| Objectives: The objective of this study is to develop an system for cancer burden calculation.Real data from Wuhan city will be used to explore the practical application of the calculation methods in order to provide comprehensive digestive system cancer burden indicators for Wuhan city from 2010 to 2019.Additionally,we will comprehensively estimate the attributable burden of the major risk factors for digestive system cancers.Methods: This study conducted a comprehensive methodological exploration in four aspects:death burden,disability burden,attributable burden,and predictive analysis.(1)Death burden: To calculate life expectancy,cause-eliminated life expectancy,mortality,and YLL rates by year,gender and regions,we used simplified life tables,cause-eliminated life tables and the GBD 2017 standard life table based on death surveillance data and household registration population data from Wuhan city between 2010 and 2019.Joinpoint regression analysis was used to examine changes in mortality and YLL rates.The 2010 population census data in China was used as the standard population to calculate standardized mortality and standardized YLL rates,and spatial autocorrelation was used to analyze the spatial clustering of these indicators.The contribution of population growth,aging,and changes in age-specific mortality rates to changes in the number of deaths was analyzed using the mortality difference decomposition method.(2)Disability burden: Disease prevalence was estimated by integrating data from multiple sources(mortality,incidence,and covariates)using the Bayesian meta-regression method based on the Dis Mod-MR model.Years lived with disability(YLD)due to digestive system cancers were estimated by combining DW values specific to China with cancer incidence data in Wuhan City and 10-year survival rate data of Hubei Province estimated in GBD 2019.Joinpoint regression analysis was used to examine changes in disease prevalence and YLD rates.(3)Attributable burden: The population attributable fraction(PAF)was calculated using the counterfactual analysis method of GBD comparative risk assessment theory,and the attribution burden of risk factors was estimated by combining PAF and the number of deaths or DALYs.(4)Predictive analysis: Using the Bayesian age-period-cohort(BAPC)model with the integrated nested Laplace approximation method to obtain the marginal posterior distribution,this study aims to predict the burden of digestive system cancers in Wuhan city over the next five years,based on mortality and DALY rates from 2010-2019.Results: This study obtained comprehensive indicators,including life expectancy,causeeliminated life expectancy,mortality,YLL rate,prevalence,YLD rate,and DALY rate for Wuhan city from 2010 to 2019,as well as their temporal,spatial,and demographic differences.The study also obtained the impact effects of three major factors on changes in mortality,and comprehensively estimated the attributable burden of nine risk factors.Moreover,the study predicted the burden of digestive system cancers in Wuhan city for the next five years.(1)Life expectancy,Cause-eliminated life expectancyIn 2010,the life expectancy for people of Wuhan city was 79.79 years,digestive system cancer-eliminated life expectancy was 81.44 years,and the loss of life due to digestive system cancer was 1.66 years.In 2019,the life expectancy was 81.42 years,digestive system cancereliminated life expectancy was 82.94 years,and the loss of life due to digestive system cancer was 1.52 years.Overall,life expectancy showed an upward trend,while the loss of life due to digestive system cancer remained relatively stable at around 1.52-1.72 years.In 2019,the life expectancy for male was 78.94 years,digestive system cancer-eliminated life expectancy was80.74 years,and the loss of life due to digestive system cancer was 1.81 years.The life expectancy for female was 84.08 years,digestive system cancer-eliminated life expectancy was85.23 years,and the loss of life due to digestive system cancer was 1.15 years.Female had higher life expectancy and cause-eliminated life expectancy than male,and the loss of life due to digestive system cancer was consistently lower for female compared to male over the years.(2)Mortality and trend of changesFrom 2010 to 2019,the mortality of liver and stomach cancer in Wuhan showed a decreasing trend,while those for colorectal cancer,pancreatic cancer and gallbladder biliary tract cancer showed an increasing trend,and the trend of other cancers was not statistically significant.In2019,the mortality of liver cancer,stomach cancer,colorectal cancer,esophageal cancer,pancreatic cancer,gallbladder biliary tract cancer,oral and lip cavity cancer,and other pharynx cancer were 22.73/100,000,22.19/100,000,17.10/100,000,10.02/100,000,8.8/100,000,2.99/100,000,1.58/100,000 and 0.45/100,000 respectively.(3)YLL rates and trend of changesFrom 2010 to 2019,the YLL rates of liver cancer and stomach cancer showed a decreasing trend,and the YLL rates of colorectal cancer,pancreatic cancer,and gallbladder biliary tract cancer showed an increasing trend,while the trends of other cancers were not statistically significant.In 2019,the YLL rates of liver cancer,stomach cancer,colorectal cancer,esophageal cancer,pancreatic cancer,gallbladder biliary tract cancer,oral and lip cancer,and other pharynx cancer were 580.25/100,000,497.45/100,000,357.20/100,000,218.04/100,000,197.02/100,000,65.45/100,000,36.91/100,000,and 11.61/100,000,respectively.(4)The standardized mortality and standardized YLL ratesFrom 2010 to 2019,the standardized mortality and standardized YLL rate for digestive system cancers in Wuhan were both lower for females than males,and showed a slightly decreasing trend.The regional differences in standardized mortality and standardized YLL rate were significant,with lower rates observed in central urban areas such as Wuchang,Jiang’an,Jianghan,Qiaokou,Qingshan,Hongshan,and Hanyang,while higher rates were found in distant suburban areas including Huangpi,Xinzhou,Jiangxia,and Hannan.The results of local spatial autocorrelation showed that in 2010,there were four low-low agglomeration areas for standardized mortality and standardized YLL rate: Wuchang,Qingshan,Jianghan,and Qiaokou.In 2015,there were five low-low agglomeration areas: Wuchang,Jiang’an,Qingshan,Jianghan,and Qiaokou.In 2019,there were two low-low agglomeration areas: Wuchang and Qingshan.