基于GBD 2021的早发性癌症的负担和时间趋势-动脉网

The burden and temporal trend of early onset pancreatic cancer based on the GBD 2021

Nature 等信源发布 2025-01-30 14:19

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Abstract

摘要

In the context of the global increase in early-onset tumours, investigating the global disease burden caused by early-onset pancreatic cancer (EOPC) is imperative. Data on the burden of EOPC were obtained from the Global Burden of Disease Study 2021. A joinpoint regression model was used to analyse the temporal trend of the EOPC burden, and an age‒period‒cohort (APC) model was used to analyse the influence of age, period, and birth cohort on burden trends.

在全球早发性肿瘤增加的背景下，调查由早发性胰腺癌（EOPC）引起的全球疾病负担势在必行。EOPC负担的数据来自2021年全球疾病负担研究。使用连接点回归模型分析EOPC负担的时间趋势，并使用年龄段队列（APC）模型分析年龄，时期和出生队列对负担趋势的影响。

Globally, the number of EOPC cases increased from 24,480 to 42,254, and the number of deaths increased from 17,193 to 26,996 between 1990 and 2021. The results of the APC model showed that the burden of EOPC increases with increasing age, whereas the variations in period and cohort effects exhibited a complex pattern across different sociodemographic index regions.

。APC模型的结果表明，EOPC的负担随着年龄的增长而增加，而时期和队列效应的变化在不同的社会人口指数区域表现出复杂的模式。

Consequently, the disease burden of EOPC is increasing worldwide, highlighting the need for effective interventions..

因此，EOPC的疾病负担在全球范围内不断增加，突出了有效干预的必要性。。

Introduction

简介

In recent years, the incidence of cancer in the young population has increased significantly because of multiple factors, such as unhealthy dietary habits, sedentary lifestyles, and environmental exposures. Typically, cancers that occur in people younger than 50 years are defined as early-onset cancers.

近年来，由于不健康的饮食习惯，久坐的生活方式和环境暴露等多种因素，年轻人群的癌症发病率显着增加。通常，发生在50岁以下人群中的癌症被定义为早发性癌症。

. Among all tumours, early-onset tumours of the digestive system have the fastest increasing incidence, with the greatest increases in the incidences of tumours in the appendix, intrahepatic bile duct, and pancreas

在所有肿瘤中，消化系统早发性肿瘤的发病率增长最快，阑尾，肝内胆管和胰腺肿瘤的发病率增长最大

. Although pancreatic cancer is relatively uncommon globally in comparison with other malignancies, it ranks among the most lethal forms of cancer

尽管与其他恶性肿瘤相比，胰腺癌在全球范围内相对罕见，但它是最致命的癌症之一

. Research has shown that early-onset pancreatic cancer (EOPC) accounts for approximately 5%-12% of all pancreatic cancers, with the proportion still increasing

研究表明，早发性胰腺癌（EOPC）约占所有胰腺癌的5%〜12%，其比例仍在增加

. Compared with general pancreatic cancer, EOPC is more malignant and has a greater likelihood of metastasis

与普通胰腺癌相比，EOPC的恶性程度更高，转移的可能性更大

. In addition, due to social role conflicts, patients with EOPC face more difficulties, such as increased economic pressure caused by high medical costs and anxiety caused by illness

此外，由于社会角色冲突，EOPC患者面临更多困难，例如高昂的医疗费用造成的经济压力增加以及疾病引起的焦虑

. Therefore, more attention needs to be given to the management of EOPC.

因此，需要更加重视EOPC的管理。

Currently, research on the disease burden of EOPC has focused on a handful of countries, particularly high-income countries with well-established cancer registries and epidemiological databases

目前，关于EOPC疾病负担的研究集中在少数国家，特别是拥有完善的癌症登记和流行病学数据库的高收入国家

. Previous studies used data from the 2019 Global Burden of Disease (GBD) project, providing valuable references for the study of EOPC

先前的研究使用了2019年全球疾病负担（GBD）项目的数据，为EOPC的研究提供了有价值的参考

. However, we acknowledge the significant impact of COVID-19 outbreak in recent years worldwide, and the changes caused by epidemics may lead to certain time lags in our analysis of the burden of disease and may not fully reflect the latest health trends. Newer and more accurate data are therefore important for assessing the global disease burden of EOPC and for developing effective public health policies.

然而，我们承认近年来全球爆发新型冠状病毒肺炎的重大影响，流行病引起的变化可能导致我们对疾病负担的分析出现某些时间滞后，并且可能无法完全反映最新的健康趋势。。

On the other hand, the disease burden of EOPC not only varies with age but is also influenced by advances in diagnostic technology and differences in health status across generations. However, previous studies have failed to fully account for the interplay of age, period, and cohort effects. Age-period-cohort (APC) analysis is a statistical method that simultaneously examines the impact of age, period, and cohort effects, revealing the complex interactions that shape disease trends over time.

。然而，以前的研究未能充分考虑年龄，时期和队列效应的相互作用。年龄段队列（APC）分析是一种统计方法，可以同时检查年龄，时期和队列效应的影响，揭示随着时间的推移影响疾病趋势的复杂相互作用。

. Through APC analysis, we can not only determine the specific contributions of individual factors to evolving disease trends but also provide a scientific foundation for the development of targeted public health interventions.

通过APC分析，我们不仅可以确定个体因素对疾病发展趋势的具体贡献，还可以为制定有针对性的公共卫生干预措施提供科学基础。

The GBD 2021 database is a comprehensive, multinational, multidisciplinary health research program that aggregates the latest health data worldwide, including information on disease incidence, mortality, disability, and risk factors

GBD 2021数据库是一个全面的、多国的、多学科的健康研究项目，它汇总了全球最新的健康数据，包括疾病发病率、死亡率、残疾和风险因素的信息

. Numerous studies utilizing the GBD database have provided substantial evidence regarding the global disease burden, which plays a pivotal role in shaping global health policies, advancing disease research, and informing public health decision-making

。许多利用GBD数据库的研究提供了有关全球疾病负担的大量证据，这在制定全球卫生政策、推进疾病研究和为公共卫生决策提供信息方面起着关键作用

. This study described the disease burden of EOPC and analysed trends in the burden of EOPC from 1990 to 2021. In addition, we analysed the factors influencing the disease burden via APC analysis to provide new references for resource planning and health policy-making with respect to EOPC.

这项研究描述了EOPC的疾病负担，并分析了1990年至2021年EOPC负担的趋势。此外，我们通过APC分析分析了影响疾病负担的因素，为EOPC的资源规划和卫生政策制定提供了新的参考。

Results

结果

Global level

全球层面

Overall, the prevalence and mortality rates of EOPC increased rapidly (Fig.

总体而言，EOPC的患病率和死亡率迅速增加（图）。

and Table

和表

). The number of cases of EOPC nearly doubled from 24,480 (95% UI, 22,957 to 26,100) in 1990 to 42,254 (95% UI, 38,708 to 45,940) in 2021. The number of deaths caused by EOPC worldwide was 17,193 (95% UI, 16,038 to 18,465), with an ASDR of 0.75 deaths per 100,000 population (95% UI, 0.70 to 0.81) in 1990.

)。EOPC病例数量几乎翻了一番，从1990年的24480（95%用户界面，22957至26100）增加到2021年的42254（95%用户界面，38708至45940）。1990年，全世界EOPC造成的死亡人数为17193人（95%用户界面，16038至18465），每10万人口中有0.75人死亡（95%用户界面，0.70至0.81）。

By 2021, the number of deaths caused by EOPC reached 26,996 (95% UI, 24,481 to 29,699), but the ASDR decreased to 0.65 deaths per 100,000 population (95% UI, 0.59 to 0.72) (AAPC: −0.44 (95%CI:−0.58 to −0.30), .

到2021年，EOPC导致的死亡人数达到26996人（95%用户界面，24481至29699），但ASDR下降到每10万人口0.65人（95%用户界面，0.59至0.72）（AAPC:-0.44（95%置信区间：-0.58至-0.30）。

< 0.001). Compared with the ASDR, the ASPR remained stable (1.04 cases per 100,000 population (95% UI, 0.98 to 1.11) in 1990 to 1.03 cases per 100,000 population (95% UI, 0.94 to 1.12) in 2021 (AAPC: −0.09 (95% CI: −0.34 to 0.16),

与ASDR相比，ASPR保持稳定（1990年为每10万人1.04例（95%用户界面，0.98至1.11），2021年为每10万人1.03例（95%用户界面，0.94至1.12）（AAPC:-0.09（95%CI:-0.34至0.16），

> 0.05)) (Table

>>0.05））（表

Fig. 1: Trends in the burden of EOPC worldwide from 1990 to 2021.

