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Article(id=1241025203216634362, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412122, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733760000000, receivedDateStr=2024-12-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773813065579, onlineDateStr=2026-03-18, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773813065579, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773813065579, creator=13701087609, updateTime=1773813065579, updator=13701087609, issue=Issue{id=1241025201983508979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='7', pageStart='1153', pageEnd='1344', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773813065285, creator=13701087609, updateTime=1773815493878, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241035388320543403, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241035388320543404, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241025201983508979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1193, endPage=1200, ext={EN=ArticleExt(id=1241025203468292606, articleId=1241025203216634362, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Burden and predictive analysis of disability-adjusted life years due to esophageal cancer in China from 1990 to 2021, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the changes in the burden of Disability-Adjusted Life Years (DALY) due to esophageal cancer in China from 1990 to 2021 and to predict the DALY trends over the next 20 years, providing scientific basis for policy-making and public health interventions.

Methods

The analysis of DALY changes due to esophageal cancer in China from 1990 to 2021 was conducted using the Global Burden of Disease Study database. Joint point regression analysis was employed to assess the annual percentage change in the DALY rate for esophageal cancer in China, and comparisons were made with North Korea, Japan, South Korea, and the United States. A decomposition analysis was performed to evaluate the contributions of population aging, population growth, and age-specific factors to the changes in esophageal cancer DALY. The Bayesian Age-Period-Cohort (BAPC) model was used to forecast the changes in esophageal cancer DALY over the next 20 years.

Results

In 2021, the total number of DALYs due to esophageal cancer in China was approximately 6.8 987 million years, with a significantly higher burden in males compared to females;individuals aged 65 and older accounted for 52.71% of the total DALYs. Compared to international data, China exhibited a more pronounced declining trend in esophageal cancer DALYs. From 1990 to 2021, the DALY rate decreased, with population aging and growth being the main driving factors for the increase in DALY burden. The BAPC predictive analysis indicated a slow declining trend in the total standardized DALY rate for esophageal cancer in China over the next 20 years.

Conclusion

Over the past 30 years, the burden of DALYs due to esophageal cancer in the Chinese population has shown a significant declining trend, particularly among males and the elderly. Future efforts should focus on enhancing screening coverage and interventions for high-risk populations.

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目的

分析1990—2021年中国因食管癌所致伤残调整寿命年（DALY）的疾病负担变化，并预测未来20年的DALY变化，为政策制定和公共卫生干预提供科学依据。

方法

基于全球疾病负担研究数据库分析1990—2021年中国食管癌DALY变化。采用jointpoint回归分析评估中国食管癌DALY率的年均变化百分比，并与朝鲜、日本、韩国和美国进行比较。利用因素分解法分析人口老龄化、人口增长和年龄别对食管癌DALY变化的贡献。利用贝叶斯年龄-时期-队列（BAPC）预测未来20年食管癌DALY变化。

结果

2021年，中国食管癌所致DALY总数约689.87万人年，男性DALY负担显著高于女性，65岁及以上人群占DALY总数的52.71%。与国际数据比较，中国食管癌DALY下降趋势较为明显。1990—2021年DALY率下降，人口老龄化和人口增长成为DALY负担增加的主要推动因素。BAPC预测分析未来20年中国食管癌总标化DALY率将呈现缓慢下降趋势。

结论

过去30年，中国人群食管癌所致DALY负担呈显著下降趋势，男性和老年人群负担尤为突出。未来应加强高危人群筛查覆盖率及干预。

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鞠永健，E-mail:
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叶侠（1992—），女，硕士，住院医师，研究方向：从事肿瘤内科及放射治疗的研究

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叶侠（1992—），女，硕士，住院医师，研究方向：从事肿瘤内科及放射治疗的研究

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叶侠（1992—），女，硕士，住院医师，研究方向：从事肿瘤内科及放射治疗的研究

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注：图A不同性别DALY；图B不同年龄组DALY；图C不同性别标化DALY率；图D不同年龄组标化DALY率。

, figureFileSmall=Kk65FzgiNPixaTD6NyX8pw==, figureFileBig=5lHdz+6ctULjQqgE6+dIRw==, tableContent=null), ArticleFig(id=1241025210284036776, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=EN, label=Figure 2, caption=The proportion of DALYs caused by esophageal cancer in China from 1990 to 2021, figureFileSmall=cj/pP9qwj6jSZsbla6h+jA==, figureFileBig=pJnnKZT04cx1kGMyagduWw==, tableContent=null), ArticleFig(id=1241025210409865902, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=CN, label=图2, caption=1990—2021年中国食管癌DALY比例

