1990—2021年中国中青年结直肠癌疾病负担时间趋势分析

国际肿瘤学杂志››2025,Vol. 52››Issue (8): 508-516.doi:10.3760/cma.j.cn371439-20250328-00086

1990—2021年中国中青年结直肠癌疾病负担时间趋势分析

陈俊¹^,²^,³, 唐丹丹¹^,²^,³, 周雨馨¹^,²^,³, 谭玉婷²^,³, 李泓澜²^,³, 徐群⁴, 项永兵²^,³^,⁴()

¹上海交通大学公共卫生学院，上海 200025
²上海市肿瘤研究所流行病学研究室，上海 200032
³上海交通大学医学院附属仁济医院肿瘤系统医学全国重点实验室，上海 200127
⁴上海交通大学医学院附属仁济医院健康管理中心，上海 200127

收稿日期:2025-03-28修回日期:2025-06-12出版日期:2025-08-08发布日期:2025-09-15
通讯作者:项永兵 E-mail:ybxiang@shsci.org
基金资助:
国家重点研发计划(2021YFC2500404)

Time trend analysis of the disease burden of colorectal cancer among young and middle-aged adults in China from 1990 to 2021

Chen Jun¹^,²^,³, Tang Dandan¹^,²^,³, Zhou Yuxin¹^,²^,³, Tan Yuting²^,³, Li Honglan²^,³, Xu Qun⁴, Xiang Yongbing²^,³^,⁴()

¹School of Public Health， Shanghai Jiao Tong University School of Medicine， Shanghai 200025， China
²Department of Epidemiology， Shanghai Cancer Institute， Shanghai 200032， China
³State Key Laboratory of Systems Medicine for Cancer， Renji Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200127， China
⁴Health Management Center， Renji Hospital， Shanghai Jiao Tong University School of Medicine， Shanghai 200127， China

Received:2025-03-28Revised:2025-06-12Online:2025-08-08Published:2025-09-15
Contact:Xiang Yongbing E-mail:ybxiang@shsci.org
Supported by:
National Key Research and Development Program of China(2021YFC2500404)

摘要/Abstract

摘要：

目的分析1990—2021年中国中青年结直肠癌（CRC）疾病负担情况，并探讨年龄、时期和队列对中国中青年CRC发病和死亡的影响。方法从全球疾病负担研究2021（GBD 2021）数据库中提取中国1990—2021年40~59岁人群CRC相关数据，并计算发病率、死亡率、伤残调整生命年（DALY）及年龄标化率数据，用于分析1990—2021年中国中青年不同年龄、性别组的CRC发病和死亡情况；采用Joinpoint回归模型分析1990—2021年中国中青年CRC发病率、死亡率和DALY率，计算年度变化百分比（APC）和平均年度变化百分比（AAPC）；通过年龄-时期-队列模型分析年龄、时期和队列3个独立因素对中国中青年CRC发病率和死亡率的影响。结果1990—2021年，中国中青年CRC的发病例数、死亡例数以及DALY均有显著增长趋势。2021年，中国中青年CRC发病例数为18.10万，死亡例数为5.79万，比1990年（5.38万和3.30万）分别增加了236.80%和75.48%。DALY在1990—2021年期间上涨了62.59%，其中55~59岁组的增幅最大，为83.35%。1990—2021年，中国中青年CRC的年龄标准化发病率（ASIR）由25.51/10万上升至38.02/10万，增加了49.04%，年龄标准化死亡率（ASMR）从17.01/10万下降到12.12/10万，下降了28.75%。40~44岁组ASIR上升幅度最大，为57.31%，50~54岁组ASMR下降幅度最大，为30.18%。DALY率从673.52/10万下降至493.94/10万，下降了26.66%，DALY率在50~54岁组下降幅度最大，为28.26%。Jointpoint回归模型分析结果显示，1990—2021年，中国中青年CRC发病率有升高趋势，平均每年升高1.32%，其中男性的增幅高于女性（1.87%比0.36%）。死亡率呈现下降趋势，平均每年下降1.10%，女性的降幅高于男性（-2.14%比-0.50%）。DALY率呈下降趋势，平均每年下降1.00%，女性下降幅度大于男性（-2.06%比-0.41%）。以上趋势均有统计学意义（均P<0.001）。年龄-时期-队列模型结果显示，1990—2021中国中青年CRC发病率的净漂移率为每年1.21%（1.02%~1.41%），死亡率的净漂移率为-1.40%（-1.59%~-1.21%）。年龄对中国中青年CRC发病率和死亡率的影响随着年龄增大而升高，归因于年龄的发病率从40~44岁的12.66%（11.90%~13.46%）上升到55~59岁的56.68%（54.37%~59.08%）。归因于年龄的死亡率从40~44岁年龄组的6.47%（6.12%~6.85%）上升到55~59岁年龄组的25.74%（24.58%~26.96%）。在所有的年龄组中，男性CRC发病率、死亡率归因于年龄的作用均高于女性。时期效应结果显示，中国中青年CRC发病率的时期变化RR值总体呈先下降后上升趋势，以2000—2004年为参照组，2015—2019年发病风险最高，发病风险RR=1.36（95%CI为1.28~1.43）；死亡率的时期效应呈下降趋势，以2000—2004年为参照组，1990—1994年死亡风险最高，死亡风险RR=1.23（95%CI为1.15~1.32）。队列效应结果显示，越晚出生的队列CRC发病风险越高，以1953—1957年出生队列为参照队列，1973—1977年出生队列的发病率最高，RR=1.30（95%CI为1.16~1.45）。越晚出生的队列CRC死亡风险越低，以1953—1957年出生队列为参照队列，1973—1977年出生队列的CRC死亡率最低，RR=0.78（95%CI为0.69~0.88）。结论1990—2021年，中国中青年CRC疾病负担的变化表现为标化发病率上升而标化死亡率下降，同时时间变化趋势上存在性别差异。年龄、时期和队列均对中青年结直肠癌的发病和死亡趋势产生显著影响，应加强CRC病因学研究，并制定针对性的预防和控制策略。