图1:1990年至2021年全球EOPC负担的趋势。

Prevalence and the temporal trend in the ASPR of EOPC globally.

全球EOPC ASPR的患病率和时间趋势。

B类

Number of deaths and the temporal trend in the ASDR of EOPC; EOPC early-onset pancreatic cancer, ASPR age-standardized prevalence rate, ASDR age-standardized death rate.

EOPC ASDR的死亡人数和时间趋势；EOPC早发性胰腺癌，ASPR年龄标准化患病率，ASDR年龄标准化死亡率。

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Table 1 Global and regional burdens and temporal trends of EOPC in 1990 and 2021

表1 1990年和2021年EOPC的全球和区域负担及时间趋势

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Compared with females, males bear a greater burden. The number of EOPC cases in males accounted for 66.0% and 65.1% of the entire burden in 1990 and 2021, respectively. Specifically, the global number of EOPC cases was 16,166 (95% UI, 14,955 to 17,406) in males and 8314 (95% UI, 7644 to 9167) in females in 1990 (Fig.

与女性相比，男性承受更大的负担。1990年和2021年，男性EOPC病例分别占整个负担的66.0%和65.1%。具体而言，1990年全球EOPC病例数为男性16166例（95%UI，14955至17406），女性8314例（95%UI，7644至9167）。

and Table

和表

). By 2021, the global number of cases was 27,518 (95% UI, 24,660 to 30,757) for males and 14,736 (95% UI, 13,530 to 15,976) for females. The observed trend in the ASPR for both sexes aligned with the stability noted in the overall ASPR of EOPC. The number of deaths caused by EOPC increased from 1990 to 2021 in males (from 11,593 to 18,251) and females (from 5600 to 8744) (Fig.

)。到2021年，全球男性病例数为27518例（95%用户界面，24660至30757），女性病例数为14736例（95%用户界面，13530至15976）。观察到的两性ASPR趋势与EOPC总体ASPR中的稳定性一致。。

). Nevertheless, the ASDR of EOPC decreased in both males (from 1.00 to 0.88 deaths per 100,000 population; AAPC = -0.40 (95% CI: -0.52 to -0.28),

)。，

< 0.001) and females (from 0.50 to 0.43 deaths per 100,000 population; AAPC = -0.52 (95% CI: -0.64 to -0.39),

<0.001）和女性（每10万人死亡人数从0.50降至0.43；AAPC下降=-0.52（95%CI:0.64至-0.39），

< 0.001) between 1990 and 2021. In terms of age, both the number of cases of EOPC and the number of deaths caused by EOPC increased with age. The age group with the highest prevalence of and number of deaths caused by EOPC was the 45–49-year-old group in both 1990 and 2021 (Fig.

<0.001）在1990年至2021年之间。就年龄而言，EOPC病例数和EOPC引起的死亡人数都随着年龄的增长而增加。EOPC发病率和死亡人数最高的年龄组是1990年和2021年的45-49岁年龄组（图）。

Fig. 2: Burden of EOPC in 1990 and 2021 in the global and five SDI regions stratified by age and sex.

。

Prevalence of EOPC in 1990 and 2021 in the global and five SDI regions stratified by age and sex.

1990年和2021年全球和五个SDI地区EOPC的患病率按年龄和性别分层。

B类

Death of EOPC in 1990 and 2021 in the global and five SDI regions stratified by age and sex. The bar chart shows the number of burdens in the five SDI regions by age, and the line chart shows the crude rate of EOPC by age. EOPC early-onset pancreatic cancer, SDI sociodemographic index.

1990年和2021年，全球和五个SDI地区的EOPC死亡按年龄和性别分层。条形图按年龄显示了五个SDI地区的负担数量，折线图按年龄显示了EOPC的粗率。EOPC早发性胰腺癌，SDI社会人口指数。

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Regional level

区域层面

When stratified by the SDI, the highest ASPR (1.97 cases per 100,000 population [95% UI: 1.87 to 2.07]) of EOPC was observed in the high-SDI region, whereas the highest ASDR (1.09 deaths per 100,000 population [95% UI: 0.94 to 1.25]) was observed in the high-middle-SDI region in 2021 (Table

按SDI分层时，在高SDI地区观察到EOPC的最高ASPR（每100000人中有1.97例[95%UI:1.87至2.07]），而在2021年，在中高SDI地区观察到最高ASDR（每100000人中有1.09例死亡[95%UI:0.94至1.25]）

and Fig.

和图。

). Between 1990 and 2021, the ASPR of the low-middle-SDI region increased the fastest (AAPC: 1.26 (95% CI: 1.18 to 1.33),

)。在1990年至2021年之间，SDI中低地区的ASPR增长最快（AAPC:1.26（95%CI:1.18至1.33），

< 0.001), as did the ASDR (AAPC: 1.11 (95% CI: 1.04 to 1.18),

<0.001），ASDR也是如此（AAPC:1.11（95%置信区间：1.04至1.18），

< 0.001) (Table

<×0.001）（表

). Notably, the ASDR decreased significantly in the high- and high-middle-SDI regions, but the ASDR still increased in the low- and low-middle-SDI regions. Among the 21 regions, the highest ASPR of EOPC was in Western Europe (2.37 cases per 100,000 population [95% UI: 2.17 to 2.58]), followed by high-income North America (2.01 cases per 100,000 population [95% UI: 1.92 to 2.11]) and Eastern Europe (1.95 cases per 100,000 population [95% UI: 1.75 to 2.17]) in 2021 (Table .

)。值得注意的是，ASDR在高SDI和高中SDI区域显着下降，但在低SDI和中低SDI区域ASDR仍然增加。在21个地区中，2021年EOPC的ASPR最高的是西欧（每10万人口2.37例[95%用户界面：2.17至2.58]），其次是高收入北美（每10万人口2.01例[95%用户界面：1.92至2.11]）和东欧（每10万人口1.95例[95%用户界面：1.75至2.17]）（表）。

). In 14 of the 21 regions, the ASPR of EOPC increased significantly, with the fastest growth observed in western sub-Saharan Africa (AAPC: 1.99, 95% CI: 1.86 to 2.13,

)。在21个地区中的14个地区，EOPC的ASPR显着增加，撒哈拉以南非洲地区增长最快（AAPC:1.99，95%CI:1.86至2.13，

< 0.001) from 1990 to 2021. East Asia is one of the most densely populated regions in the world and reported 13,332 cases of EOPC (95% UI: 10,457 to 16,574), accounting for nearly one-third of the global cases in 2021. The burden of mortality attributable to EOPC was also concentrated in East Asia (9199 [95% UI: 7166 to 11,521]).

<0.001）从1990年到2021年。东亚是世界上人口最稠密的地区之一，报告了13332例EOPC（95%用户界面：10457至16574），占2021年全球病例的近三分之一。EOPC的死亡率负担也集中在东亚（9199[95%用户界面：7166至11521]）。

However, when counts were adjusted to age-standardized rates, the highest ASDR was observed in Eastern Europe (1.43 deaths per 100,000 population [95% UI: 1.28 to 1.59]), whereas the region with the lowest ASPR in 2021 was South Asia (0.21 cases per 100,000 population [95% UI: 0.18 to 0.25]). The ASDR of EOPC continued to increase in most regions but decreased significantly in Central Europe, high-income Asia Pacific, Western Europe, and high-income North America..

然而，当将计数调整到年龄标准化率时，东欧的ASDR最高（每10万人中有1.43人死亡[95%用户界面：1.28至1.59]），而2021年ASPR最低的地区是南亚（每10万人中有0.21例[95%用户界面：0.18至0.25]）。EOPC的ASDR在大多数地区继续增加，但在中欧、亚太高收入地区、西欧和北美高收入地区则显著下降。。

National level

国家层面

France had the highest ASPR of EOPC (4.63 cases per 100,000 population (95% UI: 3.75 to 5.69)), followed by Germany (3.68 cases per 100,000 population (95% UI: 2.99 to 4.44)) and Monaco (3.03 cases per 100,000 population (95% UI: 1.45 to 5.14)) in 2021 (Fig.

2021年，法国EOPC的ASPR最高（每10万人中有4.63例（95%用户界面：3.75至5.69）），其次是德国（每10万人中有3.68例（95%用户界面：2.99至4.44））和摩纳哥（每10万人中有3.03例（95%用户界面：1.45至5.14））。

and Supplementary Table

和补充表

). Ukraine had the highest ASDR of EOPC (1.60 deaths per 100,000 population (95% UI: 1.06 to 2.23)), followed by Monaco (1.50 deaths per 100,000 population (95% UI: 0.73 to 2.51)) and Mongolia (1.44 deaths per 100,000 population (95% UI: 1.02 to 1.96)) in 2021. Conversely, Mozambique had both the lowest ASPR (0.09 cases per 100,000 population (95% UI: 0.05 to 0.13)) and ASDR (0.07 deaths per 100,000 population (95% UI: 0.05 to 0.12)) in 2021.

