Article(id=1240375271442927975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401393, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1674489600000, receivedDateStr=2023-01-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658109770, onlineDateStr=2026-03-16, pubDate=1713974400000, pubDateStr=2024-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658109770, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658109770, creator=13701087609, updateTime=1773658109770, updator=13701087609, issue=Issue{id=1240375270163673092, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658109465, creator=13701087609, updateTime=1773658579758, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377242795176417, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377242795176418, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375270163673092, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1370, endPage=1376, ext={EN=ArticleExt(id=1240375271711363435, articleId=1240375271442927975, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Death trends and age-period-cohort model analyses of lung cancer, Sichuan, 2007-2021, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the mortality trend of lung cancer in Sichuan Province from 2007 to 2021, and provide evidence for formulating lung cancer prevention and control policies in the new period.

Methods

Lung cancer mortality was obtained from Health Statistics Yearbook of Sichuan Province. A cohort age-period model was used to estimate the effect of age, period and birth cohort on lung cancer mortality in residents aged 20-84.

Results

The mortality rates of lung cancer in male and female increased from 59.68/100 000 and 16.48/100 000 in 2007 to 75.14/100 000 and 30.49/100 000 in 2021 respectively. Compared with residents aged 20-24, male and female residents aged 75-79 were 101 times and 121 times higher than those aged 20-24 respectively; male and female lung cancer mortality risks from 2017 to 2021 were 1.29 times and 1.31 times higher than those from 2012 to 2016 respectively; male and female lung cancer mortality risks born in 1927—1931 were 73.42 times and 38.49 times higher than those born in 1992—1996 respectively.

Conclusion

Lung cancer mortality in Sichuan Province fluctuates from 2007 to 2021, and male mortality is higher. There were differences in lung cancer mortality risk by age, period, and birth cohort.

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目的

分析2007—2021年四川省居民肺癌死亡趋势,为新时期制定肺癌防治政策提供依据。

方法

肺癌死亡率源自四川省卫生统计年鉴。以20~84岁居民为研究对象,运用年龄-时期-队列模型,从年龄、时期与出生队列方面估计对肺癌死亡率的影响效应。

结果

男女性肺癌死亡率分别由2007年的59.68/10万、16.48/10万波动升至2021年的75.14/10万、30.49/10万。相较于20~24岁居民,男女性75~79岁居民分别是其肺癌致死风险的101倍、121倍;男女性2017—2021年肺癌致死风险分别是2012—2016年的1.29倍、1.31倍;1927—1931年出生的男女性肺癌致死风险分别是出生于1992—1996年的73.42倍、38.49倍。

结论

2007—2021年四川省肺癌死亡率呈现波动上升,男性死亡率更高。年龄、时期及出生队列的肺癌致死风险存在差异。

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康红,E-mail:
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胡凤(1993—),女,本科,初级职称,研究方向:公共卫生

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Mortality trends and age-period-cohort model analysis of colorectal cancer in China, 1990-2019[J]. Modern Preventive Medicine, 2023, 50(18): 3281-3287., articleTitle=Mortality trends and age-period-cohort model analysis of colorectal cancer in China, 1990-2019, refAbstract=null)], funds=[Fund(id=1240748866857914650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, awardId=SWFZ23-Q-77, language=CN, fundingSource=四川省基层卫生事业发展研究中心青年项目(SWFZ23-Q-77), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240748863506665534, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, xref=null, ext=[AuthorCompanyExt(id=1240748863515054144, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, companyId=1240748863506665534, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Key Laboratory of Birth Defects and Related Women and Children’s Diseases, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1240748863527637061, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, companyId=1240748863506665534, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西第二医院出生缺陷及相关妇儿疾病教育部重点实验室,四川 成都 610041)])], figs=[ArticleFig(id=1240748865897418980, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=EN, label=Fig.1, caption=Change trend of lung cancer mortality rate in Sichuan Province and between men and women from 2007 to 2021, figureFileSmall=dVFTpUerDZ3XoSuBNLnIsw==, figureFileBig=8/juGnNjpNCRFw1OH74nag==, tableContent=null), ArticleFig(id=1240748866014859497, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=CN, label=图1, caption=2007—2021年四川省肺癌死亡率在全省及男女间的变化趋势, figureFileSmall=dVFTpUerDZ3XoSuBNLnIsw==, figureFileBig=8/juGnNjpNCRFw1OH74nag==, tableContent=null), ArticleFig(id=1240748866115522799, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=EN, label=Fig.2, caption=Death trend of male and female lung cancer in different age groups in Sichuan Province from 2007 to 2021, figureFileSmall=mvmqST8p57rciNsJsMZgCA==, figureFileBig=BdWubAj/lohRoE4Si2iLTQ==, tableContent=null), ArticleFig(id=1240748866228769013, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=CN, label=图2, caption=2007—2021年四川省男女性肺癌在不同年龄组的死亡趋势

