10 030例增加到2019年的39 080例，预计到2039年将达到47 820例［6］。研究发现，中国是全球TC病例数和死亡数最多的国家［7］。医疗资源的可及性影响术后随访和辅助治疗的标准化，对TC复发和转移产生重要影响，进而影响TC的疾病负担。目前，国内外关于甲状腺癌的研究主要集中在临床特征和治疗等方面，侧重于患者的治疗和预后。但是，掌握疾病的长期变化趋势，能够为政府部门提供准确的疾病的危害信息、防控重点和实施精准预防，优化卫生资源配置［6］，减少医疗成本。本文基于2021年全球疾病负担数据库（Global Burden of Disease，GBD），分析男性和女性的TC发病率变化趋势，为政策制定者了解TC发病率变化，合理分配卫生资源，调整防控措施提供参考。
1　资料与方法
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1.1　数据来源
所有数据来自GBD2021数据库，该数据库包含204个国家和地区的371种疾病和伤害相关负担［8］。研究从GBD2021数据库中提取中国甲状腺癌的发病数、发病率、ASIR及95%不确定区间（uncertainty interval，UI），根据国际疾病分类编码第10版（ICD-10），甲状腺癌的ICD-10编码为C73［2］。
1.2　方法
1.2.1　Joinpoint回归模型
1992-2021年中国甲状腺癌的AISR趋势分析使用Joinpoint回归模型。该模型是根据疾病分布的时间特征建立分段回归。使用多个连接点（最多不超过5个）将研究时间划分为各种区间，并对每个区间进行拟合和优化，以更全面地评估整体时间范围内变化趋势［9］。通过计算不同时间段的年度变化百分比（annual percentage chang，APC）和平均年度变化百分比（average annual percent change，AAPC）来进行比较，检验方法采用t检验。若APC或AAPC>0，说明发病率呈上升趋势，反之，呈下降趋势［10］。
1.2.2　年龄-时期-队列（age-period-cohort，APC）模型
经典的APC模型可以根据年龄、时期和队列3个维度反映疾病的变化趋势［11］。模型中，“周期=年龄+队列”存在完全共线性关系，本研究采用内生因子法进行模型的系数估计［12］。APC模型要求年龄和时期以“5岁”及“5年”进行划分，因此将年龄划分为5~9岁、10~14岁……≥85岁等18个年龄组（1992-2021年5岁及以下年龄段甲状腺癌发病数为0，本研究未将该年龄段纳入分析）；时期分为“1992-1996、1997-2001……2017-2021”等6个时期［13］。APC模型中，年龄效应是指疾病率的变化随年龄的变化情况；时期效应是指因人为因素造成疾病率的变化；队列效应是指不同出生队列的人群，因暴露因素的不同导致的疾病率的变化［14］。率比（rate ratio，RR）是指与对照组（队列或时期）相比，调整年龄和时期或队列后的相对风险［14］。为提高分析的精度，本文参考既往研究文献［12］，使用1996、2001、2006、2011、2016、2021的发病率代替5年的平均发病率。
1.2.3　预测分析
使用差分自回归移动平均模型（autoregressive integrated moving average model，ARIMA），对2022-2041年甲状腺癌的ASIR开展预测研究。ARIMA模型具有结构简单、适用性强等特点，在公共卫生领域应用广泛［15］。使用均方根误差（root mean squared error，RMSE）、均方误差（mean squared error，MSE）、平均绝对误差（mean absolute error，MAE）、平均绝对百分比误差（mean absolute percentage error，MAPE）评价模型预测效果，数值越小，模型拟合效果越好［15］。
1.3　统计学分析
采用Excel 2013整理下载的发病数据，Joinpoint软件5.2.0分析甲状腺癌ASIR的变化趋势，并计算APC和AAPC，R软件4.3.0建立甲状腺癌ASIR的年龄-时期-队列模型和ARIMA模型。使用白噪声对ARIMA模型进行检验，模型通过白噪声检验，可以用于预测。检验水准α=0.05。
2　结果
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2.1　基本情况
1992-2021年，我国甲状腺癌发病数从13 247例（95%UI：11 151~15 999）上升到48 106例（95%UI：38 695~60 068），发病数增长率为263.15%。我国男性甲状腺癌发病数从3 327例（95%UI：2 703~4 335）上升到20 190例（95%UI：14 546~26 951），发病数增长率为506.85%；女性甲状腺癌发病数从9 920例（95%UI：7 744~12 385）上升到27 916例（95%UI：20 321~41 256），发病数增长率为181.41%。