)。2021年，乌克兰的EOPC ASDR最高（每10万人口死亡1.60人（95%用户界面：1.06至2.23）），其次是摩纳哥（每10万人口死亡1.50人（95%用户界面：0.73至2.51））和蒙古（每10万人口死亡1.44人（95%用户界面：1.02至1.96））。相反，2021年，莫桑比克的ASPR最低（每10万人口0.09例（95%用户界面：0.05至0.13））和ASDR（每10万人口0.07例死亡（95%用户界面：0.05至0.12））。

Owing to its large population, China reported the highest number of cases (12,831 (95% UI: 9,956 to 16,072)) and deaths (8,887 (95% UI: 6,853 to 11,204)) globally in 2021. From 1990 to 2021, the temporal trend of EOPC presented significant variation across countries and territories. Between 1990 and 2021, the ASPR of EOPC significantly increased in 129 countries (territories), whereas it decreased in 20 countries (territories).

由于人口众多，中国报告的2021年全球病例数（12831例（95%用户界面：9956至16072））和死亡人数（8887例（95%用户界面：6853至11204））最高。从1990年到2021年，EOPC的时间趋势在国家和地区之间呈现出显着差异。1990年至2021年间，EOPC的ASPR在129个国家（地区）显着增加，而在20个国家（地区）下降。

The countries with the fastest increase in the ASPR (AAPC: 9.65 (95% CI: 7.51 to 11.83), .

ASPR增长最快的国家（AAPC:9.65（95%CI:7.51至11.83）。

< 0.001) were in Turkmenistan. The countries with the fastest decrease in the ASPR (AAPC: -1.59 (95% CI: -1.78 to -1.40),

<0.001）在土库曼斯坦。ASPR下降最快的国家（AAPC：-1.59（95%置信区间：-1.78至-1.40），

< 0.001) were in Poland. Only 40 of the 204 countries (territories) presented a decrease in the ASDR of EOPC. The country with the fastest decrease in the ASDR was Luxembourg (AAPC: -2.07 (95% CI: -2.76 to -1.37),

<0.001）在波兰。204个国家（地区）中只有40个国家（地区）的EOPC ASDR有所下降。ASDR下降最快的国家是卢森堡（AAPC：-2.07（95%置信区间：-2.76至-1.37），

< 0.001).

（0.001）

Fig. 3: World maps of the burden of EOPC in 2021 and temporal trends between 1990 to 2021.

图3:2021年EOPC负担的世界地图以及1990年至2021年的时间趋势。

ASPR of EOPC in 2021; (

2021年EOPC的ASPR；(

B类

) AAPC in the ASPR of EOPC 1990 to 2021; (

)1990年至2021年EOPC ASPR中的AAPC；（笑声）(

C级

) ASDR of EOPC in 2021; (

2021年EOPC的ASDR；（

) AAPC in the ASDR of EOPC from 1990 to 2021. AAPC average annual percentage change, EOPC early-onset pancreatic cancer, ASPR age-standardized prevalence rate, ASDR age-standardized death rate.

)1990年至2021年EOPC ASDR中的AAPC。AAPC平均年百分比变化，EOPC早发性胰腺癌，ASPR年龄标准化患病率，ASDR年龄标准化死亡率。

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Age-period-cohort analysis of the EOPC burden

EOPC负担的年龄段队列分析

The net drifts (%) of the global EOPC prevalence and mortality rates (per 100,000 population) were -0.07 (95% CI: -0.18, 0.03) and -0.61 (95% CI: -0.75, -0.46), respectively, indicating that the prevalence of EOPC remained stable and that the mortality rate decreased significantly (Fig.

全球EOPC患病率和死亡率（每10万人口）的净漂移（%）分别为-0.07（95%CI：-0.18,0.03）和-0.61（95%CI：-0.75，-0.46），表明EOPC的患病率保持稳定，死亡率显着下降（图）。

). In terms of specific ages and SDI regions, the results of the local drift analysis differed from those of the global trend analysis. Similar to the findings from the joinpoint regression, the mortality rates decreased in regions with high SDIs, whereas both prevalence and mortality rates continued to increase in areas with low SDIs.

)。就特定年龄和SDI地区而言，局部漂移分析的结果与全球趋势分析的结果不同。与joinpoint回归的结果类似，SDI高的地区死亡率下降，而SDI低的地区的患病率和死亡率继续上升。

These findings suggest that high-SDI regions have made significant progress in cancer prevention and control, whereas low-SDI regions continue to face challenges in addressing the cancer disease burden. With the period and cohort effects controlled for, the prevalence and mortality rates of EOPC both increased with age.

这些发现表明，高SDI地区在癌症预防和控制方面取得了重大进展，而低SDI地区在解决癌症疾病负担方面继续面临挑战。随着时期和队列效应的控制，EOPC的患病率和死亡率均随着年龄的增长而增加。

The period effect results revealed that the period effect of prevalence remained almost unchanged and that the period effect of death significantly decreased at the global level from 1992 to 2021 (Supplementary Fig. .

周期效应结果显示，从1992年到2021年，流行率的周期效应几乎保持不变，死亡的周期效应在全球范围内显着下降（补充图）。

). Regions with high SDIs experienced a significant risk of increased prevalence prior to 2011. In contrast, the risk of increased prevalence in regions with low SDIs was not significant between 1992 and 2006 but exhibited dramatic increases after 2006 (Supplementary Fig.

)。SDI高的地区在2011年之前经历了患病率增加的重大风险。相比之下，1992年至2006年间，SDIs低的地区患病率增加的风险并不显着，但在2006年后表现出急剧增加（Supplementary Fig.）。

). For the risk of death, high-SDI areas showed a downwards trend, whereas low-SDI areas showed an increasing trend. Similar to the period effect, in regions with high SDIs, as the birth year shifted backwards, the prevalence risk initially increased significantly and then remained stable. The increased prevalence and death risk associated with EOPC continued to increase among birth cohorts in low- and low-middle-SDI regions (Supplementary Fig.

)。对于死亡风险，高SDI地区呈下降趋势，而低SDI地区呈上升趋势。与时期效应类似，在SDI较高的地区，随着出生年份的向后移动，患病风险最初显着增加，然后保持稳定。在中低SDI地区的出生队列中，与EOPC相关的患病率和死亡风险增加继续增加（Supplementary Fig.）。

Fig. 4: Local drift with net drift of EOPC globally and in the five SDI regions.

图4：全球和五个SDI地区EOPC净漂移的局部漂移。

Prevalence, (

患病率(

B类

) Mortality. EOPC early-onset pancreatic cancer, SDI sociodemographic index.

)死亡率。EOPC早发性胰腺癌，SDI社会人口指数。

Full size image

全尺寸图像

Discussion

讨论

In this study, we found that both the global number of prevalent cases and deaths increased dramatically between 1990 and 2021. However, when the counts were transformed to age-standardized rates, the overall global ASPR remained stable, and the ASDR showed a downwards trend. During this period, the disease burden distribution and temporal trend of EOPC significantly differed across countries and regions..

在这项研究中，我们发现1990年至2021年间，全球流行病例和死亡人数急剧增加。然而，当计数转换为年龄标准化率时，全球总体ASPR保持稳定，ASDR呈下降趋势。在此期间，EOPC的疾病负担分布和时间趋势在不同国家和地区之间存在显着差异。。

The burden of EOPC presented a rapid increasing trend and increased with age, similar to the growth pattern of overall pancreatic cancer burden worldwide

EOPC的负担呈快速增加趋势，并随着年龄的增长而增加，类似于全球胰腺癌总体负担的增长模式

. When the oldest EOPC patients were born, the world population was approximately 2.5 billion; the current world population is around 8 billion, which is more than three times the number in the mid-20th century

.当年龄最大的EOPC患者出生时，世界人口约为25亿；目前世界人口约为80亿，是20世纪中叶的三倍多

. This significant increase in the population means that more people may be at risk for pancreatic cancer, especially high-risk individuals with a family history or genetic predisposition. Moreover, some modifiable dietary habits and lifestyle changes have also contributed significantly to the increasing burden of EOPC.

人口的显著增加意味着更多的人可能有患胰腺癌的风险，尤其是有家族史或遗传易感性的高危人群。此外，一些可改变的饮食习惯和生活方式的改变也大大增加了EOPC的负担。

In terms of diet, the consumption of processed foods by the general public has increased significantly due to convenience and ease of storage. Excessive consumption of processed foods and sedentary behaviour are strongly associated with the development of pancreatic cancer.