注:A、B分别表示女性与男性。

, figureFileSmall=mvmqST8p57rciNsJsMZgCA==, figureFileBig=BdWubAj/lohRoE4Si2iLTQ==, tableContent=null), ArticleFig(id=1240748866329432315, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=EN, label=Fig.3, caption=Relative risk of lung cancer mortality in Sichuan Province based on APC model effects, figureFileSmall=rpRolOt2Y4aAGRkJsyeP2A==, figureFileBig=N7rRNWuf979Ei5AS/XZuew==, tableContent=null), ArticleFig(id=1240748866430095620, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=CN, label=图3, caption=基于APC模型效应的四川省肺癌致死风险相对危险度

注:A1—A13分别表示20~24岁至80~84岁;P1—P3分别表示2007—2011年至2017—2021年;C1—C15分别表示1927—1931年至1997—2001年。

, figureFileSmall=rpRolOt2Y4aAGRkJsyeP2A==, figureFileBig=N7rRNWuf979Ei5AS/XZuew==, tableContent=null), ArticleFig(id=1240748866530758921, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=EN, label=Table 1, caption=

Analysis of lung cancer mortality in Sichuan Province based on APC model

, figureFileSmall=null, figureFileBig=null, tableContent=
组别女性男性
效应系数(95% CIP效应系数(95% CIP
年龄(岁)
20~24-3.245(-5.417~-1.072)0.003-2.954(-6.109~0.202)0.067
25~29-2.129(-3.387~-0.872)0.001-1.948(-3.573~-0.324)0.019
30~34-1.994(-3.002~-0.986)<0.001-1.636(-2.974~-0.299)0.016
35~39-0.792(-1.635~0.051)0.066-0.886(-1.974~0.201)0.110
40~44-0.081(-0.783~0.621)0.821-0.465(-1.404~0.474)0.331
45~490.183(-0.407~0.774)0.543-0.118(-0.891~0.656)0.766
50~540.430(-0.039~0.899)0.0720.154(-0.452~0.760)0.619
55~590.859(0.513~1.205)<0.0010.838(0.402~1.273)<0.001
60~641.057(0.808~1.306)<0.0010.999(0.701~1.297)<0.001
65~691.262(1.047~1.477)<0.0011.307(1.075~1.539)<0.001
70~741.421(1.148~1.694)<0.0011.528(1.229~1.827)<0.001
75~791.549(1.165~1.933)<0.0011.659(1.215~2.103)<0.001
80~841.479(0.964~1.995)<0.0011.523(0.907~2.138)<0.001
时期(年)
2007—20110.069(-0.081~0.219)0.3650.129(-0.062~0.320)0.185
2012—2016-0.168(-0.214~-0.122)<0.001-0.190(-0.250~-0.130)<0.001
2017—20210.099(-0.051~0.249)0.1960.061(-0.130~0.252)0.532
出生队列(年)
1927—19311.933(1.394~2.473)<0.0011.858(1.146~2.569)<0.001
1932—19361.397(0.996~1.797)<0.0011.196(0.648~1.744)<0.001
1937—19411.150(0.875~1.425)<0.0010.985(0.575~1.396)<0.001
1942—19460.848(0.656~1.039)<0.0010.820(0.487~1.152)<0.001
1947—19510.710(0.506~0.914)<0.0010.757(0.405~1.110)<0.001
1952—19560.481(0.180~0.781)0.0020.758(0.303~1.213)0.001
1957—19610.048(-0.381~0.476)0.8270.666(0.066~1.266)0.030
1962—1966-0.269(-0.830~0.293)0.3490.240(-0.523~1.003)0.537
1967—1971-0.359(-1.048~0.329)0.306-0.002(-0.930~0.927)0.997
1972—1976-0.546(-1.360~0.267)0.188-0.538(-1.628~0.552)0.333
1977—1981-0.774(-1.702~0.155)0.102-0.942(-2.196~0.312)0.141
1982—1986-1.425(-2.564~-0.286)0.014-1.151(-2.524~0.222)0.100
1987—1991-0.572(-1.703~0.558)0.321-1.382(-3.069~0.305)0.108
1992—1996-2.363(-5.171~0.445)0.099-1.792(-4.492~0.907)0.193
1997—2001-0.258(-3.201~2.685)0.864-1.473(-6.759~3.813)0.585
模型拟合检验
偏差(Deviance)0.502.24
最小信息量准则(AIC)6.037.41
贝叶斯信息准则(BIC)-34.85-15.70
), ArticleFig(id=1240748866660782350, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375271442927975, language=CN, label=表1, caption=

