Objective: From a screening-focused perspective, to analyze the 30-year changes in disability adjusted life years (DALYs) caused by colorectal cancer (CRC) in China and in some other selected populations, to inform extent of burden of CRC and future related prevention and control in populations in China. Methods: Based on the data of Global Burden of Disease 2019 (GBD 2019), the DALYs, world standardized DALY rate, and the composition of different subgroups in China were collected. Joinpoint regression model was used to analyze the trend during 1990-2019, and comparison was made with the international data and population screening situation. The trend of DALY burden caused by CRC in China was predicted. Results: In 2019, the DALYs due to CRC in China was 6.395 million person-years, accounting for 26.3% of the global burden and 9.5% of all cancers burden in China; the DALYs in men accounted for 65.2%, in those aged ≥65 years old accounted for 44.8%, in the age group recommended by local screening guidelines (40-75 years) accounted for 73.7%. The years lived with disability accounted for 4.8%. Compared with 1990, the CRC-caused DALYs in China increased by 181.5% in 2019. Factors with the largest increase in the attributable percentage were high Body Mass Index (151.1%), diet high in red meat (86.4%) and diet high in processed meat (78.8%), etc. For DALY rate, it was 245.6/100 000 in 1990 and 320.6/100 000 in 2019, an increase of 30.5%. For reference, Australia (began in 2006), the UK (2006), and Japan (1992), where CRC population-wide screening has been conducted, had decreases in DALY rate of 36.0%, 28.6%, and 17.8%, respectively. The predication of DALYs suggested that without continued expansion of population-based screening, the DALYs in China would reach 7.7 million person-year-9.1 million person-year by 2030, an increase of 19.9%-41.8% compared with 2019. Conclusions: The burden of CRC-caused DALYs in China increased over the past 30 years, and would become more serious because of population aging and the concomitant disability problem. The age range recommended by the current local screening guideline could theoretically include 70% of the population from which the DALYs burden originates, however, the real-world population screening coverage is still limited. The observed decline in CRC-related DALY rate in selected countries was substantially due to the implementation of mass screening, indicating the importance of speedily expanding the population coverage of CRC screening in China.
目的： 基于筛查干预视角，分析中国人群结直肠癌所致伤残调整寿命年（DALY）负担的现况、既往与未来，并行国际比较，为中国人群结直肠癌疾病负担及其筛查干预提供参考。 方法： 基于全球疾病负担研究（GBD）平台摘录数据，描述中国2019年结直肠癌所致DALY数、世标率及不同亚组值；通过Joinpoint回归模型，分析1990-2019年变化趋势，结合人群筛查情况行国际比较。进一步预测中国结直肠癌所致DALY负担未来变化趋势。 结果： 中国2019年结直肠癌所致DALY总数为639.5万人年，占全球结直肠癌负担的26.3%，占中国全部癌种负担的9.5%；其中男性DALY数占65.2%，≥65岁者占44.8%，与本土结直肠癌筛查指南推荐接近的年龄段（40~74岁）人群占73.7%，伤残损失寿命年（YLD）数占4.8%。相比1990年，2019年中国结直肠癌所致DALY总数增长了181.5%，有明确归因占比上升幅度最大的因素是高BMI、红肉摄入过量和加工肉制品摄入过量等（增幅依次为151.1%、86.4%和78.8%）。就结直肠癌所致DALY率，中国1990年为245.6/10万，2019年为320.6/10万，增幅达30.5%；作为参照，已开展全人群结直肠癌筛查的澳大利亚（2006年启动）、英国（2006年）和日本（1992年），DALY率降幅分别为36.0%、28.6%和17.8%。预测提示，若无继续扩大范围的人群筛查，2030年中国结直肠癌所致DALY总数将达766.6万人年~906.6万人年，较2019年将增加19.9%~41.8%。 结论： 中国结直肠癌所致DALY负担近30年持续增加，人口老龄化及伴随失能会使负担更重。目前本土推荐筛查年龄可覆盖七成DALY负担来源人群，但人群的实际筛查覆盖有限。其他国家结直肠癌所致DALY负担的下降与筛查开展密不可分，提示尽快扩大本土结直肠癌有效筛查覆盖率的重要性。.