在饮食方面，由于方便和易于储存，普通公众对加工食品的消费量显着增加。过度食用加工食品和久坐行为与胰腺癌的发展密切相关。

. Compared with middle-aged and elderly individuals, younger individuals are more significantly influenced by these factors, leading to a higher incidence of obesity and metabolic-related diseases

与中老年人相比，年轻人受这些因素的影响更大，导致肥胖和代谢相关疾病的发生率更高

. Obesity has long been recognized as an important risk factor for many different types of tumours

长期以来，肥胖一直被认为是许多不同类型肿瘤的重要危险因素

. Being overweight, especially in early adulthood, is strongly associated with a younger age at diagnosis of pancreatic cancer

。超重，尤其是在成年早期，与诊断为胰腺癌的年龄较小密切相关

. With respect to sex, the burden of EOPC was greater among males than females. Putative explanations include differences in health behaviours and awareness, such as smoking and drinking habits

在性别方面，男性的EOPC负担大于女性。假定的解释包括健康行为和意识的差异，例如吸烟和饮酒习惯

. Tobacco consumption is an important risk factor for pancreatic cancer, and its role in EOPC has also been widely recognized

烟草消费是胰腺癌的重要危险因素，其在EOPC中的作用也得到了广泛认可

. Worldwide, the proportion of males who smoke and drink greatly exceeds that of females

.在世界范围内，吸烟和饮酒的男性比例大大超过女性

Previous studies have demonstrated a correlation between pancreatic cancer incidence and socioeconomic development, a pattern further corroborated by our study, which revealed that high-income regions bear the primary burden of EOPC

先前的研究表明，胰腺癌发病率与社会经济发展之间存在相关性，我们的研究进一步证实了这种模式，该研究表明，高收入地区承担了EOPC的主要负担

. The accumulation of risk factors and early screening are important reasons for the higher prevalence of EOPC in regions with higher SDIs. In terms of obesity, the prevalence of central obesity is 44.7% in high-income countries but only 30.6% in low-income countries

。危险因素的积累和早期筛查是SDI较高地区EOPC患病率较高的重要原因。就肥胖而言，高收入国家中心性肥胖的患病率为44.7%，而低收入国家仅为30.6%

. In addition, high-income areas have more abundant medical resources for rapid pancreatic imaging and regular pancreatic monitoring, which may help identify individuals with EOPC. However, we noted a significant international disparity: the growth rate in the prevalence in lower-SDI countries exceeded that in higher-SDI regions.

此外，高收入地区拥有更丰富的医疗资源，可用于快速胰腺成像和定期胰腺监测，这可能有助于识别EOPC患者。然而，我们注意到一个巨大的国际差距：SDI较低国家的患病率增长率超过了SDI较高地区的增长率。

This observation highlights differences in the effectiveness of cancer prevention strategies in terms of their formulation and implementation across countries. Specifically, smoking is a major risk factor for pancreatic cancer, and bans and health education related to smoking behaviours have been shown to be effective in reducing the incidence of pancreatic cancer.

这一观察结果突出了各国癌症预防策略在制定和实施方面的有效性差异。。

. As early as 2009, the World Health Organization recommended that countries implement comprehensive smoke-free policies, but such tobacco control measures were implemented only in a small number of high- and middle-income countries. Under this initiative, the smoking rate among individuals aged 22 to 23 years decreased significantly from 74.6% in 2002 to 51.4% in the United States in 2018, highlighting the effectiveness of such policies.

早在2009年，世界卫生组织就建议各国实施全面的无烟政策，但这种控烟措施仅在少数高收入和中等收入国家实施。根据这一举措，22至23岁人群的吸烟率从2002年的74.6%显着下降到2018年美国的51.4%，突显了这些政策的有效性。

. However, according to the latest edition of the 2023 report on the global tobacco epidemic, the rigor of tobacco control policies in some low-income countries remains inadequate because of insufficient policy enforcement and poor public health awareness

然而，根据最新版的2023年全球烟草疫情报告，由于政策执行不足和公共卫生意识差，一些低收入国家的烟草控制政策仍然不够严格

. In addition, limited health expenditures significantly hamper cancer control efforts in low- and middle-income countries (LMICs). For example, in 2021, 17.4% of the gross domestic product in the United States was allocated to health, compared with only 4.23% in low-income countries such as Armenia.

此外，有限的卫生支出严重阻碍了中低收入国家（LMICs）的癌症控制工作。例如，2021年，美国国内生产总值的17.4%用于医疗保健，而亚美尼亚等低收入国家只有4.23%。

. Insufficient health spending restricts access to high-quality cancer screening and treatment services, causing many patients to miss critical opportunities for early detection and effective treatment

.卫生支出不足限制了获得高质量癌症筛查和治疗服务的机会，导致许多患者错过了早期发现和有效治疗的关键机会

Pancreatic cancer is an extremely malignant cancer with a low 5-year survival rate. Surgery is currently the only effective way for pancreatic cancer patients to potentially be cured and have long-term survival

胰腺癌是一种恶性程度极高的癌症，5年生存率较低。手术是目前胰腺癌患者治愈和长期生存的唯一有效方法

. In higher-SDI regions, advanced health care infrastructure, including imaging technologies and early detection protocols, allows for timely surgical interventions, which reduce the risk of death. In the United States, owing to the robust medical foundation and early diagnostic technology, the proportion of patients diagnosed with stage IA pancreatic ductal adenocarcinoma has increased, enabling more patients to undergo surgical resection, which has notably increased their overall survival rate.

。在美国，由于强大的医学基础和早期诊断技术，诊断为IA期胰腺导管腺癌的患者比例有所增加，使更多患者能够接受手术切除，这显着提高了他们的总生存率。

. On the other hand, radiotherapy plays a crucial role in the treatment of pancreatic cancer and is relatively common as a supplementary treatment in developed countries. Radiotherapy can not only be used as an adjuvant treatment before and after surgery to improve the surgical resection rate and pathological response but also provide palliative treatment to alleviate symptoms and improve quality of life for patients with locally advanced and metastatic pancreatic cancer.

另一方面，放射治疗在胰腺癌的治疗中起着至关重要的作用，在发达国家作为辅助治疗相对普遍。放疗不仅可以作为手术前后的辅助治疗，提高手术切除率和病理反应，还可以为局部晚期和转移性胰腺癌患者提供姑息治疗，缓解症状，提高生活质量。

. However, compared with developed countries, LMICs often face limited treatment options because of the lack of medical resources. In particular, there is a serious shortage of radiotherapy equipment in many LMICs. According to a survey, 51 out of 137 LMICs (37.3%) currently lack radiotherapy facilities.

然而，与发达国家相比，由于缺乏医疗资源，中低收入国家往往面临有限的治疗选择。特别是，许多中低收入国家严重缺乏放射治疗设备。根据一项调查，137个中低收入国家中有51个（37.3%）目前缺乏放射治疗设施。

. This shortage means that even when patients are diagnosed, it is difficult for them to receive standard radiotherapy, affecting their chances of receiving the best possible treatment. Furthermore, treatment options such as precision medicine, targeted therapy, and immunotherapy in high-income countries offer patients with pancreatic cancer more choices for treatment, significantly increasing their survival and quality of life.

这种短缺意味着，即使患者被诊断出，他们也很难接受标准的放射治疗，从而影响了他们接受最佳治疗的机会。此外，高收入国家的精准医学，靶向治疗和免疫治疗等治疗选择为胰腺癌患者提供了更多的治疗选择，大大提高了他们的生存率和生活质量。

. Furthermore, it is important to consider the potential impact of the COVID-19 pandemic on the epidemiology of EOPC. Many countries reported sharp decreases in cancer diagnoses and screenings at the peak of the COVID-19 pandemic. For example, the number of newly diagnosed cancers in South Korea decreased by 3.6% in 2020 compared with 2019.

此外，重要的是要考虑新型冠状病毒肺炎大流行对EOPC流行病学的潜在影响。许多国家报告说，在新型冠状病毒大流行高峰期，癌症诊断和筛查急剧下降。例如，与2019年相比，2020年韩国新诊断的癌症数量减少了3.6%。

. The situation was similar in the UK, where approximately 3.4 million fewer key cancer diagnostic tests—such as endoscopy, CT imaging, ultrasound, and MRI—were conducted between March and August 2020 than in the same period in 2019, representing a 35% decrease

。英国的情况类似，2020年3月至8月期间，进行的内窥镜检查，CT成像，超声波和MRI等关键癌症诊断测试比2019年同期减少了约340万次，减少了35%

. This could have influenced the reported trends in the EOPC burden. While the decrease in the ASDR is significant, it is crucial to acknowledge that the effects of the pandemic on health care access and disease reporting may have contributed to this trend.