注：图A为YLD和YLL比例；图B为不同性别食管癌DALY比例；图C为不同年龄组食管癌DALY比例。

, figureFileSmall=cj/pP9qwj6jSZsbla6h+jA==, figureFileBig=pJnnKZT04cx1kGMyagduWw==, tableContent=null), ArticleFig(id=1241025210489557683, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=EN, label=Figure 3, caption=Changes in the number of DALY attributed to population aging, population growth, and epidemiological change for esophageal cancer in China from 1990 to 2021, figureFileSmall=4q/29ehApC8hRGAR9YAV4w==, figureFileBig=ca8kYSSe3PgcXf8V6o9WHw==, tableContent=null), ArticleFig(id=1241025210565055158, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=CN, label=图3, caption=1990—2021年中国食管癌归因于人口老龄化、人口增长和流行病学变化DALY变化量, figureFileSmall=4q/29ehApC8hRGAR9YAV4w==, figureFileBig=ca8kYSSe3PgcXf8V6o9WHw==, tableContent=null), ArticleFig(id=1241025210661524156, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=EN, label=Figure 4, caption=The prediction of the change in the DALY rate of esophageal cancer in China over the next 20 years, figureFileSmall=QgWT/dQMcetUNXs81Z+6bw==, figureFileBig=3+f+Z8ghj+tsIjw8E8KyOQ==, tableContent=null), ArticleFig(id=1241025210732827326, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=CN, label=图4, caption=未来20年中国食管癌DALY率变化预测分析

注：图A为总体标化DALY率预测分析;图B为男性标化DALY率预测分析;图C为女性标化DALY率预测分析。

, figureFileSmall=QgWT/dQMcetUNXs81Z+6bw==, figureFileBig=3+f+Z8ghj+tsIjw8E8KyOQ==, tableContent=null), ArticleFig(id=1241025210799936194, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=EN, label=Table 1, caption=

DALY caused by esophageal cancer in China in 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标DALY(人年)YLD(人年)YLL(人年)
数量标化DALY率(1/10万)百分比(%)
总计6 898 666.18317.1810086 059.426 812 606.76
性别
男性5 612 571.90534.1881.3666 075.945 546 495.96
女性1 286 094.28114.5818.6419 983.48126 610.80
年龄（岁）
<40118 146.0711.951.711 226.18116 919.90
40～643 143 995.06581.2945.5734 572.943 109 422.11
≥653 636 525.051 873.0952.7150 260.303 586 264.75
), ArticleFig(id=1241025210879627974, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=CN, label=表1, caption=

2021年中国食管癌所致DALY

, figureFileSmall=null, figureFileBig=null, tableContent=
指标DALY(人年)YLD(人年)YLL(人年)
数量标化DALY率(1/10万)百分比(%)
总计6 898 666.18317.1810086 059.426 812 606.76
性别
男性5 612 571.90534.1881.3666 075.945 546 495.96
女性1 286 094.28114.5818.6419 983.48126 610.80
年龄（岁）
<40118 146.0711.951.711 226.18116 919.90
40～643 143 995.06581.2945.5734 572.943 109 422.11
≥653 636 525.051 873.0952.7150 260.303 586 264.75
), ArticleFig(id=1241025210959319754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=EN, label=Table 2, caption=

