| 周心怡,王鑫,李燕婕,吴宇洁,王乐,王红,石菊芳.中国女性乳腺癌疾病负担与经济负担:系统整合分析[J].中华流行病学杂志,2024,45(9):1185-1196 |
| 中国女性乳腺癌疾病负担与经济负担:系统整合分析 |
| Disease burden and economic burden of breast cancer in females in China: a synthesis analysis |
| 收稿日期:2024-01-29 出版日期:2024-09-14 |
| DOI：10.3760/cma.j.cn112338-20240129-00048 |
| 中文关键词: 乳腺癌 疾病负担 发病率 死亡率 经济负担 |
| 英文关键词: Breast cancer Disease burden Incidence Mortality Economic burden |
| 基金项目:中国医学科学院肿瘤医院人才激励计划；国家自然科学基金（81773521）；中华医学基金会卫生政策与体系科学公开竞标项目（19-340） |
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| 中文摘要: |
| 目的 对中国女性乳腺癌疾病负担和经济负担进行更新整合分析。方法 基于前期研究及摘录6个数据源信息，包括《中国肿瘤登记年报》《中国死因监测数据集》《中国卫生健康统计年鉴》、GLOBOCAN、五大洲癌症发病率、全球疾病负担研究（GBD），整合更新中国女性乳腺癌的发病、死亡和伤残调整寿命年（DALY）等信息，分析乳腺癌现况、变化趋势和预期的疾病负担状况；应用Joinpoint软件进行趋势分析；采用文献法系统更新分析相关经济负担数据。结果 ①现状：GLOBOCAN 2022估计2022年中国女性乳腺癌发病世界人口标化率（世标率）、死亡世标率和1年患病世标率分别为33.0/10万、6.1/10万和40.1/10万。《中国肿瘤登记年报》数据显示，2018年中国女性乳腺癌发病世标率与死亡世标率分别为28.4/10万和5.8/10万。《中国死因监测数据集》显示，2021年中国女性乳腺癌死亡世标率为4.5/10万，城乡死亡比为1.2∶1。GBD报道2021年中国乳腺癌DALY数为292.1万人年，占全球的14.4%。②变化趋势：《中国肿瘤登记年报》数据显示，2009-2018年中国女性乳腺癌发病世标率和死亡世标率分别下降2.1%和11.4%，而农村分别上升43.9%和8.2%；Joinpoint分析提示中国女性乳腺癌总体发病世标率和死亡世标率平均年变化百分比（AAPC）分别为-0.2%（P>0.05）和-1.6%（P<0.05），农村发病世标率和死亡世标率AAPC分别为3.9%（P<0.05）和0.6%（P>0.05），城市发病世标率和死亡世标率AAPC分别为-0.3%（P>0.05）和-1.2%（P<0.05）。《中国卫生健康统计年鉴》数据显示，2014-2021年中国城市女性死亡世标率下降12.3%，对应AAPC为-2.6%（P<0.05）。③预测：GLOBOCAN 2022预测2050年中国女性乳腺癌发病和死亡例数将分别达387 776例和111 133例，相比2022年分别增加8.6%和48.2%，其中≥65岁女性增长明显（发病和死亡例数分别增加80.8%和124.9%）。④经济负担：纳入13项基于患者个体的研究分析结果显示，2010-2019年中国女性乳腺癌诊疗例均医疗费用（M=2.1万元~3.9万元）及例均住院时间（M=11.0~30.5 d）呈下降，而次均费用（M=0.9万元~2.3万元）呈上升趋势；人群层面的全国分析仅1项，显示2018年中国乳腺癌治疗费用达252.4亿元，占全部肿瘤治疗费用的6.4%。结论中国女性乳腺癌发病率和死亡率在近十年整体平稳，但农村的上升趋势值得关注；乳腺癌例均诊治费用可能有下降，但因老龄人口构成增加，人群经济负担仍会较重。 |
| 英文摘要: |
| Objective To understand the current and integrated disease burden and economic burden caused by breast cancer in females in China. Methods Based on six updated data sources, including the series of Chinese Cancer Registry Annual Report, China Death Cause Surveillance Datasets, China Health Statistical Yearbook, GLOBOCAN, Cancer Incidence in Five Continents, Global Burden of Disease Study (GBD), the information about incidence, mortality and disability adjusted life years (DALY) of breast cancer were extracted for the analysis on the current incidence and time trend of breast cancer and predicted disease burden of breast cancer in females in China. Software Joinpoint was used for time trend analysis. The data of economic burden were systematically updated and analyzed by literature review. Results 1) GLOBOCAN 2022 estimated that the age-standardized incidence rate (ASIR) age-standardized mortality rate (ASMR) and one- year prevalence rate of breast cancer in females were 33.0/100 000, 6.1/100 000 and 40.1/100 000, respectively, in China in 2022. According to Chinese Cancer Registry Annual Report, the ASIR and ASMR were 28.4/100 000 and 5.8/100 000, respectively, in 2018. The China Death Cause Surveillance Datasets showed that the ASMR was 4.5/100 000 in 2021, and the urban to rural area mortality ratio was 1.2∶1. GBD reported that the DALYs of breast cancer were 2.921 million in China in 2021, accounting for 14.4% of the global total. 2) Chinese Cancer Registry Annual Report data showed that the ASIR and ASMR of breast cancer decreased by 2.1% and 11.4%, respectively, in China from 2009 to 2018, while increased by 43.9% and 8.2% in rural area, respectively. The Joinpoint analysis showed that the average annual percentage change (AAPC) of ASIR and ASMR in China were -0.2% (P>0.05) and -1.6% (P<0.05). The AAPC of ASIR and ASMR in rural area were 3.9% (P<0.05) and 0.6% (P>0.05), and -0.3% (P>0.05) and -1.2% (P<0.05) in urban area, respectively. China Health Statistical Yearbook data showed that the urban ASMR decreased by 12.3% from 2014 to 2021 with AAPC of -2.6% (P<0.05). 3) The GLOBOCAN 2022 predicted that, the breast cancer case count and death count in China would be 387 776 and 111 133 by 2050, an increase of 8.6% and 48.2%, respectively, compared with 2022, the increases would be more obvious in people over 65 years old, an increase of 80.8% and 124.9%, respectively. 4) Thirteen individual- based studies reported that the median medical expenditure per patient (M=21 000 to 39 000 Yuan) and length of hospital stay (M=11.0 to 30.5 days) for breast cancer treatment decreased from 2010 to 2019, while the average medical expenditure per visit (M=9 000 to 23 000 Yuan) showed an upward trend. There was only one national-level analysis, which showed that the treatment cost of breast cancer was 25.24 billion Yuan in China in 2018, accounting for 6.4% of the total cancer treatment cost. Conclusions According to the above updated multi-source data, the incidence and mortality of female breast cancer in China were stable in the past ten years, but the increasing trend in rural area should be noted. The direct medical expenditure of breast cancer treatment per case might decrease, but the population-level economic burden would remain heavy due to population aging. |
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