1990—2021 年中国居民乙型肝炎病毒感染所致肝癌疾病负担及趋势预测

作者： style="font-size: 12px ">余小燕 张丽航 王佳艳 王一飞 校丽芳

单位：上海市嘉定区中心医院 消化内科 上海 201800

关键词：肝炎病毒 乙型 肝癌 疾病负担 趋势分析 趋势预测

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出版年,卷(期):页码：2026,18(1):40-49

摘要：

摘要：目的 分析 1990—2021 年中国居民乙型肝炎病毒（hepatitis B virus，HBV）感 染所致肝癌疾病负担的变化并预测其至 2050 年的发展趋势。方法 利用 2021 年全球疾 病负担研究（global burden of disease 2021，GBD 2021）数据，对 1990 年和 2021 年 中国居民 HBV 感染所致肝癌的死亡率和伤残调整寿命年（disability adjusted life year， DALY）按年龄、性别进行分层分析。采用 JoinPoint 回归模型计算平均年度变化百分 比（average annual percent change，AAPC）及其 95%CI，分析 1990—2021 年 中 国、 全球及不同社会人口指数（social demographic index，SDI）地区 HBV 感染所致肝癌疾 病负担的变化趋势。采用贝叶斯年龄-时期-队列（Bayesian age-period-cohort analysis， BAPC）模型预测 2022—2050 年我国居民 HBV 感染所致肝癌的标化死亡率和标化 DALY 率的发展趋势。结果 我国居民 HBV 感染所致肝癌的标化死亡率从 1990 年的 6.53/10 万下降至 2021 年的 4.83/10 万，率值下降了 26.03%。标化 DALY 率从 1990 年 的 220.05/10 万下降至 2021 年的 155.81/10 万，下降了 29.19%。年龄和性别分层分析显 示，≥ 15～ ＜ 50 岁的年轻人群标化 DALY 率下降显著高于 ≥ 50～≤ 74 岁及 ≥ 75 岁 人群（30.85% 比 29.89% 比 0.17%），女性标化 DALY 率下降幅度大于男性（41.92% 比 25.59%）。趋势分析发现，1990—2021 年我国 HBV 感染所致肝癌总体标化死亡率 逐年下降 0.97%（95%CI：-1.19%～-0.75%，P ＜ 0.001），全球标化死亡率逐年下降 0.65%（95%CI：-0.80%～-0.49%，P ＜ 0.001），中高 SDI 地区逐年下降 0.65%（95%CI： -?0.90%～-?0.39%，P ＜ 0.001）。同期我国总体标化 DALY 率逐年下降 1.22%（95%CI： -?1.48%～-?0.97%，P ＜ 0.001）， 而 全 球 标 化 DALY 率逐年下降 0.94% （95%CI： -?1.10%～-?0.78%，P ＜ 0.001），中高 SDI 地区标化 DALY 率逐年下降 1.01%（95%CI： -?1.28%～-?0.72%，P ＜ 0.001）。预测结果显示，2022—2050 年我国居民 HBV 感染所 致肝癌的标化死亡率将每年下降 2.86%（95%CI：-2.91%～-2.82%，P ＜ 0.001），标化 DALY 率将每年下降 3.02%（95%CI：-3.08%～-2.97%，P ＜ 0.001）。结论 我国 HBV 感染所致的肝癌疾病负担增率下降，仍需加强 HBV 感染的预防和治疗，从而降低肝癌 疾病负担，助力我国人口高质量发展。

Abstract: Objective To analyze the changes in the disease burden of liver cancer induced by hepatitis B virus (HBV) infection among Chinese residents from 1990 to 2021, and project its development trends up to 2050. Methods Data were extracted from the global burden of disease 2021 (GBD 2021) study. Stratified analysis by age and gender was conducted to assess the mortality rate and disability adjusted life year (DALY) of liver cancer induced by HBV infection among Chinese residents in 1990 and 2021. The Joinpoint regression model was applied to calculate the average annual percent change (AAPC) and its 95%CI to analyze the temporal trends of disease burden of HBV-related liver cancer in China, globally, and across regions with different sociodemographic index (SDI) levels from 1990 to 2021. Furthermore, the Bayesian age-period-cohort (BAPC) model was employed to project the trends of age-standardized mortality rate and age-standardized DALY rate of HBV-induced liver cancer among Chinese residents from 2022 to 2050. Results The age-standardized mortality rate of HBV-related liver cancer in Chinese residents fell from 6.53 to 4.83 per 100 000 population between 1990 and 2021 (a 26.03% reduction), while the age-standardized DALY rate declined by 29.19% from 220.05 to 155.81 per 100 000 population over the same period. Age and gender stratified analysis indicated that the decline in age-standardized DALY rate was significantly more prominent in the younger population aged 15 to 49 years than in those aged 50 to 74 years and those aged 75 years and older (30.85% vs. 29.89% vs. 0.17%). The reduction of age-standardized DALY rate was greater in females than in males (41.92% vs. 25.59%). Trend analysis revealed that the overall age-standardized mortality rate of HBV-induced liver cancer in China decreased by 0.97% annually from 1990 to 2021 (95%CI: - 1.19%～- 0.75%, P ＜ 0.001). The global age-standardized mortality rate of HBV related liver cancer decreased by 0.65% per year over the same period (95%CI: - 0.80%～ - 0.49%, P ＜ 0.001), while the rate in medium-high SDI regions declined by 0.65% annually (95%CI: - 0.90%～- 0.39%, P ＜ 0.001). Over the same period, the age-standardized DALY rate decreased by 1.22% annually in China (95%CI: - 1.48%～- 0.97%, P ＜ 0.001), 0.94% globally (95%CI: - 1.10%～- 0.78%, P ＜ 0.001) and 1.01% in medium-high SDI regions (95%CI: - 1.28%～- 0.72%, P ＜ 0.001). Projection results indicated that the age standardized mortality rate of HBV-related liver cancer among Chinese residents will decrease by 2.86% per year during 2022—2050 (95%CI: - 2.91%～- 2.82%, P ＜ 0.001), and the age-standardized DALY rate will decline by 3.02% annually over the same forecasting period (95%CI: - 3.08%～- 2.97%, P ＜ 0.001). Conclusion Despite the downward trend in the growth rate of the disease burden of HBV-related liver cancer in China, efforts to strengthen HBV infection prevention and treatment still need to be scaled up, so as to further reduce the disease burden of liver cancer and support China’s high-quality population development.

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