Average annual percent change in DALY caused by esophageal cancer in different countries from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
国家总体男性女性
年份（年）APC（%）
(95%CI)		AAPC（%）
(95%CI)		年份（年）APC（%）
(95%CI)		AAPC（%）
(95%CI)		年份（年）APC（%）
(95%CI)		AAPC（%）
(95%CI)
中国-2.31(-2.46～-2.16)-1.90(-2.06～-1.74）-3.51(-3.77～-3.25)
1990—1998-1.75(-1.91～-1.58)1990—1998-1.61(-1.80～-1.43)1990—2004-1.87(-1.97～-1.77)
1998—2004-0.27(-0.57～0.04)1998—20040.33(0.01～0.66)2004—2007-7.66(-9.55～-5.74)
2004—2007-5.99(-7.17～-4.78)2004—2007-5.21(-6.34～-4.08)2007—2014-6.87(--7.16～-6.58)
2007—2016-4.03(-4.17～-3.89)2007—2016-3.36(-3.53～-3.19)2014—2017-2.55(-4.24～0.83)
2016—2021-0.24(-0.71～0.23)2016—2021-0.30(-0.87～0.28)2017—2021-0.270(-1.32～-0.07)
朝鲜-0.51(-0.55～-0.47)-0.55（-0.62～-0.48）-1.16(-1.22～-1.09)
1990—20010.01(-0.00～0.03)1990—2001-0.07(-0.1～-0.03)1990—1998-0.24(-0.29～-0.19)
2001—2005-0.76(-0.90～-0.62)2001—2005-0.74(-1.00～-0.48)1998—2001-0.56(-1.03～-0.08)
2005—2010-0.02(-0.10～0.07)2005—2010-0.06(-0.21～0.10)2001—2004-1.42(-1.90～-0.94)
2010—2013-1.03(-1.30～-0.76)2010—2013-0.90(-1.39～-0.41)2004—2010-0.62(-0.72～-0.52)
2013—2017-1.48(-1.61～-1.35)2013—2017-1.56(-1.79～-1.32)2010—2021-2.19(-2.22～-2.16)
2017—2021-0.97(-1.06～-0.87)2017—2021-0.98(-1.15～-0.81)
日本-1.10(-1.33～-0.87)-1.27（-1.53～-1.02）-0.72(-0.96～-0.47)
1990—19921.01(-0.55～2.59)1990—19921.23(-0.52～3.02)1990—1995-1.96(-2.42～-1.50)
1992—1995-0.82(-2.32～0.70)1992—1995-0.82(-2.47～0.87)1995—2004-0.25(-0.51～0.00)
1995—20010.38(0.01～0.75)1995—20010.25(-0.15～0.65)2004—2007-1.37(-3.74～1.06)
2001—2010-1.32(-1.53～-1.12)2001—2010-1.50(-1.72～-1.28)2007—2021-0.43(-0.56～-0.30)
2010—2018-2.59(-2.88～-2.30)2010—2018-3.02(-3.33～-2.70)
2018—2021-1.01(-2.34～0.34)2018—2021-1.05(-2.57～0.49)
韩国-3.50(-3.70～-3.30)-3.56（-.376～-3.37）-4.45(-4.68～-4.22)
1990—1994-1.78(-2.54～-1.02)1990—1994-1.43(-2.22～-0.63)1990—1994-3.81(-4.65～-2.96)
1994—1998-4.24(-5.28～-3.20)1994—1999-4.12(-4.80～-3.43)1994—2006-6.80(-6.94～-6.67)
1998—2007-5.60(-5.82～-5.37)1999—2007-5.74(-6.02～-5.46)2006—2010-4.97(-5.88～-4.05)
2007—2016-3.00(-3.25～-2.75)2007—2017-3.26(-3.46～-3.05)2010—2019-2.31(-2.55～-2.07)
2016—2021-1.33(-1.87～-0.78)2017—2021-1.31(-2.11～-0.50)2019—2021-0.22(-2.37～2.89)
美国-0.36(-0.58～-0.13)-0.32（-0.58～-0.07）-0.83(-0.98～-0.69)
1990—19941.02(0.39～1.65)1990—19941990—2003-0.36(-0.48～-0.24)
1994—1997-0.43(-2.44～1.62)1994—19972003—2008-2.06(-2.85～-1.28)
1997—20021.02(0.36～1.68)1997—20022008—2021-0.83(-0.97～1-0.69)
2002—2021-0.99(-1.06～-0.92)2002—2021
), ArticleFig(id=1241025211085148878, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=CN, label=表2, caption=

1990—2021年不同国家食管癌所致DALY平均年度变化百分比

, figureFileSmall=null, figureFileBig=null, tableContent=
国家总体男性女性
年份（年）APC（%）
(95%CI)		AAPC（%）
(95%CI)		年份（年）APC（%）
(95%CI)		AAPC（%）
(95%CI)		年份（年）APC（%）
(95%CI)		AAPC（%）
(95%CI)
中国-2.31(-2.46～-2.16)-1.90(-2.06～-1.74）-3.51(-3.77～-3.25)
1990—1998-1.75(-1.91～-1.58)1990—1998-1.61(-1.80～-1.43)1990—2004-1.87(-1.97～-1.77)
1998—2004-0.27(-0.57～0.04)1998—20040.33(0.01～0.66)2004—2007-7.66(-9.55～-5.74)
2004—2007-5.99(-7.17～-4.78)2004—2007-5.21(-6.34～-4.08)2007—2014-6.87(--7.16～-6.58)
2007—2016-4.03(-4.17～-3.89)2007—2016-3.36(-3.53～-3.19)2014—2017-2.55(-4.24～0.83)
2016—2021-0.24(-0.71～0.23)2016—2021-0.30(-0.87～0.28)2017—2021-0.270(-1.32～-0.07)
朝鲜-0.51(-0.55～-0.47)-0.55（-0.62～-0.48）-1.16(-1.22～-1.09)
1990—20010.01(-0.00～0.03)1990—2001-0.07(-0.1～-0.03)1990—1998-0.24(-0.29～-0.19)
2001—2005-0.76(-0.90～-0.62)2001—2005-0.74(-1.00～-0.48)1998—2001-0.56(-1.03～-0.08)
2005—2010-0.02(-0.10～0.07)2005—2010-0.06(-0.21～0.10)2001—2004-1.42(-1.90～-0.94)
2010—2013-1.03(-1.30～-0.76)2010—2013-0.90(-1.39～-0.41)2004—2010-0.62(-0.72～-0.52)
2013—2017-1.48(-1.61～-1.35)2013—2017-1.56(-1.79～-1.32)2010—2021-2.19(-2.22～-2.16)
2017—2021-0.97(-1.06～-0.87)2017—2021-0.98(-1.15～-0.81)
日本-1.10(-1.33～-0.87)-1.27（-1.53～-1.02）-0.72(-0.96～-0.47)
1990—19921.01(-0.55～2.59)1990—19921.23(-0.52～3.02)1990—1995-1.96(-2.42～-1.50)
1992—1995-0.82(-2.32～0.70)1992—1995-0.82(-2.47～0.87)1995—2004-0.25(-0.51～0.00)
1995—20010.38(0.01～0.75)1995—20010.25(-0.15～0.65)2004—2007-1.37(-3.74～1.06)
2001—2010-1.32(-1.53～-1.12)2001—2010-1.50(-1.72～-1.28)2007—2021-0.43(-0.56～-0.30)
2010—2018-2.59(-2.88～-2.30)2010—2018-3.02(-3.33～-2.70)
2018—2021-1.01(-2.34～0.34)2018—2021-1.05(-2.57～0.49)
韩国-3.50(-3.70～-3.30)-3.56（-.376～-3.37）-4.45(-4.68～-4.22)
1990—1994-1.78(-2.54～-1.02)1990—1994-1.43(-2.22～-0.63)1990—1994-3.81(-4.65～-2.96)
1994—1998-4.24(-5.28～-3.20)1994—1999-4.12(-4.80～-3.43)1994—2006-6.80(-6.94～-6.67)
1998—2007-5.60(-5.82～-5.37)1999—2007-5.74(-6.02～-5.46)2006—2010-4.97(-5.88～-4.05)
2007—2016-3.00(-3.25～-2.75)2007—2017-3.26(-3.46～-3.05)2010—2019-2.31(-2.55～-2.07)
2016—2021-1.33(-1.87～-0.78)2017—2021-1.31(-2.11～-0.50)2019—2021-0.22(-2.37～2.89)
美国-0.36(-0.58～-0.13)-0.32（-0.58～-0.07）-0.83(-0.98～-0.69)
1990—19941.02(0.39～1.65)1990—19941990—2003-0.36(-0.48～-0.24)
1994—1997-0.43(-2.44～1.62)1994—19972003—2008-2.06(-2.85～-1.28)
1997—20021.02(0.36～1.68)1997—20022008—2021-0.83(-0.97～1-0.69)
2002—2021-0.99(-1.06～-0.92)2002—2021
), ArticleFig(id=1241025211169034964, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=EN, label=Table 3, caption=