基于APC模型的四川省肺癌死亡率分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别女性男性
效应系数(95% CIP效应系数(95% CIP
年龄(岁)
20~24-3.245(-5.417~-1.072)0.003-2.954(-6.109~0.202)0.067
25~29-2.129(-3.387~-0.872)0.001-1.948(-3.573~-0.324)0.019
30~34-1.994(-3.002~-0.986)<0.001-1.636(-2.974~-0.299)0.016
35~39-0.792(-1.635~0.051)0.066-0.886(-1.974~0.201)0.110
40~44-0.081(-0.783~0.621)0.821-0.465(-1.404~0.474)0.331
45~490.183(-0.407~0.774)0.543-0.118(-0.891~0.656)0.766
50~540.430(-0.039~0.899)0.0720.154(-0.452~0.760)0.619
55~590.859(0.513~1.205)<0.0010.838(0.402~1.273)<0.001
60~641.057(0.808~1.306)<0.0010.999(0.701~1.297)<0.001
65~691.262(1.047~1.477)<0.0011.307(1.075~1.539)<0.001
70~741.421(1.148~1.694)<0.0011.528(1.229~1.827)<0.001
75~791.549(1.165~1.933)<0.0011.659(1.215~2.103)<0.001
80~841.479(0.964~1.995)<0.0011.523(0.907~2.138)<0.001
时期(年)
2007—20110.069(-0.081~0.219)0.3650.129(-0.062~0.320)0.185
2012—2016-0.168(-0.214~-0.122)<0.001-0.190(-0.250~-0.130)<0.001
2017—20210.099(-0.051~0.249)0.1960.061(-0.130~0.252)0.532
出生队列(年)
1927—19311.933(1.394~2.473)<0.0011.858(1.146~2.569)<0.001
1932—19361.397(0.996~1.797)<0.0011.196(0.648~1.744)<0.001
1937—19411.150(0.875~1.425)<0.0010.985(0.575~1.396)<0.001
1942—19460.848(0.656~1.039)<0.0010.820(0.487~1.152)<0.001
1947—19510.710(0.506~0.914)<0.0010.757(0.405~1.110)<0.001
1952—19560.481(0.180~0.781)0.0020.758(0.303~1.213)0.001
1957—19610.048(-0.381~0.476)0.8270.666(0.066~1.266)0.030
1962—1966-0.269(-0.830~0.293)0.3490.240(-0.523~1.003)0.537
1967—1971-0.359(-1.048~0.329)0.306-0.002(-0.930~0.927)0.997
1972—1976-0.546(-1.360~0.267)0.188-0.538(-1.628~0.552)0.333
1977—1981-0.774(-1.702~0.155)0.102-0.942(-2.196~0.312)0.141
1982—1986-1.425(-2.564~-0.286)0.014-1.151(-2.524~0.222)0.100
1987—1991-0.572(-1.703~0.558)0.321-1.382(-3.069~0.305)0.108
1992—1996-2.363(-5.171~0.445)0.099-1.792(-4.492~0.907)0.193
1997—2001-0.258(-3.201~2.685)0.864-1.473(-6.759~3.813)0.585
模型拟合检验
偏差(Deviance)0.502.24
最小信息量准则(AIC)6.037.41
贝叶斯信息准则(BIC)-34.85-15.70
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2007—2021年四川省肺癌死亡趋势及年龄-时期-队列的效应分析
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胡凤 , 马原 , 康红
现代预防医学 | 流行病与统计方法 2024,51(8): 1370-1376
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现代预防医学 | 流行病与统计方法 2024, 51(8): 1370-1376
2007—2021年四川省肺癌死亡趋势及年龄-时期-队列的效应分析
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胡凤, 马原, 康红
作者信息
  • 四川大学华西第二医院出生缺陷及相关妇儿疾病教育部重点实验室,四川 成都 610041
  • 胡凤(1993—),女,本科,初级职称,研究方向:公共卫生

