1990-2019年中国归因于水果摄入不足的食管癌死亡趋势

目的  分析1990-2019年中国归因于水果摄入不足的食管癌死亡率的长期趋势，并预测2020-2034年的变化，为中国食管癌的防控提供科学建议。方法  从2019年全球疾病负担(Global Burden of Disease 2019, GBD 2019)获取1990-2019年中国归因于水果摄入不足的死亡负担数据，运用Joinpoint回归模型分析其死亡率的变化趋势，并使用年龄-时期-队列(age-period-cohort, APC)模型评估年龄、时期、队列效应。采用R软件Nordpred包对2020-2034年的死亡情况进行预测。结果  1990-2019年中国归因于水果摄入不足的食管癌标化死亡率整体呈现下降趋势，总人口从3.86/10万降至1.02/10万、男性从5.27/10万降至1.72/10万、女性从2.61/10万降至0.44/10万，平均年度变化百分比(average annual percentage change, AAPC)分别为总人口-4.54%、男性-3.83%、女性-5.94%。APC模型分析显示，1990-2019年中国归因于水果摄入不足的食管癌纵向年龄死亡率随年龄增加呈现先上升后下降的趋势，整体呈上升趋势，总人口从0.20/10万增至3.54/10万、男性从0.26/10万增至6.40/10万、女性从0.37/10万增至1.36/10万；随着时期的推移死亡风险减小，总人口RR值从1.28降至0.19、男性RR值从1.24降至0.22、女性RR值从1.52降至0.11；越晚出生的队列其死亡风险越小，总人口RR值从12.31降至0.04、男性RR值从8.96降至0.05、女性RR值从26.04降至0.01。预计2020-2034年，死亡人数降至73 897例，死亡率降至0.52/10万。结论  相应防控策略对1990-2019年中国归因于水果摄入不足的食管癌防制有效，须重点加强缺乏水果摄入的50岁以上男性人群的相关疾病防控和体检筛查，科学指导居民摄入水果。

Analysis and prediction of the trends of esophageal cancer mortality attributable to low fruit intake in China from 1990 to 2019

  Objective  To analyze the long-term trends in esophageal cancer attributable to low fruit intake in China from 1990 to 2019, and to predict the changes from 2020 to 2034, so as to provide scientific suggestions for esophageal cancer prevention and control in China.  Methods  Data on mortality burden of esophageal cancer attributable to low fruit intake in China from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 (GBD2019). Joinpoint regression model was used to analyze the trend of esophageal cancer mortality. Age, period, birth cohort effects were evaluated using age-period-cohort (APC) models. Deaths from 2020 to 2034 were predicted using the R software Nordpred package.  Results  The age-standardized mortality rates showed an overall downward trend for esophageal cancer attributable to low fruit intake from 1990 to 2019 in China, decreased from 3.86/105 to 1.02/105 in total population, from 5.27/105 to 1.72/105 in male, and from 2.61/105 to 0.44/105 in female, with the average annual percentage change (AAPC) of both -4.54%, male -3.83%, female -5.94%, respectively. The analysis of APC model showed that the longitudinal mortality rates of esophageal cancer attributable to low fruit intake showed an upward trend first and then a downward trend with age, and the overall trend was upward, the mortality increased from 0.20/105 to 3.54/105 in total population, from 0.26/105 to 6.40/105 in male, and from 0.37/105 to 1.36/105 in female. Risk of death decreased over time. The RR decreased from 1.28 to 0.19 in total population, from 1.24 to 0.22 in male, from 1.52 to 0.11 in female. Cohorts born later had lower mortality risk. The RR decreased from12.31 to 0.04 in total population, from 8.96 to 0.05 in male, and from 26.04 to 0.01 in female. From 2020 to 2034, the number of deaths will fall to 73 897 and mortality rate to 0.52/105.  Conclusions  The corresponding prevention and control strategies are effective for esophageal cancer attributable to low fruit intake in China from 1990 to 2019. At the same time, it is necessary to strengthen the related disease and physical examination of men over the age of 50 and scientifically guide the fruit intake of residents.