1990至2023年美国及全球鼻咽癌疾病负担：一项配对分析及至2050年的死亡率预测

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中文摘要

背景： 鼻咽癌（NPC）是一种罕见但具有地理聚集性的恶性肿瘤。针对美国与全球人群之间NPC趋势的长期比较分析，尤其是按性别分层者，仍较为有限。方法：利用全球疾病负担2023数据，我们分析了1990至2023年美国及全球NPC发病率、患病率和死亡率的时间趋势。计算了每10万人口的年龄标化率。Joinpoint回归估计了年度百分比变化（APC）和平均年度百分比变化（AAPC）及其95%置信区间。配对比较评估了美国与全球趋势之间的差异。至2050年的死亡率预测采用既有的全球疾病负担预测框架生成。结果：1990至2023年，美国年龄标化死亡率下降44%，从每10万0.34降至0.19（AAPC：-1.70），而全球死亡率从1.46降至0.83（AAPC：-1.70）。全球死亡率在2020至2023年间上升（APC：2.06），与美国下降趋势不同。研究期间美国发病率下降（AAPC：-1.03），而全球基本稳定。然而，全球发病率在2020至2023年间上升（APC：3.86）。同样，美国患病率下降（AAPC：-0.81），而全球呈上升趋势（AAPC：0.74）。男性在所有指标上均持续表现出更高水平。配对比较显示美国与全球趋势之间存在显著差异。2023至2050年，全球NPC年龄标化死亡率预计上升12.05%（0.93，95%不确定性区间[UI]：0.75-1.16），由男性上升21.8%（1.45，95% UI：1.18-1.78）驱动，而女性下降11.76%（0.45，95% UI：0.33-0.63）。在美国，年龄标化死亡率预计上升10.5%（0.21，95% UI：0.18-0.23），其中男性上升17.9%（0.33，95% UI：0.29-0.37），女性下降11.82%（0.097，95% UI：0.08-0.12）。结论：美国NPC疾病负担已稳步下降，而全球模式显示患病率上升及近期死亡率增加。所观察到的疾病负担和时间趋势差异凸显了在高风险人群中进一步研究监测、早期发现和预防策略的重要性。

英文摘要

Nasopharyngeal carcinoma (NPC) is a rare but geographically concentrated malignancy. Long-term comparative analyses of NPC trends between the United States and global populations, particularly by sex, are limited. Using Global Burden of Disease 2023 data, we analyzed temporal trends in NPC incidence, prevalence, and mortality from 1990 to 2023 in the United States and worldwide. Age-standardized rates per 100,000 population were calculated. Joinpoint regression estimated annual percent changes (APCs) and average annual percent change (AAPC) with 95% confidence intervals. Pairwise comparisons assessed differences between United States and global trends. Mortality forecasts through 2050 were generated using the established Global Burden of Disease forecasting framework. From 1990 to 2023, US age-standardized mortality declined by 44%, from 0.34 to 0.19 per 100,000 (AAPC: -1.70), while global mortality decreased from 1.46 to 0.83 (AAPC: -1.70). Global mortality increased between 2020 and 2023 (APC: 2.06), unlike the US decline. The incidence rate declined in the United States over the study period (AAPC: -1.03), while remaining largely stable globally. However, global incidence increased between 2020 and 2023 (APC: 3.86). Similarly, prevalence decreased in the United States (AAPC: -0.81) while showing a rising trend worldwide (AAPC: 0.74). Males consistently exhibited higher rates across all measures. Pairwise comparisons showed significant differences between United States and global trends. From 2023 to 2050, global NPC age-standardized mortality rate is projected to increase by 12.05% (0.93, 95% uncertainty interval [UI]: 0.75-1.16), driven by a 21.8% rise in males (1.45, 95% UI: 1.18-1.78), while declining by 11.76% in females (0.45, 95% UI: 0.33-0.63). In the United States, age-standardized mortality rate is projected to increase by 10.5% (0.21, 95% UI: 0.18-0.23), with a 17.9% rise in males (0.33, 95% UI: 0.29-0.37) and an 11.82% decline in females (0.097, 95% UI: 0.08-0.12). US NPC burden has declined steadily, while global patterns show rising prevalence and recent mortality increases. The observed differences in burden and temporal trends underscore the importance of further research into strategies for surveillance, early detection, and prevention in high-risk populations.