关键词:结直肠肿瘤,中青年,发病率,死亡率,伤残调整生命年,时间趋势,年龄-时期-队列效应

Abstract:

ObjectiveTo analyze the disease burden of colorectal cancer （CRC） among young and middle-aged people in China from 1990 to 2021， and to explore the influence of age， period and cohort on the incidence and mortality of CRC in young and middle-aged people of China.MethodsData on CRC in patients aged 40-59 years in China from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 （GBD 2021） database. Statistics such as incidence rate， mortality rate， disability-adjusted life years （DALY）， and their corresponding age-standardized rates were calculated to analyze the CRC incidence and mortality in different age and sex groups of young and middle-aged Chinese young people from 1990 to 2021. The Joinpoint regression model was used to analyze the CRC incidence， the mortality and the DALY rate， as well as to calculate the annual percentage change （APC） and the average annual percentage change （AAPC）. The effects of three independent factors， namely age， period and cohort， on the incidence and mortality of CRC in young and middle-aged people of China were analyzed and evaluated through the age-period-cohort model.ResultsFrom 1990 to 2021， there was a remarkable upward trend in the incidence， mortality， and DALY of CRC among Chinese young and middle-aged adults. In 2021， the number of incidence cases of CRC among young and middle-aged people in China reached 181 000， and the number of deaths reached 57 900， which were 236.80% and 75.48% higher than those in 1990 （53 800 and 33 000， respectively）. During the same period， DALY increased by 62.59%， with the 55-59 age group having the largest increase at 83.35%. From 1990 to 2021， the age-standardized incidence rate （ASIR） increased by 49.04%， rising from 25.51/100 000 to 38.02/100 000， and the age-standardized mortality rate （ASMR） declined by 28.75%， decreasing from 17.01/100 000 to 12.12/100 000， respectively. The increase in ASIR was the greatest among the 40-44 age group， reaching 57.31%， while the decline in ASMR was the most significant among the 50-54 age group， amounting to 30.18%. However， the DALY rate declined by 26.66%， from 673.52/100 000 to 493.94/100 000. The decline in DALY was the greatest among the 50-54 age group， reaching 28.26%. Joinpoint regression model analysis showed that， from 1990 to 2021， the incidence of CRC in Chinese young and middle-aged adults rose on average by 1.32% annually， and the increase was higher in men （1.87%） than that in women （0.36%）. The mortality rate showed a downward trend， with an average annual decline of 1.10%， with a higher decline in women than in men （-2.14%vs.-0.50%）. The DALY rate showed a downward trend， with an average annual decline of 1.00%， and more decline in women than in men （-2.06%vs.-0.41%）. All of these trends were statistically significant （allP<0.001）. The age-period-cohort model analysis showed that， the net drift of CRC incidence was 1.21% （1.02%-1.41%） per year among Chinese young and middle-aged adults between 1990 and 2021， while the net drift in mortality was -1.40% （-1.59%--1.21%） per year. The impact of age on CRC incidence and mortality intensified with advancing age. Incidence attributable to age rose from 12.66% （11.90%- 13.46%） in the 40-44 age group to 56.68% （54.37%-59.08%） in the 55-59 age group. Similarly， mortality attributable to age increased from 6.47% （6.12%-6.85%） in the 40-44 age group to 25.74% （24.58%-26.96%） in the 55-59 age group. In all age groups， the role of CRC incidence and mortality attributable to age was higher in men than in women. Period effects on theRRvalue of CRC incidence showed a declining trend followed by an upward trend， with the highest risk during 2015-2019 （RR=1.36， 95%CI： 1.28-1.43）， using 2000-2004 as the reference. For mortality， period effects exhibited a declining trend， with the highest risk during 1990-1994 （RR=1.23， 95%CI： 1.15-1.32）， using 2000-2004 as the reference. Cohort effects indicated that later birth cohorts had higher incidence risks， with the highest incidence observed in the 1973-1977 birth cohort （RR=1.30， 95%CI： 1.16-1.45）， using the 1953-1957 birth cohort as the reference. Conversely， later birth cohorts had lower mortality risks， with the lowest mortality in the 1973-1977 birth cohort （RR=0.78， 95%CI： 0.69-0.88）， using the 1953-1957 birth cohort as the reference.ConclusionsFrom 1990 to 2021， the changes in the disease burden of CRC among young and middle-aged people in China are manifested as an increase in standardized incidence rate and a decrease in standardized mortality rate. Meanwhile， there are gender differences in the trend of temporal changes. Age， period and cohort all have a significant impact on the incidence and mortality trends of colorectal cancer in young and middle-aged people. Research on the etiology of CRC should be strengthened， and targeted prevention and control strategies should be formulated.

