全球女性乳腺癌疾病负担分析及其与社会经济水平和医疗质量关系的初步探讨

发布时间：2018-06-17 07:00

本文选题：乳腺癌 + 发病率　；参考：《浙江大学》2016年博士论文

【摘要】：背景与目的乳腺癌已成为威胁女性健康的首要恶性肿瘤,全球平均每18位女性一生中即有一位会罹患乳腺癌,但不同地区不同国家女性乳腺癌的流行病学特点却有着明显的差异。本研究拟探讨世界女性乳腺癌的疾病负担现状和变化趋势,并分析国家社会经济发展水平及医疗质量对乳腺癌患者病后生存结局的影响。方法文章纳入全球疾病负担2013(GBD 2013)、五大洲肿瘤发病率趋势(CI5plus)及全球肿瘤2012(GLOBOCAN 2012)数据库中女性乳腺癌发病数、死亡数和伤残调整生命年等数据,1990至2013年世界卫生组织(WHO)各国人口数据,人类发展报告2013及2015人类发展指数(HDI)数据,WHO世界健康报告2000医疗卫生系统绩效数据。通过连接点回归、相关分析、线性回归、百分位回归、单因素方差分析等统计学方法分析了各国女性乳腺癌疾病负担变化趋势及其与国家社会经济发展水平、医疗质量间的关系。结果世界女性乳腺癌疾病负担现状在不同地区不同国家之间差异较大,欧洲及美洲地区的发病率、死亡率和伤残调整寿命年水平均要高于东南亚、非洲和东地中海地区。1980-2007年期间,女性乳腺癌的发病率在全球范围内总体呈现上升趋势。美国、新西兰、英国等发达国家乳腺癌发病率变化表现为上世纪80至90年代上升至21世纪趋于稳定甚至有所下降,其中以50-69岁女性发病率变化最为明显；而亚非国家乳腺癌发病率在各年龄阶段均呈明显上升趋势。世界女性乳腺癌死亡率在1990-2013年期间总体呈现下降趋势,尤其是在极高HDI水平国家,75岁以下的各年龄段女性乳腺癌患者的死亡率均有大幅度下降。因此,虽然发达国家的女性乳腺癌发病率较高,但其死亡率与发病率之比(MIR)水平较低,患者总体预后较理想。但即使是在社会经济最发达的国家,老年女性乳腺癌患者的死亡率始终处于较高水平,且至2013年该部分患者已占据了这些国家因乳腺癌死亡人数的一半。而对于发展中国家而言,虽然女性乳腺癌的发病率与死亡率整体水平要远低于发达国家,但中青年患者为主的乳腺癌疾病负担正在这些国家不断加重,且患者病后结局较差,实际疾病负担与其乳腺癌低发病率并不匹配。结论随着世界各国女性乳腺癌早期筛查项目的实施及诊疗手段的进步,女性乳腺癌患者的预后已有了较大幅度的改善。社会经济发展水平和医疗质量是影响乳腺癌患者病后生存结局的重要因素,因此,发达国家与发展中国家的女性乳腺癌疾病负担及发展趋势存在明显的差异。世界各国,尤其是处于快速发展阶段的中低收入国家,仍需积极开展乳腺癌的防治工作,加强国民对乳腺癌的正确认知,推广经济有效的早期筛查项目,并进一步提高乳腺癌诊治手段。
[Abstract]:Background and objective Breast cancer has become the leading malignant tumor threatening the health of women. On average, one in 18 women in the world will develop breast cancer in their lifetime. However, the epidemiological characteristics of female breast cancer in different regions and countries have significant differences. This study aims to explore the current situation and trend of disease burden in women with breast cancer in the world, and to analyze the influence of national social and economic development level and medical quality on the survival outcome of breast cancer patients. Methods the data of breast cancer incidence, mortality and disability adjusted life years in the databases of global disease burden (GBD2013, CI5plus) and global cancer (2012GLOBOCAN2012) were included in the population data of the countries of the World Health Organization (WHO) from 1990 to 2013. HDI data from the HDI 2013 and 2015 HDI data from the WHO World Health report 2000 Health system performance data. By means of connection point regression, correlation analysis, linear regression, percentile regression, univariate analysis of variance and other statistical methods, this paper analyzed the changing trend of female breast cancer burden and its relationship with national social and economic development level. The relationship between medical quality. Results the burden of female breast cancer in the world varies greatly among different regions and countries. The morbidity, mortality and disability adjusted life years in Europe and America are higher than those in Southeast Asia. Between 1980 and 2007, the incidence of breast cancer in women increased globally in Africa and the Eastern Mediterranean. The incidence of breast cancer in the developed countries such as the United States, New Zealand, Britain and other developed countries showed that the incidence of breast cancer increased to the 21st century from the 1980s to the 1990s, and even decreased, especially among women aged 50-69. The incidence of breast cancer in Asian and African countries showed a significant upward trend at all ages. The mortality rate of women with breast cancer in the world showed an overall downward trend from 1990 to 2013, especially among women under 75 years of age in countries with extremely high HDI levels. Therefore, although the incidence of female breast cancer is higher in developed countries, the ratio of mortality to morbidity is lower and the overall prognosis of patients is better. But even in the most economically developed countries, the mortality rate among older women with breast cancer has remained high, and by 2013 it had accounted for half of all breast cancer deaths in those countries. For developing countries, although the overall level of morbidity and mortality of female breast cancer is much lower than that of developed countries, the burden of breast cancer, which is dominated by young and middle-aged patients, is increasing in these countries, and the outcome of the disease is poor. The actual burden of disease does not match the low incidence of breast cancer. Conclusion the prognosis of female breast cancer patients has been greatly improved with the implementation of early screening program and the improvement of diagnosis and treatment methods in the world. The level of social and economic development and the quality of medical treatment are the important factors that affect the survival outcome of breast cancer patients. Therefore, there are obvious differences between developed countries and developing countries in the burden and development trend of female breast cancer. Countries all over the world, especially low- and middle-income countries at the stage of rapid development, still need to actively carry out the prevention and treatment of breast cancer, strengthen the people's correct understanding of breast cancer, and promote economic and effective early screening programs. And further improve the diagnosis and treatment of breast cancer.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R737.9

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