1992-2021年，我国甲状腺癌ASIR从1.29/10万（95%UI：1.09~1.54）上升到2.47/10万（95%UI：1.99~3.09），上升幅度为91.47%。男性ASIR从0.70/10万（95%UI：0.57~0.92）上升到2.11/10万（95%UI：1.53~2.76），上升幅度为201.43%；女性ASIR从1.91/10万（95%UI：1.48~2.37）上升到2.87/10万（95%UI：2.09~4.28），上升幅度为50.26%（图1）。
2.2　1992-2021年中国甲状腺癌ASIR的 Joinpoint回归分析
1992-2021年，我国全人群、男性、女性甲状腺癌ASIR呈上升变化趋势，AAPC全人群=2.26%（95%CI：2.10%~2.41%，P<0.001）、AAPC男性=3.93%（95%CI：3.86%~4.00%，P<0.001）、AAPC女性=1.43%（95%CI：1.36%~1.50%，P<0.001）。见表1。
2.3　1992-2021年中国甲状腺癌ASIR的年龄-时期-队列模型分析
2.3.1　年龄效应
APC模型分析显示，男性净漂移值为4.87%（95%CI：4.67%~5.07%，χ 2=2 407.08，P<0.001），女性净漂移值为1.34%（95%CI：1.20%~1.47%，χ 2=382.41，P<0.001），表明1992-2021年男性和女性的ASIR呈上升趋势。从纵向年龄曲线看，甲状腺癌ASIR随着年龄的增长呈上升趋势。男性ASIR从5~9岁组的0.10/10万上升到≥85岁组的230.51/10万；女性ASIR整体波动不大，从5~9岁组的0.19/10万上升到≥85岁组的12.38/10万（图2）。
2.3.2　时期效应
1992-2021年，中国男性、女性甲状腺癌发病风险随时期变化呈上升趋势，以1992-1996年为参照组（RR=1），男性2017-2021年发病风险最高（RR=2.94，95%CI：2.78~3.11），其次是2012-2016年（RR=2.75，95%CI：2.60~2.91）、2007-2011年（RR=2.46，95%CI：2.32~2.60）、2002-2006年（RR=1.66，95%CI：1.57~1.77）、1997-2001年（RR=1.18，95%CI：1.11~1.25）；女性2017-2021年发病风险最高（RR=1.37，95%CI：1.32~1.42），其次是2012-2016年（RR=1.24，95%CI：1.20~1.29）、2007-2011年（RR=1.24，95%CI：1.19~1.29）、2002-2006年（RR=1.10，95%CI：1.06~1.14）（图3）。
2.3.3　队列效应
1992-2021年，我国男性、女性甲状腺癌发病风险随队列变化呈上升趋势，以1987-1991年为参照组（RR=1），1907-1986年，发病风险相对较低，女性发病风险高于男性。1992-2016年，男性发病风险大于女性，其中，男性2012-2016年（RR=2.54，95%CI：1.80~3.57）发病风险最大，其次是2007-2011年（RR=2.32，95%CI：1.81~2.97）、2002-2006年（RR=1.87，95%CI：1.53~2.30）、1997-2001年（RR=1.65，95%CI：1.41~1.94）、1992-1996年（RR=1.34，95%CI：1.19~1.50）；女性在1992-2016年发病风险均大于对照组，但差异无统计学意义（图4）。
2.4　2022-2041年中国甲状腺癌ASIR的ARIMA预测分析
使用ARIMA（1，1，0）对男性和女性的ASIR开展预测，对男性（RMSE=0.023，MSE=0.001，MAE=0.021，MAPE=0.009）、女性（RMSE=0.028，MSE=0.001、MAE=0.021、MAPE=0.009）的ASIR拟合效果较好。分析发现，2022-2041年中国男性、女性甲状腺癌ASIR持续上升。到2041年，男性甲状腺癌ASIR达到2.79/10万（95%CI：1.96~3.61），女性甲状腺癌ASIR达到3.54/10万（95%CI：3.02~4.06）。见图5。
3　讨论
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本研究基于GBD2021数据库，利用Joinpoint回归模型及APC模型分析中国甲状腺癌ASIR的变化趋势，并利用ARIMA模型预测未来20年中国甲状腺癌ASIR的情况，对中国甲状腺癌的防治具有重要意义。
3.1　1992-2021年中国甲状腺癌的ASIR变化趋势分析