通讯作者:

康红,E-mail:
Death trends and age-period-cohort model analyses of lung cancer, Sichuan, 2007-2021
Feng HU, Yuan MA, Hong KANG
Affiliations
  • Key Laboratory of Birth Defects and Related Women and Children’s Diseases, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2024-04-25 doi: 10.20043/j.cnki.MPM.202401393
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目的

分析2007—2021年四川省居民肺癌死亡趋势,为新时期制定肺癌防治政策提供依据。

方法

肺癌死亡率源自四川省卫生统计年鉴。以20~84岁居民为研究对象,运用年龄-时期-队列模型,从年龄、时期与出生队列方面估计对肺癌死亡率的影响效应。

结果

男女性肺癌死亡率分别由2007年的59.68/10万、16.48/10万波动升至2021年的75.14/10万、30.49/10万。相较于20~24岁居民,男女性75~79岁居民分别是其肺癌致死风险的101倍、121倍;男女性2017—2021年肺癌致死风险分别是2012—2016年的1.29倍、1.31倍;1927—1931年出生的男女性肺癌致死风险分别是出生于1992—1996年的73.42倍、38.49倍。

结论

2007—2021年四川省肺癌死亡率呈现波动上升,男性死亡率更高。年龄、时期及出生队列的肺癌致死风险存在差异。

肺癌  /  死亡趋势  /  年龄-时期-队列模型  /  四川
Objective

To analyze the mortality trend of lung cancer in Sichuan Province from 2007 to 2021, and provide evidence for formulating lung cancer prevention and control policies in the new period.

Methods

Lung cancer mortality was obtained from Health Statistics Yearbook of Sichuan Province. A cohort age-period model was used to estimate the effect of age, period and birth cohort on lung cancer mortality in residents aged 20-84.

Results

The mortality rates of lung cancer in male and female increased from 59.68/100 000 and 16.48/100 000 in 2007 to 75.14/100 000 and 30.49/100 000 in 2021 respectively. Compared with residents aged 20-24, male and female residents aged 75-79 were 101 times and 121 times higher than those aged 20-24 respectively; male and female lung cancer mortality risks from 2017 to 2021 were 1.29 times and 1.31 times higher than those from 2012 to 2016 respectively; male and female lung cancer mortality risks born in 1927—1931 were 73.42 times and 38.49 times higher than those born in 1992—1996 respectively.