Key words:Colorectal neoplasms,Young and middle-aged adults,Incidence,Mortality,Disability-adjusted life year,Time trends,Age-period-cohort effects

陈俊, 唐丹丹, 周雨馨, 谭玉婷, 李泓澜, 徐群, 项永兵. 1990—2021年中国中青年结直肠癌疾病负担时间趋势分析[J]. 国际肿瘤学杂志, 2025, 52(8): 508-516.

Chen Jun, Tang Dandan, Zhou Yuxin, Tan Yuting, Li Honglan, Xu Qun, Xiang Yongbing. Time trend analysis of the disease burden of colorectal cancer among young and middle-aged adults in China from 1990 to 2021[J]. Journal of International Oncology, 2025, 52(8): 508-516.

图/表8

表1

1990—2021年中国中青年CRC发病、死亡与疾病负担情况"

指标	40~44岁	45~49岁	50~54岁	55~59岁	合计
1990
新发病例数（万）	0.89	0.97	1.52	2.00	5.38
ASIR（1/10万）	13.20	18.85	31.81	46.09	25.51
95%UI	10.90~15.52	15.67~22.06	26.49~37.71	38.27~54.14	20.67~30.35
死亡病例数（万）	0.48	0.68	0.97	1.18	3.30
ASMR（1/10万）	8.44	12.50	21.11	31.52	17.01
95%UI	6.96~9.89	10.35~14.63	17.60~25.17	26.21~37.12	13.07~20.96
DALY（万人年）	27.57	28.17	39.08	46.72	141.54
DALY率（1/10万）	410.93	545.71	819.07	1 077.21	673.52
95%UI	339.26~482.07	451.55~640.29	682.36~976.11	895.22~1 266.20	557.25~789.79
2021
新发病例数（万）	1.90	3.12	5.67	7.42	18.10
ASIR（1/10万）	20.77	28.25	46.90	67.47	38.02
95%UI	16.42~25.73	21.92~35.13	36.16~58.77	52.89~84.87	32.11~43.94
死亡病例数（万）	0.58	1.00	1.78	2.43	5.79
ASMR（1/10万）	6.37	9.02	14.74	22.12	12.12
95%UI	4.98~8.00	7.02~11.35	11.28~18.64	17.26~27.70	8.79~15.46
DALY（万人年）	29.01	44.44	71.01	85.66	230.12
DALY率（1/10万）	316.92	402.81	587.58	779.11	493.94
95%UI	248.46~397.20	312.21~506.35	447.71~745.95	607.45~977.21	413.82~574.06
1990—2021
新发病例变化率（%）	114.61	220.39	273.44	271.11	236.80
死亡病例变化率（%）	22.23	145.95	84.59	106.73	75.48
DALY变化率（%）	5.21	57.76	81.72	83.35	62.59
ASIR变化率（%）	57.31	49.91	47.42	46.39	49.04
ASMR变化率（%）	-24.52	-27.80	-30.18	-29.82	-28.75
DALY率变化率（%）	-22.88	-26.19	-28.26	-27.67	-26.66

表1

表2

1990—2021年中国中青年CRC的ASIR的Jointpoint回归模型分析（%）"