(5)Decomposition of the change in the number of deathsFrom 2010 to 2019,the number of deaths from digestive system cancers increased by 18.31%in total,with an increase of 16.77% in males and 21.40% in females.In the whole population,the proportion of age-specific mortality causing the increase in total deaths was-16.57%,while population growth accounted for 10.84% and population aging accounted for 24.04%.Population aging was the main reason for the increase in the number of deaths,while population growth increased the number of deaths,and changes in age-specific mortality contributed positively or negatively to the change in deaths among different digestive system cancers.(6)Prevalence and trend of changesThe prevalence of digestive system cancers in Wuhan showed an increasing trend from 2010 to 2019.In 2019,the highest to lowest cancer prevalence were colorectal cancer(272.88/100,000),liver cancer(143.95/100,000),stomach cancer(128.44/100,000),esophageal cancer(45.41/100,000),pancreatic cancer(38.95/100,000),gallbladder biliary tract cancer(20.19/100,000),oral and lip cavity cancer(14.57/100,000),and other pharynx cancer(4.07/100,000).Colorectal cancer had a higher prevalence in males than females,while other cancers had slightly higher prevalence in females.The age-specific prevalence of digestive system cancers was highest in the older age groups,with the highest rate in those over 80 years old,and there was no significant spatial trend.(7)YLD rates and trend of changesThe YLD rates for colorectal,pancreatic,gallbladder biliary tract cancer,oral and lip cancers showed an increasing trend from 2010 to 2019;stomach and liver cancers showed a decreasing trend;the trend for other cancers was not statistically significant.In 2019,the YLD rates from highest to lowest were colorectal cancer(15.96/100,000),stomach cancer(8.49/100,000),liver cancer(5.38/100,000),esophageal cancer(2.7/100,000),pancreatic cancer(1.42/100,000),gallbladder biliary tract cancer(1.14/100,000),lip and oral cavity and cancer(0.92/10),and other pharynx cancer(0.17/100,000).The YLD rates for gallbladder biliary tract cancer,oral cavity and lip cancer were higher in females than in males,while those for other cancers were higher in males.The age-specific YLD rates for digestive system cancers were higher at ages70-80.There were regional differences,with standardized YLD rates being relatively low in central urban areas and relatively high in remote urban areas.(8)DALY rates and trend of changesFrom 2010-2019,the DALY rates for liver and stomach cancers showed a decreasing trend;colorectal,pancreatic,and gallbladder biliary tract cancers showed an increasing trend;esophageal,oral and lip,and other pharynx cancer showed no statistically significant trend.In2019,the DALY rates in descending order were: liver cancer(585.63/100,000),stomach cancer(505.95/100,000),colorectal cancer(373.16/100,000),esophageal cancer(220.74/100,000),pancreatic cancer(198.44/100,000),gallbladder biliary tract cancer(66.37/100,000),oral and lip cancer(38.05/100,000),and other pharynx cancers(11.78/100,000).The DALY rates for gallbladder biliary tract cancer and other pharynx cancer were higher in females than in males,while those for other cancers were higher in males.The DALY rates for major digestive system cancers were higher in the 65-84 age group.Standardized DALY rates were lower in central urban areas than in remote urban areas.In 2019,the YLD proportions of colorectal cancer,oral and lip cancer,gastric cancer,other pharynx cancer,gallbladder biliary tract cancer,esophageal cancer,liver cancer,and pancreatic cancer in DALY were 4.28%,3.01%,1.68%,1.46%,1.40%,1.22%,0.92%,and 0.72%,respectively.(9)Attributable burden of nine risk factorsThe ranking of deaths from digestive cancers in 2019 from highest to lowest for the nine risk factor categories was: smoking(810),high sodium diet(663),high BMI(415),alcohol consumption(330),low fruit intake(282),low physical activity(246),high blood glucose(165),high red meat intake(160),low vegetable intake(49).The distribution of DALY was roughly the same as the number of deaths,with DALY ranked from highest to lowest as follows:smoking(19522.02 person-years),high sodium diet(15124.07 person-years),high BMI(9972.53 person-years),alcohol consumption(8043.02 person-years),low fruit intake(6209.09person-years),low physical activity(5360.38 person-years),high blood glucose(3985.62person-years),high red meat intake(3511.4 person-years),low vegetable intake(1080.05person-years).(10)Mortality and DALY rate projectionsThe BAPC forecast show that the standardized mortality rate for digestive system cancer in Wuhan is expected to exhibit a declining trend over the next five years,with the rate dropping from 54.65/100,000 in 2020 to 45.5 / 100,000 in 2024.However,the age-specific mortality rate among people aged 85 and above shows an upward trend.The standardized DALY rate for digestive system cancer also indicates a decline,with the rate decreasing from 1430.49/100,000 in 2020 to 1230.89/100,000 in 2024.Nonetheless,the age-specific DALY rate for individuals aged 80 and above exhibits an increasing trend.Conclusions: The methodological integration system for cancer burden measurement is practical and feasible,and the results of the applied study in Wuhan are reasonable and reliable.(1)At present,there are few systematic and comprehensive methodological studies on the burden of cancer in China,and the methodological system for measuring the burden of cancer disease constructed in this study is practical and feasible,which can be used as a reference for other disease burden studies.(2)The applied study based on real data in Wuhan provides a set of systematic and comprehensive cancer burden indicators for the digestive system from 2010 to 2019,and the results are reasonable and reliable when compared with global and Chinese levels,which can provide a scientific basis for prevention and control digestive system cancers in Wuhan. |
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