Conclusion

Lung cancer mortality in Sichuan Province fluctuates from 2007 to 2021, and male mortality is higher. There were differences in lung cancer mortality risk by age, period, and birth cohort.

Lung cancer  /  Mortality trend  /  Age-period-cohort model  /  Sichuan
胡凤, 马原, 康红. 2007—2021年四川省肺癌死亡趋势及年龄-时期-队列的效应分析. 现代预防医学, 2024 , 51 (8) : 1370 -1376 . DOI: 10.20043/j.cnki.MPM.202401393
Feng HU, Yuan MA, Hong KANG. Death trends and age-period-cohort model analyses of lung cancer, Sichuan, 2007-2021[J]. Modern Preventive Medicine, 2024 , 51 (8) : 1370 -1376 . DOI: 10.20043/j.cnki.MPM.202401393
在全球范围内,肺癌的发病率与死亡率居高不下,成为最常见的恶性肿瘤之一。据国际癌症研究中心发布的全球癌症统计报告显示,2020年全球与中国因肺癌死亡人数分别达179.6万、81.6万,均居恶性肿瘤死亡谱首位[1]。四川省位于中国西南部,2021年《四川卫生健康统计年鉴》数据显示肺癌死亡率为53.24/10万,远高于其他癌种,但鲜有研究分析四川省域肺癌死亡趋势变化。本研究利用四川省官方统计数据,应用前沿统计学模型分析2007—2021年居民肺癌死亡率,探究年龄、时期与出生队列的影响效应,旨在为新时期制定及优化肺癌防治政策提供科学依据。
研究数据来源于2007—2012年《四川卫生统计年鉴》、2013—2016年《四川卫生和计划生育统计年鉴》、2017—2021年《四川卫生健康统计年鉴》。根据世界卫生组织推荐的国际疾病和有关健康问题统计分类第十版的分类规则,确定肺癌疾病编码为C34。从年鉴编制的居民病伤死亡原因中收集不同性别全年龄组及20~84岁以每5岁分组的死亡率数据。
采用年龄-时期-队列模型(age-period-cohort, APC),以期从年龄、时期与出生队列三个方面探析对肺癌死亡率的独立效应影响,并展示其在时间变化上的趋势。由于APC模型要求年龄、时期与出生队列间隔保持一致,故借鉴已有研究[2],将年龄以5岁为组距分为13组,时期分为2007—2011年、2012—2016年、2017—2021年3组,时期减年龄共计15个出生队列。为使APC模型获得唯一解,规避年龄、时期与出生队列间存在共线性,本文运用Fu[3]与Yang[4]等提出的内生因子估算法(Intrinsic Estimator, IE)进行模型求解。APC模型的基本表达式如下:
式中:M解释为肺癌死亡率;常数项、残差用λε表示;年龄、时期与出生队列用XaXpXc代表,其对应的效应系数分别用αβδ展现。
使用Excel 2016软件整理肺癌死亡率数据。运用Stata 14.0软件计算肺癌死亡率总体与不同性别的平均年度变化趋势百分比(average annual percent change, AAPC),并拟合APC模型。当AAPC的95% CI不包含0时,提示肺癌死亡率变化趋势具有统计学意义[5]。基于APC模型拟合结果,依次从年龄、时期与出生队列方面展示其对肺癌死亡率的独立效应,同时参照于总体平均效应[6],分别计算不同年龄、时期与出生队列的肺癌死亡相对危险度(relative risk, RR)。以α=0.05作为统计分析的检验水准。
