基于年龄-时期-队列模型的中国结直肠癌发病率与死亡率趋势分析

doi:10.3969/j.issn.1004-616x.2025.05.008

摘要/Abstract

摘要： 目的：分析1990—2021年中国结直肠癌的发病率和死亡率趋势，探讨年龄、时期和队列效应的影响，并预测2022—2045年中国结直肠癌的发病和死亡趋势，为结直肠癌的防治策略和资源分配提供数据支持。 方法：基于全球疾病负担研究(GBD)数据库，使用Joinpoint回归分析评估不同时间段的结直肠癌发病率和死亡率变化趋势。采用年龄-时期-队列模型分析1992—2021年中国结直肠癌的发病率和死亡率的年龄效应、时期效应和队列效应。通过Nordpred预测模型，结合性别差异预测2022—2045年结直肠癌的标化发病率和标化死亡率。 结果：1990—2021年中国结直肠癌的标化发病率持续上升，年均变化率(APC)为1.64%[95%CI(1.38%，1.89%)，P<0.01]，男性增幅尤为显著。标化死亡率则整体呈下降趋势，APC 为-0.41%[95%CI(-0.58%，-0.24%)，P<0.01]，但在2014—2021年间出现反弹。结直肠癌的发病率和死亡率受到年龄、时期和队列效应的影响。年龄效应分析显示，老年群体为高风险人群。时期效应和队列效应分析表明，发病风险逐年下降，而死亡风险则呈上升趋势。性别差异显著，男性的发病率和死亡率均高于女性。预测结果显示，2022—2045年中国结直肠癌的标化发病率仍将上升。 结论：1990—2021年，中国结直肠癌的发病率持续上升，而死亡率虽整体下降，但近年出现反弹趋势。年龄、时期和队列效应对结直肠癌负担均有显著影响，其中老年人群和男性为高风险群体。预测结果提示，未来中国结直肠癌的发病率仍将增加，疾病防控形势依然严峻。应进一步加强早筛、早诊和规范化治疗，优化资源配置，尤其需关注男性及老年高危人群，以降低未来结直肠癌的疾病负担。

关键词: 结直肠癌, 发病率, 死亡率, 年龄-时期-队列模型

Abstract: OBJECTIVE：The aims of this paper were to analyze the incidence and mortality trends of colorectal cancer in China from 1990 to 2021，to explore the impact of age，period and cohort effects，to predict the future trend of colorectal cancer from 2022 to 2045， and to provide data support for control strategies and resource allocation. METHODS： Based on the Global Burden of Disease (GBD) database， Joinpoint regression analysis was used to evaluate the trend of changes in different time periods. The age-period-cohort model was used to analyze the age effect，period effect and cohort effect of the incidence and mortality of colorectal cancer in China from 1992 to 2021. Through Nordpred prediction model，combined with gender differences， the standardized morbidity and mortality of colorectal cancer in 2022—2045 were predicted. RESULTS：From 1990 to 2021，the standardized incidence of colorectal cancer in China continued to rise，with an average annual percentage change (APC) of 1.64% [95%CI (1.38%，1.89%)，P<0.01]. The increase was particularly significant in men. The standardized mortality rate showed an overall downward trend， with an APC of -0.41% [95%CI (-0.58%，-0.24%)，P<0.01]，but rebounded between 2014 and 2021. The incidence and mortality of colorectal cancer were affected by the complex interweaving of age， period and cohort effects. The age effect shows that the elderly group was a high-risk group. The period effect and cohort effect show that the risk of disease decreased year by year，while the risk of death increased. The gender difference was significant，and the morbidity and mortality of males were higher than those of females. The prediction results show that the standardized incidence of colorectal cancer in China will continue to rise in the future. CONCLUSION： From 1990 to 2021， the incidence of colorectal cancer in China showed a continuous increase，whereas the mortality rate declined overall but rebounded in recent years. Age，period， and cohort effects significantly contributed to the disease burden， with older adults and males as high-risk populations. Projections suggest that the incidence of colorectal cancer will continue to rise in the coming decades，indicating a persistent public health challenge. Strengthening early screening，timely diagnosis，and standardized treatment， along with optimizing resource allocation， particularly for male and elderly high-risk groups，will be essential to reduce the future burden of colorectal cancer.

Key words: colorectal cancer, incidence rate, mortality, age-period-cohort

中图分类号:

R735.3

刘嘉博, 林华, 崔贝依, 孙惠昕. 基于年龄-时期-队列模型的中国结直肠癌发病率与死亡率趋势分析[J]. 癌变·畸变·突变, 2025, 37(5): 393-399.

LIU Jiabo, LIN Hua, CUI Beiyi, SUN Huixin. Trends in incidence and mortality of colorectal cancer in China: based on age-period-cohort model[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2025, 37(5): 393-399.

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