Factor decomposition analysis of DALY caused by esophageal cancer in China from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
性别年份（年）DALY
(人年)		总数归因于人口老龄化归因于人口增长归因于流行病学变化
数量比例(%)数量（人年）比例(%)数量（人年）比例(%)
总体19905 852 132.32基准参考基准参考Ref基准参考基准参考基准参考基准参考
20056 963 538.241 111 405.921 131 417.42101.801 494 920.87134.51-1 514 932.37-136.31
20216 898 666.181 046 533.863 477 775.40332.312 710 088.44258.96-5 141 329.98-491.27
女性19901 522 191.20基准参考基准参考RefRefRefRefRef
20051 594 556.0872 364.87247 754.14342.37388 115.37536.33-563 504.64-778.70
20211 286 094.28-236 096.92885 388.95-375.01670 622.19-284.05-1 792 108.07759.06
男性19904 329 941.12基准参考基准参考RefRefRefRefRef
20055 368 982.171 039 041.05924 717.6589.001 066 089.73102.60-951 766.33-91.60
20215 612 571.901 282 630.782 613 079.57203.731 978 202.75154.23-3 308 651.53-257.96
), ArticleFig(id=1241025211265503961, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241025203216634362, language=CN, label=表3, caption=

1990—2021年中国食管癌癌所致DALY的因素分解分析

, figureFileSmall=null, figureFileBig=null, tableContent=
性别年份（年）DALY
(人年)		总数归因于人口老龄化归因于人口增长归因于流行病学变化
数量比例(%)数量（人年）比例(%)数量（人年）比例(%)
总体19905 852 132.32基准参考基准参考Ref基准参考基准参考基准参考基准参考
20056 963 538.241 111 405.921 131 417.42101.801 494 920.87134.51-1 514 932.37-136.31
20216 898 666.181 046 533.863 477 775.40332.312 710 088.44258.96-5 141 329.98-491.27
女性19901 522 191.20基准参考基准参考RefRefRefRefRef
20051 594 556.0872 364.87247 754.14342.37388 115.37536.33-563 504.64-778.70
20211 286 094.28-236 096.92885 388.95-375.01670 622.19-284.05-1 792 108.07759.06
男性19904 329 941.12基准参考基准参考RefRefRefRefRef
20055 368 982.171 039 041.05924 717.6589.001 066 089.73102.60-951 766.33-91.60
20215 612 571.901 282 630.782 613 079.57203.731 978 202.75154.23-3 308 651.53-257.96
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1990—2021年中国食管癌所致伤残调整寿命年负担及预测分析
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叶侠 , 李克新 , 宣婷婷 , 鞠永健
现代预防医学 | 流行病与统计方法 2025,52(7): 1193-1200
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现代预防医学 | 流行病与统计方法 2025, 52(7): 1193-1200
1990—2021年中国食管癌所致伤残调整寿命年负担及预测分析
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叶侠, 李克新, 宣婷婷, 鞠永健
作者信息
  • 南通市第一人民医院放疗科，江苏 南通 226000