2007—2021年,总体上四川省肺癌死亡率呈现波动上升。数据从2007年的38.08/10万升至2021年的53.24/10万,趋势具有统计学意义(AAPC=1.13,95% CI:0.17~2.09)。女性肺癌死亡率由2007年的16.48/10万升至2021年的30.49/10万,趋势不具有统计学意义(AAPC=1.61,95% CI:-0.76~3.98)。男性肺癌死亡率由2007年的59.68/10万升至2021年的75.14/10万,趋势具有统计学意义(AAPC=0.93,95% CI:0.31~1.55)。见图1
男女性分别在20~49岁、20~54岁年龄组内,肺癌死亡率的增长趋势相对平缓,分别从50岁、55岁开始,死亡率的增长趋势变得明显。见图2
在所有年龄组中,20~24岁男女性肺癌致死风险呈现最小,其相对危险度分别为0.052、0.039。75~79岁男女性肺癌致死风险则排列首位,其相对危险度分别为5.256、4.709。男性在20~34岁、65~84岁的肺癌致死风险超过女性,而女性则在35~64岁超过男性。
随着时期向后推移,不同性别肺癌致死风险呈现先降后升。相较于2012—2016年,2017—2021年男女性肺癌致死风险分别增加了1.29倍、1.31倍。男性在2007—2011年的肺癌致死风险超过女性,而女性则在2012—2021年超过男性。
相较于1992—1996年出生者,1927—1931年出生的男女性肺癌致死风险分别增加了73.42倍、38.49倍。其中,男性在1947—1976年、1982—1986年、1992—1996年出生的居民肺癌致死风险超过女性,而女性则在1927—1946年、1977—1981年、1987—1991年、1997—2001年出生的居民超过男性。见表1图3
2021年,四川省肺癌死亡率已达53.24/10万,高于甘肃省肿瘤登记地区(24.22/10万)[7]、陕西省肿瘤登记地区(38.09/10万)[8]、江西省肿瘤登记地区(35.02 /10万)[9],但低于山东省肿瘤登记地区(57.04/10万)[10]。分析原因,可能与四川省地处盆地,经济发展、环境因素、人口老龄化及医疗资源水平与其他地区不同相关联[11]
2007—2021年四川省肺癌死亡率总体呈现波动上升趋势,这与全国[12]、陕西省肿瘤地区[8]、内蒙古肿瘤登记地区[13]、黑龙江省佳木斯市[14]等肺癌死亡变化趋势相一致。由此可见,肺癌已成为影响全国居民健康的重要因素,引起的疾病负担也愈发严重。因此,持续推进《健康中国行动——癌症防治实施方案(2019—2022年)》,根据方案内容明晰实际差距,不断完善肺癌防治体系[10],提升患者生命质量,这是四川省目前卫生事业发展应该关注的重点问题。
相较于女性,四川省男性肺癌死亡率更高,这与相关研究结果一致[1315]。究其原因,一是吸烟为引起肺癌的主要危险因素,2018年慢性病与营养监测报告显示四川省18岁及以上居民吸烟率为35.21%,且男性高于女性[16]。烟草中含有尼古丁、焦油及一氧化碳等有害物质,长期吸食容易造成呼吸道粘膜、气管、肺泡等损伤,诱发细胞癌变。有研究也表明,吸烟人群肺癌发生风险远高于不吸烟人群,且吸烟年限越长、数量越多,肺癌发生风险就越高[17]。二是男性有更多机会暴露于职业危险因素[18],以及受制于个体不良健康生活方式[19]。例如,工作环境中接触粉尘、放射性物质,生活中饮酒、熬夜、缺乏体育锻炼等。遂建议通过提高烟税及烟价、实施控烟立法,尤其是针对男性居民加大烟草危害宣传力度,同时积极倡导健康生活方式,适量饮酒、减少熬夜,增加体育锻炼,向特殊工种人群普及职业防护知识,以此减少肺癌发病及死亡风险。
随着年龄增长,四川省男女性肺癌致死风险呈现上升。75~79岁男女性致死风险分别是20~24岁的101倍、120倍,揭示年龄为肺癌死亡风险的影响因素。徐美娟等发现天津市东丽区居民肺癌死亡率在40岁以后,随年龄增加显著上升,峰值居于80~84岁年龄组[20];张小燕等以南京市浦口区为研究区域,得出男女性肺癌死亡率在80岁以上年龄组呈现高峰[21]。随着年龄增长,环境中致癌物质暴露时间就越长,加之人体机能自然减退,细胞损伤修复能力下降,发生癌变的概率也就越大[22]。此外,老年人群多伴有慢性呼吸道疾病,如慢性支气管炎、肺间质纤维化或肺炎等,疾病发展不易控制,可能增加肺癌患病风险[23]。因此,老年人应当纳为重点关注人群,一方面积极推进癌症早诊早治项目,及时进行评估与筛查,做到早发现、早干预、早治疗,提升肺癌患者五年生存率。另一方面开展肺癌病因学研究,结合低剂量螺旋CT检查及肺癌靶向治疗,有效治愈或延缓肺癌发生发展。