。这可能会影响EOPC负担的报告趋势。虽然ASDR的下降幅度很大，但至关重要的是要承认，大流行对医疗保健和疾病报告的影响可能促成了这一趋势。

In recent years, the field of pancreatic cancer screening has expanded significantly, involving biomarkers, imaging omics, and genetic mutation detection

近年来，胰腺癌筛查领域得到了显着扩展，涉及生物标志物，成像组学和基因突变检测

. Research on biomarkers such as CA19-9, circulating tumour DNA, and exosomal proteins has shown promise for the noninvasive early diagnosis of pancreatic cancer, their sensitivity and specificity remain insufficient for widespread early screening

对CA19-9，循环肿瘤DNA和外泌体蛋白等生物标志物的研究已显示出无创早期诊断胰腺癌的前景，其敏感性和特异性仍不足以进行广泛的早期筛查

. Artificial intelligence (AI) is increasingly revolutionizing the early diagnosis of various diseases. By leveraging deep learning to analyse imaging data (including computed tomography and endoscopic ultrasound), AI has significantly increased the detection rate of EOPC, offering new possibilities and directions for improving pancreatic cancer screening.

人工智能（AI）正在日益彻底改变各种疾病的早期诊断。通过利用深度学习分析成像数据（包括计算机断层扫描和内窥镜超声），AI显着提高了EOPC的检出率，为改善胰腺癌筛查提供了新的可能性和方向。

. In addition, recent research has revealed that EOPC presents unique molecular features that distinguish it from late-onset pancreatic cancer, including CDKN2A, BRCA2, and PALB2 mutations

此外，最近的研究表明，EOPC具有独特的分子特征，可将其与迟发性胰腺癌区分开来，包括CDKN2A，BRCA2和PALB2突变

. These molecular insights provide a foundation for developing targeted screening strategies tailored to EOPC, potentially improving early detection rates in this unique subgroup. However, the relatively low incidence of pancreatic cancer in the general population makes mass screening inefficient and costly.

这些分子见解为开发针对EOPC的靶向筛选策略奠定了基础，有可能提高这一独特亚组的早期检出率。然而，普通人群中胰腺癌的发病率相对较低，使得大规模筛查效率低下且成本高昂。

Current guidelines recommend screening in high-risk populations, including patients with germline mutations or a family history of pancreatic cancer, mucinous cysts, new-onset diabetes, and pancreatitis.

目前的指南建议对高危人群进行筛查，包括具有种系突变或胰腺癌家族史，粘液性囊肿，新发糖尿病和胰腺炎的患者。

. In particular, patients with inherited pancreatitis caused by PRSS1 mutations are at significantly greater risk of developing pancreatic cancer and should start screening at age 40

。特别是，由PRSS1突变引起的遗传性胰腺炎患者患胰腺癌的风险明显更高，应在40岁时开始筛查

. This finding is consistent with our finding that the risk of EOPC increases with age, with individuals aged 40 to 49 years being the primary group bearing the burden of EOPC. Therefore, in the future, 40 years of age should be considered the age at which EOPC screening is initiated, which may be helpful in reducing the burden of disease.

。这一发现与我们的发现一致，即EOPC的风险随着年龄的增长而增加，40至49岁的人是EOPC的主要负担人群。因此，未来，40岁应被视为EOPC筛查开始的年龄，这可能有助于减轻疾病负担。

The formulation and implementation of cancer prevention and control strategies are based on the following four key elements: the identification and intervention of risk factors, the early detection and diagnosis of cancer, cancer treatment and palliative care. Overall, the investment and effectiveness in the above four aspects are significantly better in high-income countries than in LMICs, which may be the main reason for the difference in the burden of pancreatic cancer.

癌症预防和控制策略的制定和实施基于以下四个关键要素：风险因素的识别和干预，癌症的早期发现和诊断，癌症治疗和姑息治疗。总体而言，高收入国家在上述四个方面的投资和有效性明显优于中低收入国家，这可能是胰腺癌负担差异的主要原因。

Therefore, promoting the implementation of cancer prevention and control policies in LMICs and narrowing the gap in these fields are important directions for reducing the burden in the future. Especially in areas with low SDIs, prioritizing early screening programs is critical for increasing the early detection of EOPC.

因此，促进中低收入国家癌症预防和控制政策的实施，缩小这些领域的差距，是未来减轻负担的重要方向。特别是在SDI较低的地区，优先考虑早期筛查计划对于增加EOPC的早期发现至关重要。

In addition, high-income countries could offer funding, technical support, and opportunities to help low-income regions enhance screening capacity and ensure the accessibility of screening equipment and medications. Through cooperation with high-income countries and international organizations, low-income countries can learn from their successful experiences and advanced management models in cancer prevention and control and rapidly increase their level of prevention and control..

此外，高收入国家可以提供资金、技术支持和机会，帮助低收入地区提高筛查能力，确保筛查设备和药物的可及性。通过与高收入国家和国际组织的合作，低收入国家可以借鉴其在癌症预防控制方面的成功经验和先进管理模式，迅速提高其预防控制水平。。

This study described the global geographic distribution and temporal trends of EOPC between 1990 and 2021 using data from the newly updated GBD 2021 database. We acknowledge that several factors may have influenced the trends observed in this study. First, the major limitation of the GBD analysis of the burden of diseases and injuries is the lack of primary data.

这项研究使用最新更新的GBD 2021数据库中的数据描述了1990年至2021年间EOPC的全球地理分布和时间趋势。我们承认，有几个因素可能影响了本研究中观察到的趋势。首先，GBD分析疾病和伤害负担的主要局限性是缺乏主要数据。

Differences in the level of health care in different countries and regions, especially in LMICs, can lead to incomplete EOPC registration, causing bias in the burden of disease of EOPC. When data are not available, the results depend on the out-of-sample predictive validity of the model efforts. Notably, the COVID-19 pandemic had a profound impact on health care systems, diagnostic practices, and disease reporting.

不同国家和地区，特别是中低收入国家，医疗保健水平的差异可能导致EOPC登记不完整，从而导致EOPC疾病负担的偏差。。值得注意的是，新型冠状病毒肺炎对医疗保健系统，诊断实践和疾病报告产生了深远的影响。

This may have led to delays in diagnosis and changes in disease burden estimates. These disruptions could influence the reported disease trends. Therefore, when interpreting the results of this study, caution must be exercised and the potential confounding effects of the COVID-19 pandemic must be considered.

这可能导致诊断延误和疾病负担估计的变化。这些中断可能会影响报告的疾病趋势。因此，在解释这项研究的结果时，必须谨慎行事，并且必须考虑COVID-19大流行的潜在混杂影响。

Second, there are different pathological types and clinical stages of pancreatic cancer, but we only evaluated the overall disease burden of EOPC, and the other types and stages should be investigated in future studies. Moreover, we did not assess the contribution of risk factors to the burden of EOPC; genetic susceptibility, environmental exposure, and lifestyle factors are critical contributors to EOPC..

其次，胰腺癌有不同的病理类型和临床阶段，但我们仅评估了EOPC的总体疾病负担，其他类型和阶段应在未来的研究中进行调查。此外，我们没有评估风险因素对EOPC负担的贡献；遗传易感性，环境暴露和生活方式因素是EOPC的关键因素。。

In conclusion, the global burden of EOPC has increased over the past three decades, with notable variances between regions and countries. It is imperative to intensify prevention efforts by improving the management of EOPC, particularly in countries and regions with high disease burdens and relatively underdeveloped economies..

总之，EOPC的全球负担在过去三十年中有所增加，各地区和国家之间存在显着差异。必须通过改进EOPC的管理来加强预防工作，特别是在疾病负担高和经济相对不发达的国家和地区。。

Methods

方法

Data source

数据源

The GBD 2021 database provides a comprehensive and reliable assessment of the incidence rates, mortality rates, and risk factors for 371 diseases and injuries (including pancreatic cancer) in 204 countries and territories from 1990 to 2021

GBD 2021数据库对1990年至2021年204个国家和地区371种疾病和伤害（包括胰腺癌）的发病率、死亡率和危险因素进行了全面可靠的评估

. This study used the Global Health Data Exchange online website (

。这项研究使用了全球健康数据交换在线网站(

https://ghdx.healthdata.org/gbd-2021

) to retrieve and download raw data about EOPC.