    • 叶侠（1992—），女，硕士，住院医师，研究方向：从事肿瘤内科及放射治疗的研究

通讯作者:

鞠永健，E-mail:
Burden and predictive analysis of disability-adjusted life years due to esophageal cancer in China from 1990 to 2021
Xia YE, Ke-xin LI, Ting-ting XUAN, Yong-jian JU
Affiliations
  • Department of Radiation Oncology, First People’s Hospital of Nantong, Nantong, Jiangsu 226000, China
出版时间: 2025-04-10 doi: 10.20043/j.cnki.MPM.202412122
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摘要
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目的

分析1990—2021年中国因食管癌所致伤残调整寿命年（DALY）的疾病负担变化，并预测未来20年的DALY变化，为政策制定和公共卫生干预提供科学依据。

方法

基于全球疾病负担研究数据库分析1990—2021年中国食管癌DALY变化。采用jointpoint回归分析评估中国食管癌DALY率的年均变化百分比，并与朝鲜、日本、韩国和美国进行比较。利用因素分解法分析人口老龄化、人口增长和年龄别对食管癌DALY变化的贡献。利用贝叶斯年龄-时期-队列（BAPC）预测未来20年食管癌DALY变化。

结果

2021年，中国食管癌所致DALY总数约689.87万人年，男性DALY负担显著高于女性，65岁及以上人群占DALY总数的52.71%。与国际数据比较，中国食管癌DALY下降趋势较为明显。1990—2021年DALY率下降，人口老龄化和人口增长成为DALY负担增加的主要推动因素。BAPC预测分析未来20年中国食管癌总标化DALY率将呈现缓慢下降趋势。

结论

过去30年，中国人群食管癌所致DALY负担呈显著下降趋势，男性和老年人群负担尤为突出。未来应加强高危人群筛查覆盖率及干预。

食管癌  /  全球疾病负担  /  伤残调整寿命年  /  中国
Objective

To analyze the changes in the burden of Disability-Adjusted Life Years (DALY) due to esophageal cancer in China from 1990 to 2021 and to predict the DALY trends over the next 20 years, providing scientific basis for policy-making and public health interventions.

Methods

The analysis of DALY changes due to esophageal cancer in China from 1990 to 2021 was conducted using the Global Burden of Disease Study database. Joint point regression analysis was employed to assess the annual percentage change in the DALY rate for esophageal cancer in China, and comparisons were made with North Korea, Japan, South Korea, and the United States. A decomposition analysis was performed to evaluate the contributions of population aging, population growth, and age-specific factors to the changes in esophageal cancer DALY. The Bayesian Age-Period-Cohort (BAPC) model was used to forecast the changes in esophageal cancer DALY over the next 20 years.

Results

In 2021, the total number of DALYs due to esophageal cancer in China was approximately 6.8 987 million years, with a significantly higher burden in males compared to females;individuals aged 65 and older accounted for 52.71% of the total DALYs. Compared to international data, China exhibited a more pronounced declining trend in esophageal cancer DALYs. From 1990 to 2021, the DALY rate decreased, with population aging and growth being the main driving factors for the increase in DALY burden. The BAPC predictive analysis indicated a slow declining trend in the total standardized DALY rate for esophageal cancer in China over the next 20 years.

Conclusion

Over the past 30 years, the burden of DALYs due to esophageal cancer in the Chinese population has shown a significant declining trend, particularly among males and the elderly. Future efforts should focus on enhancing screening coverage and interventions for high-risk populations.

