我国女性乳腺癌所致DALY疾病负担：2000-2050年分析与预测

目的 基于全球疾病负担项目2019年最新开放数据，分析我国女性人群因乳腺癌所致伤残调整寿命年（DALY）负担的现况、既往与未来并行国际比较。方法 摘录描述DALY总数、世界标化率值及不同亚组构成，分析我国女性乳腺癌2000-2019年趋势、2019年现况与国际现况比较；利用Joinpoint行2050年预测，主要指标为平均年度变化百分比（AAPC）。结果 2000-2019年，我国女性乳腺癌所致的DALY数在所有女性癌种中的顺位由第四位升至第二位，DALY总数增长了48.4%，其中伤残损失寿命年的占比从4.8%增至8.8%；标化DALY率仅有略微下降（AAPC=-0.3%，其中2016-2019年转为上升，AAPC=1.6%）。2019年，我国女性乳腺癌所致标化DALY率为278.0/10万，DALY数为287.7万人年（占全球乳腺癌的14.2%，占我国女性全部癌种负担的12.1%），其中26.5%有明确归因（以超重与肥胖最多，为33.6万人年；月经、生育等常见乳腺癌影响因素相关数据在平台未见）；预测提示，2050年，我国女性乳腺癌所致DALY总数将达380.0万人年~516.2万人年，较2019年增加32.1%~79.4%。年龄分布方面，2000-2019年，年龄别DALY数和DALY率峰值均后移，年龄≥ 65岁者的DALY数较<65岁者增长更快（AAPC分别为4.8%和1.3%）；2019年的45~74岁（中国女性乳腺癌筛查与早诊早治指南推荐筛查起始年龄）女性贡献了全部DALY负担的74.3%。结论 近20年我国女性乳腺癌所致DALY率基本未变，近年甚至有增加；若无持续扩大的有效干预，伴随人口老龄化的放大作用，乳腺癌所致DALY在我国女性人群的负担将会加重。乳腺癌主要危险因素相关DALY负担归因数据报道仍有限。

DALYs for breast cancer in China, 2000-2050: trend analysis and prediction based on GBD 2019

Objective Based on the data of Global Burden of Disease 2019 data, to analyze the past, current, and future burden of disability-adjusted life years (DALYs) in China and compare with the international status. Methods The total number of DALYs, age-standardized DALY rate, and the composition of different subgroups were extracted and described to analyze the time trend in 2000-2019 and the current situation in 2019 for Chinese female breast cancer. The burden of DALYs in 2050 was predicted by Joinpoint using average annual percent change (AAPC). Results In 2000-2019, the ranking of DALYs caused by female breast cancer in China rose from the fourth to the second in all female cancers. The total DALYs increased by 48.4%, of which the years lived with disability increased from 4.8% to 8.8%. The age-standardized DALY rate only slightly decreased (AAPC=-0.3%; which increased during 2016-2019, AAPC=1.6%). In 2019, the age-standardized DALY rate for breast cancer in China was 278.0/100 000. The DALYs were 2.88 million (accounting for 14.2% of the global burden and 12.1% of all female cancers burden in China), 26.5% of which attributed known risk factors (overweight and obesity were the largest:0.34 million DALYs, but some common breast cancer risk factors were not available on the platform, such as menstruation and fertility). In 2050, the prediction suggests that the total DALYs caused by female breast cancer in China will reach 3.80 million person-years-5.16 million person-years, increasing 32.1%-79.4% over 2019. From 2000 to 2019, the peak age of DALYs and DALY rate became older, and the DALYs among females aged 65 years and above increased faster than those younger than 65 years (AAPC were 4.8% and 1.3%, respectively). In 2019, females aged 45-74 (the starting age recommended by local guidelines for breast cancer screening) contributed 74.3% of the total DALYs.Conclusions Over the past 20 years, the age-standardized DALY rate for breast cancer in female populations in China has not changed obviously. Without the continuous expansion of effective intervention and population aging, the burden of DALYs for female breast cancer in China will increase. DALYs for breast cancer attributed leading risk factors were still limited.