)检索和下载有关EOPC的原始数据。

Definition of EOPC

EOPC的定义

EOPC is defined as pancreatic cancer that occurs in young people, but there is currently no consensus on the exact age range of people affected by EOPC. The definition of EOPC varies among studies, with some considering EOPC as occurring in individuals younger than 50 years, while others set the upper age limit at 45 or even 40 years.

EOPC被定义为发生在年轻人中的胰腺癌，但目前对受EOPC影响的人的确切年龄范围尚无共识。EOPC的定义因研究而异，一些研究认为EOPC发生在50岁以下的个体中，而另一些研究则将年龄上限设定为45岁甚至40岁。

. Considering the age structure used in the GBD 2021 database, we defined pancreatic cancer that occurred in the 15–49-year age group as EOPC. Pancreatic cancer was diagnosed according to the International Classification of Diseases (ICD) classification criteria, including the ICD-9 (157–157.9, 211.6–211.7) and the ICD-10 (C25-C25.9, D13.6-D13.7) criteria..

考虑到GBD 2021数据库中使用的年龄结构，我们将发生在15-49岁年龄组的胰腺癌定义为EOPC。根据国际疾病分类（ICD）分类标准诊断胰腺癌，包括ICD-9（157-157.9211.6-211.7）和ICD-10（C25-C25.9，D13.6-D13.7）标准。。

Measures of disease burden and the sociodemographic index (SDI)

疾病负担和社会人口指数（SDI）的测量

Two measures were used to assess the burden of EOPC in this research: prevalence and mortality. The prevalence of EOPC refers to the number of existing cases in the current year, whereas mortality refers to the number of deaths caused by EOPC per year. These rates were calculated by dividing the number of cases or deaths by the size of the population.

在这项研究中，使用了两种方法来评估EOPC的负担：患病率和死亡率。EOPC的患病率是指当年现有病例的数量，而死亡率是指每年由EOPC引起的死亡人数。这些比率是通过将病例数或死亡人数除以人口规模来计算的。

GBD estimates and corresponding 95% uncertainty intervals (UIs) for EOPC were collected for the aforementioned indicators (number of cases, prevalence rate, number of deaths, and mortality rate), for both sexes, seven age groups (15–19 years, 20–24 years, 25–29 years, 30–34 years, 35–39 years, 40–44 years, and 45–49 years), 5 SDI levels, 21 GBD-defined regions, and 204 countries and territories.

收集了上述指标（病例数、患病率、死亡人数和死亡率）、7个年龄组（15-19岁、20-24岁、25-29岁、30-34岁、35-39岁、40-44岁和45-49岁）、5个SDI水平、21个GBD定义的地区和204个国家和地区的EOPC GBD估计值和相应的95%不确定性区间（UI）。

Furthermore, in consideration of variations in age and sex distributions among populations across different countries and regions, we utilized age-standardized rates, including the age-standardized prevalence rate (ASPR) and age-standardized death rate (ASDR), to compare disease burdens. In this study, the GBD world population age structure was used as a reference for the calculation of age standardization rates.

此外，考虑到不同国家和地区人口年龄和性别分布的差异，我们利用年龄标准化率，包括年龄标准化患病率（ASPR）和年龄标准化死亡率（ASDR），来比较疾病负担。在这项研究中，GBD世界人口年龄结构被用作计算年龄标准化率的参考。

Specifically, the direct standardization method was applied to calculate the age-standardized rates for pancreatic cancer in the 15–49-year age group, which involves multiplying the crude rate for each age group (in 5-year intervals) by the corresponding proportion of the standard population in that group and then summing the values to obtain the overall age-standardized rate.

具体而言，直接标准化方法用于计算15-49岁年龄组胰腺癌的年龄标准化率，其中包括将每个年龄组的粗率（以5年为间隔）乘以该组标准人群的相应比例，然后将这些值相加以获得总体年龄标准化率。

The SDI is a summary indicator that identifies where the health-related development status of a country or region is located on the spectrum of development worldwide. The SDI considers the birth rate, educational attainment, and economic status. The SDI ranges between 0 and 1, which reflects the degree of social development; the closer the value is to 1, the higher the level of social and economic development, and the closer the value is to 0, lower the level.

SDI是一个汇总指标，用于确定一个国家或地区的健康相关发展状况在全球发展范围内的位置。SDI考虑了出生率、教育程度和经济状况。SDI在0到1之间，反映了社会发展的程度；。

According to SDI values, all 204 countries/territories were divided into one of the following SDI quintiles: high, high-middle, middle, low-middle, or low..

根据SDI值，所有204个国家/地区被分为以下SDI五分之一：高，高中，中，中低或低。。

Joinpoint regression

连接点回归

Joinpoint regression models are created by separating the study time into multiple parts according to the temporal distribution characteristics of a disease

连接点回归模型是通过根据疾病的时间分布特征将研究时间分成多个部分来创建的

. First, a logarithmic linear model was used for segmented regression. We used the grid search method to establish all possible joinpoints, calculated the corresponding mean squared errors (MSEs), and selected the grid point with the smallest MSE as the joinpoint. The Monte Carlo permutation test was subsequently used to select the number of joinpoints, with the number ranging between 0 and 5.

首先，对数线性模型用于分段回归。我们使用网格搜索方法建立所有可能的连接点，计算相应的均方误差（MSE），并选择MSE最小的网格点作为连接点。随后使用蒙特卡罗置换检验来选择连接点的数量，数量在0到5之间。

Finally, we calculated the average annual percent change (AAPC) and the corresponding 95% confidence interval (CI). The AAPC is used to describe the overall change trend; when the AAPC is >0 and P is <0.05, it indicates an increase during a period.

最后，我们计算了平均年变化百分比（AAPC）和相应的95%置信区间（CI）。AAPC用于描述总体变化趋势；当AAPC>0且P<0.05时，表示在一段时间内增加。

. For example, if the AAPC in the EOPC incidence for the period 1990–2021 is 2.0 (

例如，如果1990年至2021年期间EOPC发病率中的AAPC为2.0(

< 0.05), the incidence of EOPC has an annual rate increase of 2.0% from 1990 to 2021. Joinpoint software is provided by the National Cancer Institute and available on the website (

<0.05），从1990年到2021年，EOPC的发病率每年增加2.0%。Joinpoint软件由美国国家癌症研究所提供，可在网站上找到(

https://surveillance.cancer.gov/help/joinpoint

Age-period-cohort analysis

年龄段队列分析

APC models were employed to examine the impacts of age, period, and cohort on the disease burden of EOPC. Specifically, the age effects revealed how the risk profiles of the population changed with age, highlighting the natural progression of health risks associated with the maturation and ageing process.

APC模型用于检查年龄，时期和队列对EOPC疾病负担的影响。具体而言，年龄效应揭示了人口的风险概况如何随着年龄的增长而变化，突出了与成熟和衰老过程相关的健康风险的自然进展。

The period effects showed the influence of time-specific societal, environmental, and policy changes that uniformly affected all age groups during the study periods. The cohort effects highlight the long-term impacts of early-life experiences and exposures on the health of different birth cohorts. To meet the standards of APC analysis and present the latest data, we focused our analysis on the timeframe from 1992 to 2021.

时期效应显示了特定时间的社会，环境和政策变化的影响，这些变化在研究期间均匀地影响了所有年龄组。队列效应突出了早期生活经历和暴露对不同出生队列健康的长期影响。为了满足APC分析的标准并提供最新数据，我们将分析重点放在1992年至2021年的时间范围内。

The data were subsequently analysed using the online tools (.

随后使用在线工具分析数据（。

https://analysistools.cancer.gov/apc

) to acquire the net drift, local drift, and relative risk (RR) of period and cohort effects. Both net drift and local drift were adjusted for in the analysis of period and birth cohort effects, reflecting linear trends in the disease burden overall and across age groups, respectively. Net drift captures the overall trend or drift in disease burden due to period effects—such as changes in environmental, social, or health care-related factors over time.

)获得周期和队列效应的净漂移，局部漂移和相对风险（RR）。在分析时期和出生队列效应时，对净漂移和局部漂移进行了调整，分别反映了整体和各年龄组疾病负担的线性趋势。净漂移捕捉了由于周期效应（例如环境，社会或医疗保健相关因素随时间的变化）而导致的疾病负担的总体趋势或漂移。

This provides an indication of whether a disease burden generally increases or decreases over time, independent of specific age or period factors. Local drift focuses on more localized trends in the data, typically capturing short-term variations within particular age groups..