Esophageal cancer  /  Global burden of disease  /  Disability-adjusted life years  /  China
叶侠, 李克新, 宣婷婷, 鞠永健. 1990—2021年中国食管癌所致伤残调整寿命年负担及预测分析. 现代预防医学, 2025 , 52 (7) : 1193 -1200 . DOI: 10.20043/j.cnki.MPM.202412122
Xia YE, Ke-xin LI, Ting-ting XUAN, Yong-jian JU. Burden and predictive analysis of disability-adjusted life years due to esophageal cancer in China from 1990 to 2021[J]. Modern Preventive Medicine, 2025 , 52 (7) : 1193 -1200 . DOI: 10.20043/j.cnki.MPM.202412122
正文
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食管癌(esophageal cancer)是我国最常见的消化道恶性肿瘤之一，其发病率和死亡率均居世界前列[1]。国际癌症研究(International Agency for Research on Cancer，IARC)发布的权威数据显示，2022年食管癌位居全球肿瘤新发病例数第11位，全球共计发现51.1万例新发食管癌患者，相关死亡病例44.5万[2]。食管癌的发病具有地域差异，东亚地区（包括中国、韩国、日本等国家）占全球食管癌新发病例和死亡病例的主要份额，特别是中国[2-3]。2022年，中国食管癌新发病例数及相关死亡人数位居全球首位，分别为318 284和126 845例，占全球食管癌新发和死亡病例的62.3%和28.5%，已成为威胁我国居民健康的主要恶性肿瘤之一[2]。近年来，尽管全球范围内恶性肿瘤的总体疾病负担呈下降趋势，但食管癌的高负担仍对我国公共卫生体系和社会经济发展构成重大挑战，其疾病负担在我国乃至全球范围内具有重要的代表性和研究价值[4]。
伤残调整寿命年（disability-adjusted life years，DALY）作为衡量疾病负担的重要综合性指标，可以同时评估因疾病导致的早死寿命损失（years of life lost，YLL）和伤残寿命损失（years lived with disability，YLD）[5]。相比传统的发病率和死亡率，DALY能够全面反映疾病对健康的整体损害，为公共卫生决策和干预措施的制定提供科学依据。在我国，人口老龄化进程的加速和生活方式的转变，使食管癌的疾病负担呈现出独特的流行病学特征，尤其在不同性别、年龄组和地区之间的分布差异显著。
近年来，全球疾病负担研究（Global Burden of Disease，GBD）数据库的研究为探索疾病负担的时空变化趋势提供了高质量的循证数据[6]。本研究基于GBD数据库的最新数据，分析了1990—2021年间我国因食管癌导致的DALY负担趋势，并评估其在性别、年龄组和地区间的差异。同时，研究还借鉴了全球及代表性国家的经验，探索影响我国食管癌疾病负担变化的关键驱动因素。研究结果不仅为优化我国食管癌的防控策略提供科学支持，也为制定精准的公共卫生政策和资源配置方案奠定基础。
1　资料与方法
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1.1　数据来源
本研究基于2021年GBD数据库展开。该数据库是一个研究全球疾病和伤害情况的数据库，全面分析了全球204个国家和地区的369种疾病和伤害及87种危险因素的疾病负担[7-8]。本研究提取1990—2021年间不同国家人群因食管癌导致的DALY、YLL、YLD，所有数据均依据GBD标准人口结构进行标化，并使用95%不确定性区间（uncertainty interval，UI）表征估计的可信度。
1.2　疾病分类及测算指标
疾病分类采用国际疾病分类（ICD-10），食管癌的疾病编码为C15～C15.9、Z85.01。在分析过程中，采用DALY、YLL、YLD等指标评估中国食管癌的疾病负担情况。DALY为YLL与YLD的总和[9]。年龄标化DALY率具体计算方法为：
其中ASDR为标化DALY率；i为年龄组别，共分为20个年龄组别（0～4岁，5～9岁，.......，90～94岁，≥95岁）；Ri为第i年龄组别的DALY率；std_Pi为第i年龄组别的标准人口占比。
1.3　统计学方法
1.3.1　Jointpoint回归分析
本研究采用joinpoint 4.9.1.0进行jointpoint回归分析[10]，计算1990—2021年间的年度变化百分比（annual percentage change，APC）及平均年度变化百分比（average annual percentage change，AAPC），AAPC及APC大于0，表示食管癌DALY呈上升趋势，AAPC及APC小于0，则表示呈下降趋势，检验水准为α=0.05。
1.3.2　研究采用因素分解法
以1990年为基准参照，分析了1990—2021年间食管癌归因为人口老龄化、人口增长和人口流行病学变化而导致的DALY数变化[11]，明确影响食管癌DALY负担变化的主要驱动因素。
1.3.3　BAPC分析
应用贝叶斯年龄-时期-队列（Bayesian age period-cohort，BAPC）分析方法，基于GBD1990—2021年中国食管癌DALY数据，通过R 4.3.3软件中“BAPC”包和“INLA”包，对2022—2040年中国食管癌的标化DALY率进行预测。未来标准化人口采用GBD2021研究数据库预测的人口数。统计分析采用R4.3.3软件。
