Study On The Disease Burden And Influencing Factors Of Gastric Cancer Based On Cohort Population

Objectives:Based on the Jinchang cohort platform,this study analyzed the disease burden and changing trends of gastric cancer（GC）,identified high-risk groups for GC development,and explored the influencing factors of GC incidence.We aimed to provide a scientific basis for formulating targeted interventions and prevention strategies for the cohort population.Methods:The population of the Jinchang cohort was selected as the object.The baseline GC prevalence rate（Pre）in the cohort population during 2011-2013 was analyzed by descriptive epidemiological method.After matching the baseline with the follow-up population by employee’s ID codes,the incidence rate（Inc）from 2014-2020,the mortality rate（Mor）,fatality rate,probability of premature death,potential years of life lost（PYLL）and work potential years of life lost（WPYLL）from 2014-2019,and the economic burden of GC in the cohort population from 2011-2020 were calculated respectively.Joinpoint regression models were used to analyze the annual percentage change（APC）of these indicators and to test whether the trend changes over the years were statistically significant.The case group in the nested case-control study consisted of 248 primary GC incident cases,and the control group of 494 people was matched 1:2 by sex and age（±2 years）in healthy people who did not develop GC during the same period.Conditional logistic regressions were used to explore the influencing factors of GC.The multiplicative and additive models were used to determine whether there are interactions between the influencing factors.The prospective study of the association between serum lipid levels and GC incidence identified a total of 45,642 study subjects according to inclusion and exclusion criteria,and they were stratified by the distribution of baseline serum lipid quartiles in a healthy population.The Cox proportional hazards models were used to evaluate the hazard ratio（HR）and 95%confidence interval（CI）of GC in each layer,and the interaction effects of dyslipidemia on the pathogenesis of GC were analyzed by the generalized additive model.Results:1.During 2011-2013,the Pre of GC in the total population was 208.33/100,000,and the Pre of GC in the male and female populations were 294.86/100,000 and 74.32/100,000,respectively.2.From 2014 to 2020,the Inc of GC in the total population was 94.18/100,000,and the age-standardized incidence rate（ASIR）was 43.74/100,000.From 2014 to 2019,the Mor of GC in the total population was 38.17/100,000,the age-standardized mortality rate（ASMR）was 19.24/100,000,the case fatality rate was 7.42%,the probability of premature death was 1.32%,the PYLL and WPYLL were 911.40 person-years and 372.50 person-years,respectively,and average years of life lost（AYLL）and average work potential years of life lost（AWPYLL）were 11.39 years and 8.28 years,respectively.Among them,Mor,ASMR,probability of early death,PYLL and WPYLL showed an increasing trend with the year（P<0.05）,and the APCs were 16.20%、13.36%、15.20%、15.10%and 14.90%respectively.3.From 2014 to 2020,the Inc of GC in the male population was 135.42/100,000,and the ASIR was 69.56/100,000.From 2014 to 2019,the Mor of GC in the male population was 53.38/100,000,the ASMR was 25.84/100,000,the case fatality rate was 7.14%,the probability of premature death was 1.88%,the PYLL and WPYLL were 577.04 person-years and 277.50 person-years,respectively,and the AYLL and AWPYLL were 9.95 years and 7.93 years,respectively,there was no statistically significant change in these indicators with year（P>0.05）.4.From 2014 to 2020,the Inc of GC in the female population was 32.28/100,000,and the ASIR was 19.79/100,000.From 2014 to 2019,the Mor of GC in the female population was 15.36/100,000,the ASMR was 8.73/100,000,the case fatality rate was9.40%,the probability of premature death was 0.54%,the PYLL and WPYLL were227.18 person-years and 95.00 person-years,respectively,and the AYLL and AWPYLL were 16.23 years and 9.50 years,respectively,there was no statistically significant change in these indicators with year（P>0.05）.5.From 2011 to 2020,the average hospitalization cost of GC in the total population of the cohort was 11,470.40 yuan/time,and the average daily hospitalization cost was 943.49 yuan/day/time;the average