相较于2012—2016年,男女性2017—2021年肺癌致死风险分别增加1.29倍、1.31倍。分析2012—2016年致死风险趋势下降原因,一是源自2012年开始成立“四川省癌症防治中心”,统筹领导全省癌症防治工作,逐步加强顶层设计,并不断完善癌症防治体系。二是《四川省深化医药卫生体制改革2012年度主要工作安排的通知》(川办发〔2012〕26号)中明确要求将肺癌等12类疾病纳入大病保障与医疗救助试点范围。故而在这一时期政策效应占据首位,肺癌死亡风险呈现一定程度下降。近年来,四川省城镇化进程逐步加快,城镇人口规模不断扩大,但随之引起的环境污染问题也日趋严重,如烟尘、机动车尾气、工厂废气等。颗粒物污染中PM2.5、PM10是肺癌死亡的常见危险因素[24]。一项研究表明,PM2.5与PM10每增加1个标准差,肺癌早期患者死亡风险分别升高38%、26%[25]。因此,建议一方面持续优化癌症防治政策,构建全方位、全流程的防治体系,形成具有本地区特色的癌防模式。另一方面加强环境治理,通过使用清洁能源,发展城市轨道公共交通,增加绿地面积等控制空气污染物,提升空气质量,降低环境因素暴露风险。
1927—1931年出生的男女性肺癌致死风险分别是出生于1992—1996年的73.42倍、38.49倍,表明居民出生年代越晚,肺癌死亡风险越低。有研究认为胎儿在生命早期暴露的社会环境因素会与个体健康与疾病的发生发展存在显著关联[26]。20世纪50年代之前出生的居民经历过战争,社会发展处于动荡时期,生活条件落后,医疗资源匮乏,导致肺癌死亡风险较高[27]。新中国成立后,国民经济稳步发展,居民生活环境显著改善,医疗资源持续扩充[28],故而肺癌致死风险更低。此外,政府对慢性病预防控制的重视程度也在逐步加强,发布系列癌症防治与保障政策,做实做细癌症防治顶层设计,这亦是晚出生年代居民肺癌死亡风险降低的重要原因[28]。值得一提的是,伴随社会现代化发展,随之引发的新危险因素也不容忽视。因此,应在原有工作基础上,持续扩大肺癌早诊早治覆盖面,力争惠及全省更多更广的居民,同时加强居民健康教育力度,使之成为自身健康的第一责任人[7],自觉减少肺癌危险因素暴露,营造良好的社会防癌抗癌氛围。
综上,2007—2021年四川省肺癌死亡率总体呈现波动上升趋势,男性与老年居民肺癌致死风险更高,出生年代越晚的居民肺癌致死风险越低。重点关注男性与老年居民等肺癌高风险人群,这应是未来一定时期全省癌症防治工作的优先事项。
  • 四川省基层卫生事业发展研究中心青年项目(SWFZ23-Q-77)
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2024年第51卷第8期
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doi: 10.20043/j.cnki.MPM.202401393
  • 接收时间:2023-01-24
  • 首发时间:2026-03-16
  • 出版时间:2024-04-25
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  • 收稿日期:2023-01-24
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四川省基层卫生事业发展研究中心青年项目(SWFZ23-Q-77)
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    四川大学华西第二医院出生缺陷及相关妇儿疾病教育部重点实验室,四川 成都 610041

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

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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