这表明疾病负担是否随着时间的推移而增加或减少，与特定的年龄或时期因素无关。局部漂移侧重于数据中更本地化的趋势，通常捕捉特定年龄组内的短期变化。。

Software and statistical analysis

软件和统计分析

All analyses and visualizations were based on R (version 4.2.3), with

所有分析和可视化均基于R（版本4.2.3），其中

< 0.05 considered to indicate a significant difference. The original data for the world map used in this study were sourced from the National Geographical Information Resource Directory Service System (

<0.05被认为表明存在显着差异。本研究中使用的世界地图的原始数据来自国家地理信息资源目录服务系统(

http://www.webmap.cn/main.do?method=index

)

. The data were then processed and visualized using the ggplot2 package. This study was re-analyzed using published GBD 2021 data. We did not collect raw data on this manuscript and therefore no separate ethical approval was required for this study.

。然后使用ggplot2软件包对数据进行处理和可视化。使用已发布的GBD 2021数据重新分析了这项研究。我们没有收集这份手稿的原始数据，因此这项研究不需要单独的道德批准。

Data availability

数据可用性

The datasets analyzed during the current study are available in the Global Burden of Disease 2021 Database (

当前研究期间分析的数据集可在2021年全球疾病负担数据库中找到(

https://ghdx.healthdata.org/gbd-2021/data-input-sources

Code availability

代码可用性

Some or all data, models, or code generated or used during the study are available from the corresponding author by request.

研究期间生成或使用的部分或全部数据，模型或代码可根据要求从相应的作者处获得。

References

参考文献

Sung, H., Siegel, R. L., Rosenberg, P. S. & Jemal, A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry.

Sung，H.，Siegel，R.L.，Rosenberg，P.S。和Jemal，A。美国年轻人中新出现的癌症趋势：基于人群的癌症登记分析。

Lancet Public Health

柳叶刀公共卫生

, e137–e147 (2019).

，e137–e147（2019）。

Article

文章

PubMed

Google Scholar

谷歌学者

He, T. C. et al. Biological and clinical implications of early-onset cancers: a unique subtype.

He，T.C.等人，《早发性癌症的生物学和临床意义：一种独特的亚型》。

Crit. Rev. Oncol. Hematol.

Crit。肿瘤学博士。血液。

190

, 104120 (2023).

Article

文章

PubMed

Google Scholar

谷歌学者

Koh, B. et al. Patterns in cancer incidence among people younger than 50 years in the US, 2010 to 2019.

Koh，B.等人，《2010年至2019年美国50岁以下人群癌症发病模式》。

JAMA Netw. Open

。打开

, e2328171 (2023).

，e2328171（2023年）。

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Mizrahi, J. D., Surana, R., Valle, J. W. & Shroff, R. T. Pancreatic cancer.

Mizrahi，J.D.，Surana，R.，Valle，J.W。和Shroff，R.T。胰腺癌。

Lancet

柳叶刀

395

, 2008–2020 (2020).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Li, Y. & Zhang, X. Pancreatic cancer in young adults—an evolving entity?

Li，Y。＆Zhang，X。年轻人的胰腺癌是一个不断发展的实体？

Am. J. Cancer Res.

美国癌症研究所。

, 2763–2772 (2023).

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Tingstedt, B., Weitkamper, C. & Andersson, R. Early onset pancreatic cancer: a controlled trial.

Tingstedt，B.，Weitkamper，C。和Andersson，R。早发性胰腺癌：一项对照试验。

Ann. Gastroenterol.

安。胃肠病。

, 206–212 (2011).

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Kang, J. S., Jang, J. Y., Kwon, W., Han, Y. & Kim, S. W. Clinicopathologic and survival differences in younger patients with pancreatic ductal adenocarcinoma—a propensity score-matched comparative analysis.

Kang，J.S.，Jang，J.Y.，Kwon，W.，Han，Y。＆Kim，S.W。年轻胰腺导管腺癌患者的临床病理和生存差异-倾向评分匹配的比较分析。

Pancreatology

胰腺科

, 827–832 (2017).

Article

文章

PubMed

Google Scholar

谷歌学者

Ordonez, J. E. et al. Clinicopathologic features and outcomes of early-onset pancreatic adenocarcinoma in the United States.

Ordonez，J.E.等人。美国早发性胰腺癌的临床病理特征和预后。

Ann. Surg. Oncol.

安。外科。Oncol。

, 1997–2006 (2020).

Article

文章

PubMed

Google Scholar

谷歌学者

Printz, C. Younger cancer survivors are more likely to face financial strain.

Printz，C。年轻的癌症幸存者更有可能面临财务压力。

Cancer

癌症

126

, 3605 (2020).

PubMed

Google Scholar

谷歌学者

Huang, J. et al. Worldwide burden of, risk factors for, and trends in pancreatic cancer.

Huang，J.等人。胰腺癌的全球负担，危险因素和趋势。

Gastroenterology

胃肠病学

160

, 744–754 (2021).

Article

文章

PubMed

Google Scholar

谷歌学者

Li, Z. et al. Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of Disease Study 2019: a cross-sectional study.

Li，Z.等人，《基于2019年全球疾病负担研究：横断面研究》，1990年至2019年15-49岁青少年和成年人早发性胰腺癌的全球，区域和国家负担。

Int. J. Surg.

内景J.Surg。

110

, 1929–1940 (2024).

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Dahia, S. S., Konduru, L., Pandol, S. J. & Barreto, S. G. The burden of young-onset pancreatic cancer and its risk factors from 1990 to 2019: a systematic analysis of the global burden of disease study 2019.

Dahia，S.S.，Konduru，L.，Pandol，S.J。＆Barreto，S.G。1990年至2019年年轻发病胰腺癌的负担及其危险因素：2019年全球疾病负担研究的系统分析。

Pancreatology

胰腺科

, 119–129 (2024).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Fosse, E. & Winship, C. Bounding analyses of age-period-cohort effects.

Fosse，E。＆Winship，C。年龄段队列效应的边界分析。

Demography

人口统计学

, 1975–2004 (2019).

Article

文章

PubMed

Google Scholar

谷歌学者

Bell, A. Age period cohort analysis: a review of what we should and shouldn’t do.

Bell，A。年龄段队列分析：回顾我们应该和不应该做什么。

Ann. Hum. Biol.

生物。

, 208–217 (2020).

Article

文章

PubMed

Google Scholar

谷歌学者

Diseases, G. B. D. & Injuries, C. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.

疾病，G.B.D.和伤害，C.1990-2021年，204个国家和地区和811个国家以下地区371种疾病和伤害的全球发病率，患病率，残疾寿命（YLDs），残疾调整寿命（DALYs）和健康预期寿命（HALE）：2021年全球疾病负担研究的系统分析。

Lancet

柳叶刀

403

, 2133–2161 (2024).

Article

文章

Google Scholar

谷歌学者

Pega, F. et al. Global, regional and national burdens of non-melanoma skin cancer attributable to occupational exposure to solar ultraviolet radiation for 183 countries, 2000-2019: a systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

Pega，F.等人，《2000-2019年183个国家因职业暴露于太阳紫外线而导致的非黑色素瘤皮肤癌的全球，区域和国家负担：世界卫生组织/国际劳工组织对与工作有关的疾病和伤害负担的联合估计的系统分析》。

Environ. Int.

。内景。

181

, 108226 (2023).

Article

文章

PubMed

Google Scholar

谷歌学者

Liu, C. et al. Global, regional, and national burden of liver cancer due to non-alcoholic steatohepatitis, 1990-2019: a decomposition and age-period-cohort analysis.

Liu，C.等人，《1990-2019年非酒精性脂肪性肝炎引起的肝癌的全球，地区和国家负担：分解和年龄段队列分析》。

J. Gastroenterol.

J、胃肠道。

, 1222–1236 (2023).

Article

文章

PubMed

Google Scholar

谷歌学者

Kan, C. et al. Global, regional, and national burden of pancreatic cancer, 1990-2019: results from the Global Burden of Disease Study 2019.

Kan，C.等人，《1990-2019年胰腺癌的全球，区域和国家负担：2019年全球疾病负担研究的结果》。

Ann. Glob. Health

安。环球。健康

, 33 (2023).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Nations, T. U. Global issues population.

国家，T.U.全球问题人口。

https://www.un.org/zh/global-issues/population

(2024).

Larsson, S. C. & Wolk, A. Red and processed meat consumption and risk of pancreatic cancer: meta-analysis of prospective studies.

Larsson，S.C。和Wolk，A。红色和加工肉类消费与胰腺癌风险：前瞻性研究的荟萃分析。

Br. J. Cancer

Br.J.癌症

106

, 603–607 (2012).

Article

文章

CAS

中科院

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Zhao, Z., Yin, Z., Pu, Z. & Zhao, Q. Association between consumption of red and processed meat and pancreatic cancer risk: a systematic review and meta-analysis.

