Background

Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally.

Methods

The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented.

Findings

Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]).

Interpretation

The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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2010-19 年风险因素导致的全球癌症负担：2019 年全球疾病负担研究的系统分析

背景

了解可归因于潜在可改变风险因素的癌症负担的严重程度对于制定有效的预防和缓解策略至关重要。我们分析了 2019 年全球疾病、伤害和风险因素负担研究 (GBD) 的结果，为全球癌症控制规划工作提供信息。

方法

GBD 2019 比较风险评估框架用于估计归因于行为、环境和职业以及代谢风险因素的癌症负担。根据世界癌症研究基金会的标准，共纳入了 82 个风险-结果对。介绍了 2019 年估计的癌症死亡人数和伤残调整生命年 (DALYs)，以及 2010 年至 2019 年间这些措施的变化。

发现

在全球范围内，2019 年，该分析中包含的风险因素造成 4·45 百万（95% 不确定区间 4·01–4·94）死亡和 1.05 亿（95·0–116）男女残疾调整寿命年，占 44 ·所有癌症死亡的 4% (41·3–48·4) 和所有 DALYs 的 42·0% (39·1–45·6)。男性有 2·88 百万 (2·60–3·18) 风险归因癌症死亡（占所有男性癌症死亡的 50·6% [47·8–54·1]）和 1·58 百万 (1· 36–1·84) 女性的风险归因癌症死亡（占所有女性癌症死亡的 36·3% [32·5–41·3]）。2019 年全球可归因于风险的癌症死亡和 DALYs 的最详细级别的主要风险因素是吸烟，其次是饮酒和高 BMI。可归因于癌症的风险负担因世界地区和社会人口指数 (SDI) 而异，包括吸烟、不安全的性行为、和饮酒是 2019 年低 SDI 地区可归因于癌症 DALYs 的三大主要风险因素，而高 SDI 地区的 DALYs 反映了全球前三名风险因素排名。从 2010 年到 2019 年，全球风险归因癌症死亡增加了 20·4%（12·6–28·4），DALYs 增加了 16·8%（8·8–25·0），其中新陈代谢增加的百分比最大风险（34·7% [27·9–42·8] 和 33·3% [25·8–42·0]）。

解释

导致 2019 年全球癌症负担的主要风险因素是行为，而代谢风险因素在 2010 年至 2019 年间增幅最大。减少接触这些可改变的风险因素将降低全球癌症死亡率和 DALY 率，应适当调整政策以适应当地癌症危险因素负担。

资金

比尔和梅琳达·盖茨基金会。