2　结果
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2.1　2021年我国食管癌所致DALY负担情况
2021年中国食管癌所致的DALY总计达到689.87万人年，年龄标化DALY率为317.18/10万。从性别上看，男性的DALY总量为561.26万人年，明显高于女性的128.61万人年，占总体的81.36%，标化DALY率是女性的4.66倍。从疾病负担的构成来看，YLL是DALY的主要组成部分，达681.26万人年，占总DALY的98.77%；而YLD仅为8.61万人年，占1.23%。男性和女性的YLL分别为554.65和126.61万人年，而YLD分别为6.61和1.99万人年。从年龄组看，40岁以下人群的DALY为11.81万人年，40～64岁人群的DALY为314.40万人年，65岁及以上人群的DALY最高为363.65万人年，分别占总DALY的1.71%、45.57%、52.71%。见表1。
2.2　1990—2021年我国食管癌DALY变化趋势
1990—2021年间，中国食管癌的所致的DALY总数从1990年的585.21万人年增长至2021年的689.87万人年，整体增幅为17.88%。标化DALY率由1990年的653.31/10万显著降低至2021年的317.18/10万，从总体上来看，食管癌所致DALYs在1990—2021年期间呈现下降的趋势，表明我国食管癌防控取得一定成效。从性别分布看，男性的DALY总数明显高于女性，1990—2004年持续升高后缓慢下降，2015年逐渐升高，女性的DALY总数相对稳定。年龄标准DALY率方面，男性及女性总体上均呈下降趋势，男性下降趋势较为明显。从年龄分布来看，≥65岁年龄组的DALYs总量最高，且在1990—2004年期间逐步增加，此后缓慢下降后升高；40～65岁年龄组的DALYs次之，整体呈现缓慢上升后下降；<40岁年龄组的DALYs总量最低且较为稳定，几乎无显著变化。各年龄阶段的标化DALY率均下降，下降幅度依次降低，见图1。DALY总数内部构成方面，男性与女性及YLD与YLL比例较为稳定，YLL占比较高，但年龄构成发生较大变化，其中65岁及以上的老龄组DALY数占比增长趋势明显，由1990年的35.56%增长至2021年的52.71%，见图2。
2.3　国际比较与驱动因素分析
表2展示了1990—2021年，中国、朝鲜、日本、韩国和美国的标化DALY率的变化趋势。各国家DALY率均呈下降趋势，尤其韩国，下降趋势最明显，AAPC为-3.50%（95%CI：-3.70%～-3.30%）。其次是中国（AAPC=-2.31%，95%CI：-2.46%～-2.16%），日本的下降幅度相较于中国和韩国较小（AAPC=-1.10%）（95%CI：-1.33%～-0.87%）。尽管美国和朝鲜也呈下降趋势，但速度较为缓慢。虽然中国在疾病负担的降低方面成果显著，但仍远高于其他国家。在性别方面，各国的男性及女性标化DALY率均呈下降趋势，其中中国女性、韩国男性及女性下降幅度均较大，明显高于其他国家。因素分解分析表明，1990—2021年，流行病学变化是导致中国食管癌负担减少的主要因素。与此相对，人口老龄化和人口增长成为DALY负担增加的主要推动因素。且人口老龄化自2016年起反超人口数量增长，成为了食管癌DALY增长的首位驱动因素，见图3。2021年，人口老龄化DALY率下降所致的食管癌DALY下降数为347.78万人年，约占1990—2021年食管癌DALY下降总数的332.31%；人口增长和流行病学变化所致的食管癌DALY下降数为271.01和-514.13万人年，分别占总数的258.96%、-491.27%。见表3。
2.4　2022—2040中国食管癌DALY率变化趋势预测
本研究预测在2022—2040年，中国食管癌总标化DALY率将呈现缓慢下降趋势，将由2021年的317.18/10万下降至2040年287.36/10万。在性别方面看，女性食管癌DALY率将呈现稳定下降趋势，由114.58/10万下降至78.79/10万，但是男性食管癌DALY率则基本保持稳定，由534.18/10万下降至522.00/10万。见图4。
3　讨论
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本研究基于GBD2021数据库，分析了1990—2021年中国食管癌导致的DALY的变化趋势，并探讨了性别、年龄等方面的差异，结合国际比较和因素分解分析，揭示了食管癌疾病负担变化的关键驱动因素。本研究是首次对食管癌DALY进行研究，对未来应对策略和进一步研究的方向具有一定的意义。
研究显示，中国食管癌导致的DALY负担在过去三十年内显著下降，标化DALY率的AAPC为-2.31%。这表明，食管癌防控策略在一定程度上取得了显著进展，其中2004年后下降明显。这可能因为2005年起[12]，中国启动了“癌症早诊早治”项目，对包括食管癌在内的多种高发癌症，加大了高危人群的筛查力度，尤其是在食管癌高发区域（如河南、河北、山西等地），通过定期开展胃镜筛查，有效提高了早诊率，与既往研究相一致[13]。尽管取得了一定的成效，我国总体食管癌的DALY负担很重，男性的DALY负担仍然显著高于女性，这与以前的研究结果也是一致的[12，14]，可能与男性群体暴露于更多食管癌高危因素有关，如吸烟、喝酒、过热饮食、水果摄入不足等[15-17]。因此，未来应继续加强针对男性群体的健康教育，特别是在高危地区推广禁烟、限酒、多食新鲜水果蔬菜、提倡健康饮食习惯等干预措施，同时推动早期筛查项目的普及，特别是在高风险群体中。