分析发现，1992-2021年，我国男性和女性甲状腺癌的ASIR呈上升趋势，分析原因：①医疗技术的发展导致甲状腺癌的检出率增加，或过度诊疗［16］；②甲状腺超声检查在一般体检中比较普遍，公众对于自身的健康意识增强，导致在普通人群中甲状腺癌的检出率提高［17］；③压力、电离辐射、超重肥胖、不良生活方式等危险因素，增加甲状腺癌的发病风险［18-19］。女性ASIR均高于男性，与全球流行趋势一致［2］。女性发病率高于男性，可能与体内的激素水平有关。雌激素能刺激甲状腺细胞产生大量的活性氧，导致组织突变［20］，是甲状腺癌的危险因素。性激素水平在甲状腺癌的进展中也扮演重要的角色。法国的研究发现，绝经后的女性，患甲状腺癌的风险更高［21］。其他研究也表明，女性生殖因素［21-22］及乳腺癌与甲状腺癌共病也会导致女性甲状腺的风险更高［23］。可见，应加强女性甲状腺癌健康教育和宣传，做好一级预防工作，养成健康的生活行为方式。同时，建议做好女性乳腺癌与甲状腺癌共病的防控。
3.2　1992-2021年中国甲状腺癌ASIR的年龄-时期-队列模型分析
从年龄效应上看，男性、女性的发病率均随着年龄的增长呈上升趋势。张新洲等［18］的研究发现，2005-2016年甲状腺癌的年龄效应峰值在50~59岁，与本研究不一致。分析发现，女性不同年龄段发病率波动较小，而男性60岁前，发病率随着年龄的增加而上升，到60~64岁组又出现下降，可能是因为随着职工医疗保障水平提升，甲状腺癌筛查作为一般体检项目，导致发病率上升［16］。男性75岁后发病率迅速上升，在≥85岁达到峰值，可能是因为男性比女性更容易暴露在吸烟、饮酒、肥胖等甲状腺危险因素［24-25］，导致男性的发病风险更大。可见，随着我国老龄化不断加剧，应关注老年男性甲状腺癌的发病风险。
从时期效应上看，随着时期的推移，甲状腺癌发病风险增加。同一队列中，1986年前的队列，女性发病风险大于男性，但是1996年后的队列，男性发病风险大于女性。男性越晚出生，甲状腺癌发病风险越大。其中，2007-2011年男性甲状腺癌发病风险快速增加，可能与2011年甲状腺癌的诊疗方案出台有关［26］，也有可能是与我国癌症筛查体系的逐渐完善，肿瘤登记的覆盖范围增加［27］有关。可见，既要做好老年人，又要做好年轻人群的甲状腺癌预防工作。
分析发现，整体水平上，女性甲状腺癌的发病数和发病率均高于男性，但从时期效应和队列效应上看，都表现出男性的甲状腺癌发病风险高于女性。既往研究多强调女性甲状腺癌防控的力度，但随着社会的发展，男性更多地暴露在甲状腺癌的危险因素中，提示应当关注男性甲状腺癌的防控。
3.3　未来20年中国甲状腺癌的发病预测分析
ARIMA预测分析发现，2022-2041年，我国男性、女性的甲状腺癌ASIR持续上升，提示我国甲状腺癌仍可能面临比较严峻的防控形式，政府部门应从一级预防的角度出发，做好甲状腺癌的健康教育和宣传，针对危险因素开展干预，降低甲状腺癌发病风险。
本研究的局限性：①GBD2021是根据全球的研究数据通过DIS-MOD2统计模型，综合全球已发表的研究数据和政府出版物进行估算［28］，可能与实际监测数据有差距；②受限于GBD2021数据本身，无法分地域开展发病率的差异研究。
综上，1992-2021年我国男性和女性的甲状腺癌ASIR呈上升趋势；女性ASIR高于男性。男性年龄越大，出生越晚，甲状腺癌的发病风险越高。未来20年，中国男性、女性的甲状腺癌发病率将持续上升。建议：①加强甲状腺癌的健康教育和宣传，提高知晓率；②做好高风险人群甲状腺癌的防控工作；③养成健康的行为生活方式和饮食习惯；④做好甲状腺癌的规范诊疗工作。

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2025年第47卷第14期
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doi: 10.16016/j.2097-0927.202504096
  • 接收时间：2025-04-23
  • 首发时间：2026-10-28
  • 出版时间：2025-07-30
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  • 收稿日期：2025-04-23
  • 修回日期：2025-05-31
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    1陆军军医大学（第三军医大学）第一附属医院乳腺甲状腺外科，重庆

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杨 英，E-mail：
YANG Ying，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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