性别	年份	APC	95%CI	P值	AAPC	95%CI	P值
合计	1990—2002	-0.17	-0.37~-0.01	0.044
	2002—2006	2.74	0.48~3.71	0.031
	2006—2016	1.75	0.93~1.94	<0.001	1.32	1.26~1.37	<0.001
	2016—2021	2.95	2.46~3.94	<0.001
男性	1990—1998	-0.11	-0.77~0.16	0.373
	1998—2003	1.29	0.47~2.29	0.003
	2003—2006	4.49	3.25~5.04	<0.001	1.87	1.81~1.92	<0.001
	2006—2021	2.61	2.49~2.70	<0.001
女性	1990—2003	-0.72	-0.84~-0.62	0.003
	2003—2007	1.26	0.77~2.01	0.014
	2007—2010	-1.55	-2.01~-0.69	0.014	0.36	0.31~0.39	<0.001
	2010—2015	0.75	0.14~1.61	0.033
	2015—2021	2.76	2.47~3.36	<0.001

表2

表3

1990—2021年中国中青年CRC的ASMR的Jointpoint回归模型分析（%）"

性别	年份	APC	95%CI	P值	AAPC	95%CI	P值
合计	1990—2009	-1.71	-1.79~-1.66	<0.001
	2009—2016	-0.59	-1.29~-0.25	0.002	-1.10	-1.15~-1.06	<0.001
	2016—2021	0.55	0.09~1.48	0.026
男性	1990—1998	-1.55	-1.79~-1.39	<0.001
	1998—2009	-0.59	-0.82~-0.46	0.004
	2009—2012	0.81	-0.56~1.15	0.074	-0.50	-0.53~-0.46	<0.001
	2012—2016	-0.49	-1.03~0.01	0.056
	2016—2021	0.64	0.35~1.27	0.002
女性	1990—1999	-0.23	-2.32~-2.12	<0.001
	1999—2007	-3.27	-3.40~-3.03	<0.001
	2007—2010	-4.23	-4.53~-3.66	<0.001	-2.14	-2.17~-2.12	<0.001
	2010—2014	-2.28	-2.58~-1.68	0.005
	2014—2021	0.28	0.11~0.47	0.008

表3

表4

1990—2021年中国中青年CRC的ASR-DALY率Jointpoint回归模型分析（%）"

性别	年份	APC	95%CI	P值	AAPC	95%CI	P值
合计	1990—1993	-1.32	-1.81~-0.70	<0.001
	1993—1997	-2.10	-2.43~-1.44	<0.001
	1997—2009	-1.54	-1.64~-0.77	<0.001	-1.00	-1.03~-0.97	<0.001
	2009—2015	-0.60	-0.84~0.02	0.052
	2015—2021	0.59	0.41~0.85	0.005
男性	1990—1998	-1.56	-1.73~-1.42	<0.001
	1998—2009	-0.51	-0.64~-0.41	<0.001
	2009—2012	1.06	0.49~1.34	0.020	-0.41	-0.43~-0.38	<0.001
	2012—2015	-0.62	-0.91~-0.08	0.032
	2015—2021	0.72	0.56~1.03	0.001
女性	1990—1999	-2.20	-2.31~-2.08	<0.001
	1999—2007	-3.22	-3.34~-2.61	<0.001
	2007—2010	-3.92	-4.18~-3.39	<0.001	-2.06	-2.08~-2.03	<0.001
	2010—2014	-2.27	-2.50~-1.83	0.022
	2014—2021	0.43	0.30~0.57	0.007

表4

表5

1990—2021年中国中青年CRC发病率与死亡率的局部漂移与净漂移情况（%）"

指标	40~44岁	45~49岁	50~54岁	55~59岁	合计
发病率
合计	1.21（0.82~1.59）	1.11（0.83~1.40）	1.19（0.94~1.43）	1.25（0.95~1.55）	1.21（1.02~1.41）
男性	2.05（1.66~2.43）	1.88（1.59~2.16）	1.97（1.72~2.23）	2.01（1.70~2.32）	2.00（1.80~2.20）
女性	-0.26（-0.63~0.11）	-0.16（-0.43~0.11）	-0.04（-0.27~0.18）	0.09（-0.18~0.36）	-0.08（-0.27~0.10）
死亡率
合计	-1.34（-1.73~-0.94）	-1.47（-1.74~-1.20）	-1.47（-1.70~-1.24）	-1.42（-1.69~-1.15）	-1.40（-1.59~-1.21）
男性	-0.48（-0.86~-0.09）	-0.67（-0.94~-0.41）	-0.65（-0.88~-0.42）	-0.63（-0.90~-0.35）	-0.58（-0.40~-0.77）
女性	-2.93（-3.31~-2.55）	-2.87（-3.12~-2.61）	-2.81（-3.02~-2.60）	-2.68（-2.93~-2.43）	-2.81（-2.63~-2.98）

表5

图1

图2

图3

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