2016年中国归因于室外PM2.5暴露的肺癌死亡情况

摘要

目的 分析2016年室外PM2.5暴露对中国造成的肺癌死亡情况.方法 数据来自2016年全球疾病负担研究(GBD 2016).GBD 2016利用卫星观察数据、地面测量数据和化学迁移模型模拟等多来源数据,采用空气质量数据集成模型来估计网格化的室外PM2.5暴露水平;利用生命登记系统、肿瘤登记系统等来源的数据,通过构建统计模型来估计不同地区、年龄和性别的肺癌死亡数.在计算人群归因分值的基础上,计算归因于室外PM2.5暴露的肺癌死亡例数,采用GBD世界标准人口的年龄结构计算年龄标化率,并在中国各省份(含31个省、自治区、直辖市,以及香港、澳门特别行政区,不包括中国台湾)之间进行比较.结果 2016年,中国因室外PM2.5暴露导致14.56万例[95%不确定性区间(UI):9.63万例~19.55万例]肺癌死亡,占肺癌总死亡的24.66%(95% UI :16.38%~33.12%),肺癌归因死亡率随年龄增加而上升,25~29岁年龄组最低,为0.25/10万(95% UI :0.17/10万~0.34/10万),80岁及以上年龄组最高,为90.70/10万(95% UI :59.85/10万~122.20/10万);男性的肺癌归因死亡率(14.84/10万,95% UI :9.78/10万~19.93/10万)高于女性(6.21/10万,95% UI :4.07/10万~8.40/10万);中国男性和女性室外PM2.5暴露导致的肺癌年龄标化归因死亡率均高于全球平均水平.不同省份由于室外空气污染导致的肺癌年龄标化归因死亡率差异有统计学意义:最高的是山东(13.51/10万,95% UI :9.14/10万~18.20/10万),西藏最低(0.85/10万,95% UI :0.44/10万~1.51/10万).结论 2016年,室外PM2.5暴露给中国带来沉重的肺癌死亡负担,且存在年龄、性别和地区差异.%Objective To analyze the lung cancer deaths attributable to ambient PM2.5 exposure in China in 2016. Methods All data were from the Global Burden of Disease Study 2016 (GBD 2016). Multiple?source data, including satellite observation, ground measurement, chemical migration model simulation, etc., and the data integration model for air quality (DIMAQ) were used to estimate the grid?level exposure to ambient PM2.5. Data from the vital registry and cancer registry were used to establish statistical model to estimate the lung cancer deaths by province, age and gender. The lung cancer deaths attributable to PM2.5 were calculated based on the calculation of population attributable fraction (PAF). The GBD world population age structure was adopted to calculate age?standardized rates for comparison among provinces (including 31 provinces, autonomous regions and municipalities directly under the central government, as well as Hong Kong and Macao special administrative regions, excluding Taiwan of China). Results In 2016, the lung cancer deaths attributable to ambient PM2.5 exposure in China were 14.56×104 (95% uncertainty interval ( UI ): 9.63×104-19.55×104), accounting for 24.66% (95% UI : 16.38%-33.12%) of total lung cancer deaths. The lung cancer death rate attributable to PM2.5 increased with age, with the lowest among 25-29 age group (0.25/105, 95%UI:0.17/105-0.34/105), the highest among≥80 age group (90.70/105, 95%UI: 59.85/105-122.20/105). The lung cancer death rate attributable to PM2.5 among males (14.84/105, 95% UI : 9.78/105-19.93/105) was higher than that in females (6.21/105, 95% UI : 4.07/105-8.40/105). The age?standardized death rates (ASDR) of lung cancer attributable to PM2.5 among males and females in China were higher than the global average level. The attributable ASDR of lung cancer varied among provinces, highest in Shandong (13.51/105, 95% UI : 9.14/105-18.20/105) and lowest in Tibet (0.85/105, 95% UI : 0.44/105-1.51/105). Conclusion In 2016, the lung cancer deaths attributable to ambient PM2.5 exposure in China was heavy, and varied in different age groups, genders and provinces.