基于GBD 2023的中国胃癌疾病负担演变及未来趋势分析

Evolution and future trends of gastric cancer burden in China: an analysis based on GBD 2023

摘要:

背景与目的 胃癌仍是中国重要的恶性肿瘤疾病负担来源，但在人口老龄化、危险因素变化及诊疗水平提升背景下，其疾病负担特征正在发生转变。本研究基于全球疾病负担研究（GBD 2023）数据，系统分析1990—2023年中国胃癌发病、死亡及伤残调整寿命年（DALY）变化趋势，探讨性别与年龄差异，并预测未来疾病负担变化，为精准防控策略制定提供依据。方法 提取GBD 2023数据库中1990—2023年中国胃癌发病数、死亡数及DALY等指标，计算年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）及年龄标准化DALY率（ASDR），采用年估计变化百分比（EAPC）评价时间变化趋势。应用Das Gupta分解分析评估人口增长、人口老龄化及流行病学变化对疾病负担的贡献；构建贝叶斯年龄-时期-队列（BAPC）模型，预测2024—2040年中国胃癌疾病负担变化趋势。结果 1990—2023年，中国胃癌发病数由47.34万例增至57.57万例，而ASIR由54.23/10万降至25.04/10万，EAPC为-2.76%。同期死亡数由42.81万例降至38.15万例，ASMR由50.93/10万降至16.62/10万，EAPC为-3.84%；DALY由1 214.30万降至890.98万，ASDR由1 314.69/10万降至390.14/10万，EAPC为-4.17%。男性ASIR、ASMR及ASDR均明显高于女性，疾病负担主要集中于55~79岁人群。分解分析显示，人口老龄化是推动胃癌发病负担增加的主要因素，而流行病学变化是死亡负担与DALY下降的主要驱动因素。BAPC模型预测显示，至2040年中国胃癌ASIR可能小幅回升，而男性疾病负担仍显著高于女性；女性ASMR及ASDR则可能呈上升趋势。结论 过去30余年中国胃癌年龄标准化疾病负担总体呈下降趋势，但人口老龄化导致病例总数持续增加，且存在明显性别与年龄异质性。未来胃癌防控仍面临严峻挑战，应进一步强化基于性别、年龄及高危因素的精准筛查与综合干预策略，以持续降低胃癌疾病负担。

Abstract:

Background and Aims Gastric cancer remains an important contributor to the cancer burden in China. However, under the combined influences of population aging, changes in risk-factor exposure, and improvements in diagnosis and treatment, its disease burden characteristics have undergone substantial changes. This study aimed to systematically analyze the trends in incidence, mortality, and disability-adjusted life years (DALYs) of gastric cancer in China from 1990 to 2023, explore sex- and age-specific differences, and predict future disease burden trends bese on Global Burden of Disease Study 2023 (GBD 2023) to provide evidence for precision prevention and control strategies.Methods Data on incidence, mortality, and DALYs of gastric cancer in China from 1990 to 2023 were extracted from the (GBD 2023). Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) were calculated, and temporal trends were evaluated using estimated annual percentage change (EAPC). Das Gupta decomposition analysis was performed to assess the contributions of population growth, population aging, and epidemiological changes to variations in disease burden. Bayesian age-period-cohort (BAPC) models were constructed to predict future trends in gastric cancer burden in China from 2024 to 2040.Results From 1990 to 2023, the number of incident gastric cancer cases in China increased from 473 430 to 575 712, whereas the ASIR decreased from 54.23/100 000 to 25.04/100 000, with an EAPC of -2.76%. During the same period, the number of deaths decreased from 428 073 to 381 500, and the ASMR declined from 50.93/100 000 to 16.62/100 000, with an EAPC of -3.84%. DALYs decreased from 12.14 million to 8.91 million, while the ASDR declined from 1 314.69/100 000 to 390.14/100 000, with an EAPC of -4.17%. Males consistently exhibited higher ASIR, ASMR, and ASDR than females, and the disease burden was mainly concentrated in individuals aged 55-79 years. Decomposition analysis showed that population aging was the major driver of the increasing incidence burden, whereas epidemiological changes mainly contributed to the reductions in mortality burden and DALYs. BAPC projections indicated that the ASIR of gastric cancer in China may slightly rebound by 2040, with males continuing to bear a substantially higher burden than females, while ASMR and ASDR among females may show an upward trend.Conclusion Although the age-standardized burden of gastric cancer in China has generally declined over the past three decades, population aging has led to a continuous increase in the absolute number of cases, accompanied by marked sex- and age-related heterogeneity. Gastric cancer prevention and control in China still face considerable challenges. Future strategies should further strengthen precision screening and comprehensive interventions based on sex, age, and high-risk populations to continuously reduce the burden of gastric cancer.