中国人口老龄化进程加快，已成为影响食管癌疾病负担的重要因素。本研究显示，老年人群（65岁及以上）对总DALY的贡献不断增加，2021年该年龄组的DALY负担占比已上升至52.71%。这一变化直接反映了中国人口老龄化对食管癌DALY负担的影响。根据中国统计局的数据，2021年中国65岁及以上老年人口已占总人口的14.2%，预计到2050年这一比例将进一步增加至33%左右[18]。因此，老年群体对食管癌负担的贡献将持续增大，成为未来防控的关键挑战。针对这一问题，近年来中国已开始实施一些面向老年群体的癌症筛查政策。例如，部分省市已开展“健康中国行动计划”[19]，通过为老年人群提供癌症筛查套餐（包括食管癌筛查）来提前发现癌症。此外，随着老龄化的推进，老年人的医疗负担将日益加重[20-21]，因此在未来，除了继续加强高危人群筛查，还需要针对老年人的多病共治进行个性化干预，以减轻他们对疾病的负担。
本研究还通过与其他国家对比，揭示了中国在食管癌负担下降方面取得的成绩与存在的差距。尽管中国的DALY负担呈下降趋势，但与韩国和日本等国家相比，下降幅度仍显不足。韩国自2002年起实施了上消化道早癌筛查计划，包括食管癌筛查，每年约50%的高危人群参与胃镜筛查，早期发现率和治疗率显著提高，DALY负担明显减少[22]。日本自20世纪90年代以来也积极推广消化道肿瘤筛查，尤其在食管癌高风险地区，筛查覆盖率达到了70%以上，相较于中国，其下降幅度小（AAPC=-1.10%）[23]。这可能与日本筛查系统相对成熟，及其他因素如生活方式、饮食习惯等有关。尽管美国的食管癌DALY负担呈下降趋势（AAPC=-0.5%），但其标化DALY率本身较低，说明该国的医疗体系在食管癌防控方面具有较高的效率。美国的较低标化DALY率反映了较为完善的医疗基础设施和高效的治疗方案。然而，在中国，虽然筛查覆盖率逐步提高，但特别是在农村地区和老年人群体，筛查的覆盖面和早诊率仍然不足。区域性差异和医疗资源不均衡是中国食管癌防控面临的主要问题，尤其是一些经济欠发达地区，筛查和治疗资源依然较为匮乏[24]。因此，未来中国在推广筛查的同时，需要加大对偏远地区和老年群体的医疗资源投入，提高筛查的普及率和医疗可及性。
根据本研究的预测，未来20年内中国食管癌DALY率将继续缓慢下降，但随着人口老龄化的推进，下降幅度可能趋于平缓，男性患者中，呈现稳定趋势，这与其他研究结果类似[25]。基于当前的研究结果，接下来可以在下面几个方面展开，以进一步减少食管癌对中国公共卫生系统的负担。（1）加强高危人群的早期筛查：未来应在食管癌高发地区，特别是在中老年男性群体中推广高效的筛查项目，提升胃镜筛查覆盖率。可以借鉴韩国和日本的经验，逐步在全国范围内开展定期的食管癌筛查，尤其是45岁以上的高危人群应成为筛查重点。结合大数据分析和AI技术，提升筛查效率和精准度。（2）加强健康教育与生活方式干预：应更加重视食管癌的主要危险因素（如吸烟、饮酒、不健康饮食习惯等）的预防，特别是对男性群体的健康教育，提升其健康素养，推动健康饮食和生活方式的普及。（3）针对老年群体的综合干预：随着老年人口比例的上升，食管癌的负担将越来越集中在老年群体。因此，除了早期筛查外，还需要推动老年多病共治的健康管理模式，提供个性化的疾病管理方案。针对老年人的健康教育也应加强，鼓励他们参与健康体检和疾病筛查。（4）加强老年人群体的癌症管理：针对老龄化趋势，应加大对老年人群体的关注，提供更为细致的多病共治和癌症筛查服务，尤其是在基层医疗体系中，推广老年癌症早筛项目，减少因疾病晚期发现而增加的医疗负担。
尽管本研究基于全球疾病负担数据，提供了关于中国食管癌DALY趋势的全面分析，但由于GBD数据的潜在不确定性及区域性差异，可能无法准确反映所有地方的实际情况。同时，本文未能深入探讨食管癌的分子机制及其与生活方式、环境因素之间的复杂关系，未来研究可以结合临床数据和流行病学调查，进一步深入挖掘这些因素对食管癌负担的影响。此外，尽管已分析了多国的防控策略，未来仍需进一步探索如何将国际经验结合中国国情，制定更加精准和可行的公共卫生政策。
总体而言，本研究揭示了中国食管癌DALY负担下降的主要成效，并指出人口老龄化、男性高危人群和地区差异等仍是影响疾病负担的关键因素。未来中国应继续强化疾病筛查、健康教育和生活方式干预，同时借鉴国际经验，以应对老龄化社会带来的新挑战。
基金
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  • 江苏省“六大人才高峰”课题(2014WSN075)
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2025年第52卷第7期
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doi: 10.20043/j.cnki.MPM.202412122
  • 接收时间：2024-12-10
  • 首发时间：2026-03-18
  • 出版时间：2025-04-10
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  • 收稿日期：2024-12-10
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江苏省“六大人才高峰”课题(2014WSN075)
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    南通市第一人民医院放疗科，江苏 南通 226000

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