hospitalization cost of the male population was 11,783.91 yuan/time,and the average daily hospitalization cost was 945.95 yuan/day/time;the average hospitalization cost of the female population was 9,901.31 yuan/time,and the average daily hospitalization cost was 929.11yuan/day/time.The average hospitalization cost for both the total population and the male population showed a decreasing trend with the year,with an APC of-3.20%,while the average daily hospitalization cost increased with the year,with an APC of 2.90%and 3.20%.6.The results of multivariate conditional logistic regression showed that high literacy（OR:0.50,95%CI:0.26,0.98）and regular consumption of garlic（OR:0.43,95%CI:0.22,0.87）reduced the risk of GC,while Helicobacter pylori（H.pylori）infection（OR:1.94,95%CI:1.14,3.30）,history of hyperlipidemia（OR:1.67,95%CI:1.17,2.37）,history of diabetes（OR:1.52,95%CI:1.04,2.24）,gastrointestinal disease（OR:2.25,95%CI:1.28,3.96）,alcohol consumption exceeding 788.40kg-year（OR:1.98,95%CI:1.12,3.50）,abnormal fasting plasma glucose（FPG）（OR:1.56,95%CI:1.04,2.34）,abnormal triglyceride（TG）（OR:1.67,95%CI:1.08,2.58）,abnormal high-density lipoprotein cholesterol（HDL-C）（OR:1.73,95%CI:1.17,2.57）and low-density lipoprotein cholesterol（LDL-C）（OR:2.16,95%CI:1.28,3.64）increased the risk of GC.There were positive linear dose-response relationships between alcohol consumption index and FPG and GC risk(P_overall<0.05,Pnon-linear>0.05).7.The interaction analysis results of factors influencing GC showed that there were multiplicative interactions between history of diabetes with H.pylori infection and alcohol consumption on the incidence of GC.The risks of GC were 4.52 times（OR:4.52,95%CI:1.50,13.66）in people with a history of diabetes and H.pylori infection and 2.28 times（OR:2.28,95%CI:1.24,4.20）in people with a history of diabetes and drinking higher than those with normal population.Similarly,a history of hyperlipidemia and gastrointestinal disease had a multiplicative interaction on the incidence of GC.The risk of GC was 5.29（OR:5.29,95%CI:1.94,14.42）times in people with a history of hyperlipidemia and gastrointestinal disease higher than those with healthy people.In addition,there were both multiplicative and additive interactions between drinking and garlic consumption on the incidence of GC,and37%of the risk of GC was attributed to their interaction（Attributable proportion due to interaction:0.37,95%CI:0.19,0.55）.8.The results of Cox proportional risk model showed that TG（≥2.30 mmol/L）and LDL-C（≥3.49 mmol/L）increased the incidence risk of GC,whose adjusted HRs were 1.53（95%CI:1.02,2.29）and 2.21（95%CI:1.51,3.24）,while HDL-C（≥1.57mmol/L）reduced the incidence risk of GC（HR:0.42,95%CI:0.26,0.67）.In male population,TG had a positive linear dose-response relationship with the risk of GC(P_overall<0.05,P_non-linear>0.05),HDL-C showed a negative nonlinear dose-response relationship(P_overall<0.05,P_non-linear<0.05),and LDL-C showed a positive nonlinear dose-response relationship(P_overall<0.05,P_non-linear<0.05).In addition,TG（≥1.70mmol/L）and HDL-C（<1.00 mmol/L）,TG（≥1.70 mmol/L）and LDL-C（≥3.40mmol/L）,HDL-C（<1.00 mmol/L）and LDL-C（≥3.40 mmol/L）had interactive effects on the incidence risk of GC,with adjusted HR of 2.75（95%CI:1.89,4.00）,2.55（95%CI:1.78,3.64）and 5.38（95%CI:1.78,3.64）and 5.38（95%CI:3.43,8.45）.Conclusions:1.The burden of disease and economic burden caused by GC in the cohort population were at a high level.2.GC caused a higher total disease burden in males than females,but GC is More harmful to women’s individual health than men.3.Higher literacy and regular consumption of garlic were protective factors for the development of GC.H.pylori infection,history of hyperlipidemia,history of diabetes,history of gastrointestinal disease,heavy alcohol consumption,and abnormal FPG and dyslipidemia were risk factors for development of GC.There were interactions between history of diabetes with H.pylori infection and alcohol consumption,history of hyperlipidemia with history of gastrointestinal diseases and alcohol consumption with garlic consumption on the incidence of GC.4.Elevated TG and LDL-C increased the incidence risk of GC,while elevated HDL-C decreased the risk of GC.Additionally,a combination of any abnormalities among TG,HDL-C,and LDL-C would interactively elevate the incidence risk of GC.