2002-2019年上海市浦东新区居民肝癌死亡特征及减寿率分析

背景　肝恶性肿瘤是全球常见的消化系统肿瘤之一，浦东新区居民肝恶性肿瘤死亡的流行病学资料依然缺乏。目的　了解2002-2019年浦东新区居民肝癌死亡特征与所导致的寿命损失，为制定针对性的干预措施提供依据。方法　以浦东新区户籍人口为对象，以户籍居民死因数据库为基础，从中筛选出死亡日期在2002-2019年的肝癌死亡资料进行分析。居民死因资料采用国际疾病分类第10版（ICD-10）进行编码与归类，肝癌的编码范围为C22。分别计算浦东新区居民肝癌粗死亡率、标化死亡率、潜在减寿年数（PYLL）、潜在减寿率（PYLLR）、平均减寿年数（AYLL）、标化潜在减寿年数（SPYLL）以及标化潜在减寿率（SPYLLR），对浦东新区居民肝癌死亡情况以及肝癌导致的寿命损失情况进行分析。肝恶性肿瘤死亡率与寿命损失的变化趋势采用年均变化百分比（APC）进行分析。结果　2002-2019年浦东新区居民肝癌死亡12 522例，年均粗死亡率为25.38/10万，标化死亡率为12.29/10万。2002-2019年浦东新区居民肝癌粗死亡率、标化死亡率均呈逐年下降趋势（粗死亡率：APC=-1.88%，Z=-12.468，P<0.001；标化死亡率：APC=-4.71%，Z=-10.601，P<0.001）。男性、女性居民肝癌粗死亡率与标化死亡率均呈下降趋势（P<0.001）。2002-2019年15~59岁、60~79岁浦东新区居民肝癌粗死亡率总体呈下降趋势（P<0.001），80岁以上浦东新区居民肝癌死亡率保持稳定（P=0.053）。2002-2019年浦东新区居民肝癌死亡PYLL为98 580年，PYLLR为2.00‰，AYLL为7.87年/人，SPYLL为61 767年，SPYLLR为1.25‰。2002-2019年浦东新区居民肝癌死亡PYLLR、SPYLLR、AYLL总体均呈逐年下降趋势（P<0.001），除2002-2010年浦东新区居民肝癌死亡AYLL保持稳定（P=0.853）。男性居民肝癌死亡PYLL为81 126年，PYLLR为3.29‰，AYLL为9.20年/人，SPYLL为50 225年，SPYLLR为2.04‰。女性居民肝癌死亡PYLL为17 454年，PYLLR为0.71‰，AYLL为4.72年/人，SPYLL为10 942年，SPYLLR为0.44‰。浦东新区男性居民肝癌死亡PYLL、PYLLR、AYLL、SPYLL及SPYLLR均大于女性。结论　2002-2019年浦东新区居民肝癌粗死亡率与标化死亡率均逐年下降，但仍引起了严重的寿命损失，肝癌对于男性及80岁高龄老年人群的危害需进一步关注，需采取差异化的防控措施，对于男性人群以改善行为危险因素为重点，降低肝癌对该人群的危害；对于高龄肝癌患者，应注重临终关怀与支持治疗工作，改善该人群的生存状态。

Liver Carcinoma-related Mortality and Potential Years of Life Lost among Residents in Pudong New Area of Shanghai between 2002 and 2019

Background　Liver carcinoma is a common digestive malignancy worldwide.There is still lack of epidemiological data of liver carcinoma-related deaths of residents in Pudong New Area.Objective　To explore liver carcinoma-related mortality and potential years of life lost（PYLL） among residents in Pudong New Area of Shanghai between 2002 and 2019，to provide a reference for the development of targeted interventions.Methods　Data of people who died of liver carcinoma （ICD-10 C22） during 2002—2019 were collected from Pudong New Area' Residents Death Surveillance Database with death causes classified by the ICD-10.The crude mortality rate，age-standardized mortality rate，PYLL，rate of PYLL，average PYLL，age-standardized PYLL，and age-standardized PYLL rate were calculated and used to analyze the deaths and PYLL from liver carcinoma.The tendency of mortality and PYLL were estimated by annual percent change （APC）.Results　During 2002—2019，12 522 cases died of liver carcinoma in Pudong New Area，with 25.38/100 000 and 12.29/100 000 as the average annual crude mortality rate and average annual standardized mortality rate，respectively.Both the crude mortality rate and the age-standardized mortality rate of liver carcinoma declined over the years （APC=-1.88%，Z=-12.468，P<0.001；APC=-4.71%，Z=-10.601，P<0.001）.And these two indicators also showed a downward trend either among males or females （P<0.001）.The crude mortality of liver carcinoma declined over years for those aged 15-59 and those aged 60-79 （P<0.001），but kept stable for those over 80 years old （P=0.053）.The PYLL of liver carcinoma was 98 580 years，the PYLL rate was 2.00‰，the average PYLL was 7.87 years per person，age-standardized PYLL was 61 767 years and age-standardized PYLL rate was 1.25‰，respectively.The PYLL rate，age-standardized PYLL rate and average PYLL due to liver carcinoma on total showed a downward trend during 2002 to 2019（P<0.001）.However，the trend of average PYLL kept stable between 2002 and 2010 （P=0.853）.The PYLL，PYLL rate，average PYLL，age-standardized PYLL，and age-standardized PYLL rate of liver carcinoma were 81 126 years，3.29‰，9.20 years per person，50 225 years and 2.04‰，respectively，among males，and were 17 454 years，0.71‰，4.72 years per person，10 942 years and 0.44‰，respectively，among females.All the above-mentioned 5 indicators of males were higher.Conclusion　The crude mortality rate and age-standardized mortality rate of liver carcinoma in Pudong New Area showed a tendency to descend during 2002—2019，but still caused severe life loss.More attention should be paid to the harm of liver carcinoma to males and the aged population over 80 years old.So interventions should be delivered according to the conditions of different populations：priority should be given to improving liver carcinoma-related behavioral risk factors to reduce the harm of this disease in males，and should be given to hospice care and supportive care to improving survival status in aged liver carcinoma patients.