Zhao，Z.，Yin，Z.，Pu，Z。＆Zhao，Q。食用红色和加工肉类与胰腺癌风险之间的关联：系统评价和荟萃分析。

Clin. Gastroenterol. Hepatol.

克林Gastroenterol。肝脏

, 486–493.e410 (2017).

，486-493.e410（2017）。

Article

文章

PubMed

Google Scholar

谷歌学者

GBD 2015 Obesity Collaborators, et al. Health effects of overweight and obesity in 195 countries over 25 years.

GBD 2015肥胖合作者等。25年来195个国家超重和肥胖的健康影响。

N. Engl. J. Med.

N.Engl。医学杂志。

377

, 13–27 (2017).

Article

文章

Google Scholar

谷歌学者

Viner, R., White, B. & Christie, D. Type 2 diabetes in adolescents: a severe phenotype posing major clinical challenges and public health burden.

Viner，R.，White，B。＆Christie，D。青少年2型糖尿病：一种严重的表型，带来了重大的临床挑战和公共卫生负担。

Lancet

柳叶刀

389

, 2252–2260 (2017).

Article

文章

PubMed

Google Scholar

谷歌学者

Ruze, R. et al. Mechanisms of obesity- and diabetes mellitus-related pancreatic carcinogenesis: a comprehensive and systematic review.

Ruze，R。等人。肥胖和糖尿病相关胰腺癌发生的机制：全面和系统的综述。

Signal Transduct. Target Ther.

信号传输管。。

, 139 (2023).

Article

文章

CAS

中科院

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Stolzenberg-Solomon, R. Z., Schairer, C., Moore, S., Hollenbeck, A. & Silverman, D. T. Lifetime adiposity and risk of pancreatic cancer in the NIH-AARP Diet and Health Study cohort.

Stolzenberg-Solomon，R.Z.，Schairer，C.，Moore，S.，Hollenbeck，A。＆Silverman，D.T。NIH-AARP饮食与健康研究队列中的终生肥胖和胰腺癌风险。

Am. J. Clin. Nutr.

美国J.克林。营养。

, 1057–1065 (2013).

Article

文章

CAS

中科院

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Urayama, K. Y. et al. Body mass index and body size in early adulthood and risk of pancreatic cancer in a central European multicenter case-control study.

Urayama，K.Y.等人，《中欧多中心病例对照研究中成年早期的体重指数和体型与胰腺癌风险》。

Int. J. Cancer

国际癌症杂志

129

, 2875–2884 (2011).

Article

文章

CAS

中科院

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Genkinger, J. M. et al. Central adiposity, obesity during early adulthood, and pancreatic cancer mortality in a pooled analysis of cohort studies.

Genkinger，J.M.等人在队列研究的汇总分析中发现了中枢性肥胖、成年早期肥胖和胰腺癌死亡率。

Ann. Oncol.

安科。

, 2257–2266 (2015).

Article

文章

CAS

中科院

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Naudin, S. et al. Healthy lifestyle and the risk of pancreatic cancer in the EPIC study.

EPIC研究中的健康生活方式和胰腺癌风险。

Eur. J. Epidemiol.

欧洲流行病学杂志。

, 975–986 (2020).

Article

文章

PubMed

Google Scholar

谷歌学者

Raimondi, S., Maisonneuve, P., Lohr, J. M. & Lowenfels, A. B. Early onset pancreatic cancer: evidence of a major role for smoking and genetic factors.

Raimondi，S.，Maisonneuve，P.，Lohr，J.M。和Lowenfels，A.B。早发性胰腺癌：吸烟和遗传因素的主要作用的证据。

Cancer Epidemiol. Biomark. Prev.

癌症流行病学。生物标志物。

, 1894–1897 (2007).

Article

文章

Google Scholar

谷歌学者

WHO. Prevalence of current tobacco use among adults aged ≥15 years (%).

谁。15岁以上成年人当前吸烟率（%）。

https://www.who.int/data/gho/indicator-metadata-registry/imr-details/128

(2023).

Wong, M. C. S. et al. Global temporal patterns of pancreatic cancer and association with socioeconomic development.

Wong，M.C.S.等人，《胰腺癌的全球时间模式及其与社会经济发展的关系》。

Sci. Rep.

科学。代表。

, 3165 (2017).

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Wong, M. C. S. et al. Global, regional and time-trend prevalence of central obesity: a systematic review and meta-analysis of 13.2 million subjects.

Wong，M.C.S.等人，《中心性肥胖的全球、区域和时间趋势患病率：1320万受试者的系统评价和荟萃分析》。

Eur. J. Epidemiol.

Eur. J. Epidemiol。

, 673–683 (2020).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Mulder, I. et al. Smoking cessation would substantially reduce the future incidence of pancreatic cancer in the European Union.

Mulder，I。等人。戒烟将大大降低欧盟未来胰腺癌的发病率。

Eur. J. Gastroenterol. Hepatol.

欧洲胃肠病学杂志。Hepatol。

, 1343–1353 (2002).

Article

文章

PubMed

Google Scholar

谷歌学者

Barrington-Trimis, J. L. et al. Trends in the age of cigarette smoking initiation among young adults in the US from 2002 to 2018.

Barrington-Trimis，J.L.等人，《2002年至2018年美国年轻人吸烟年龄的趋势》。

JAMA Netw. Open

。打开

, e2019022 (2020).

，e2019022（2020）。

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Siddiqi, K. et al. Framework convention on tobacco control 2030—a program to accelerate the implementation of World Health Organization framework convention for tobacco control in low- and middle-income countries: a mixed-methods evaluation.

Siddiqi，K.等人，《2030年烟草控制框架公约——一项加速在中低收入国家实施世界卫生组织烟草控制框架公约的计划：混合方法评估》。

Nicotine Tob. Res.

尼古丁托布。真的

, 1074–1081 (2023).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

WHO. WHO report on the global tobacco epidemic, 2023: protect people from tobacco smoke.

谁。世卫组织关于2023年全球烟草流行的报告：保护人们免受烟草烟雾的影响。

https://www.who.int/publications/i/item/9789240077164

(2023).

Global Health Expenditure Database. World Health Organization.

全球卫生支出数据库。世界卫生组织。

https://www.who.int/gho/health_financing/en/

(2024). Accessed July 25, 2024.

（2024年）。2024年7月25日访问。

Batouli, A., Jahanshahi, P., Gross, C. P., Makarov, D. V. & Yu, J. B. The global cancer divide: relationships between national healthcare resources and cancer outcomes in high-income vs. middle- and low-income countries.

Batouli，A.，Jahanshahi，P.，Gross，C.P.，Makarov，D.V。＆Yu，J.B。全球癌症鸿沟：高收入与中低收入国家国家医疗资源与癌症结局之间的关系。

J. Epidemiol. Glob. Health

J、流行病。全球。健康

, 115–124 (2014).

Article

文章

PubMed

Google Scholar

谷歌学者

Strobel, O., Neoptolemos, J., Jager, D. & Buchler, M. W. Optimizing the outcomes of pancreatic cancer surgery.

Strobel，O.，Neoptolemos，J.，Jager，D。＆Buchler，M.W。优化胰腺癌手术的结果。

Nat. Rev. Clin. Oncol.

国家修订临床。Oncol公司。

, 11–26 (2019).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Blackford, A. L., Canto, M. I., Klein, A. P., Hruban, R. H. & Goggins, M. Recent trends in the incidence and survival of stage 1A pancreatic cancer: a surveillance, epidemiology, and end results analysis.

Blackford，A.L.，Canto，M.I.，Klein，A.P.，Hruban，R.H。＆Goggins，M。1A期胰腺癌发病率和生存率的最新趋势：监测，流行病学和最终结果分析。

J. Natl Cancer Inst.

J、国家癌症研究所。

112

, 1162–1169 (2020).

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Reyngold, M. et al. Association of ablative radiation therapy with survival among patients with inoperable pancreatic cancer.

Reyngold，M.等人，《消融放射治疗与不能手术的胰腺癌患者生存率的关系》。

JAMA Oncol.

我是叔叔

, 735–738 (2021).

Article

文章

PubMed

Google Scholar

谷歌学者

Datta, N. R., Rogers, S. & Bodis, S. Challenges and opportunities to realize “The 2030 Agenda for Sustainable Development” by the United Nations: implications for radiation therapy infrastructure in low- and middle-income countries.

Datta，N.R.，Rogers，S。＆Bodis，S。联合国实现“2030年可持续发展议程”的挑战和机遇：对中低收入国家放射治疗基础设施的影响。

Int. J. Radiat. Oncol. Biol. Phys.

内景J.辐射。Oncol公司。生物物理。

105

, 918–933 (2019).

Article

文章

PubMed

Google Scholar

谷歌学者

Ige, T. et al. Understanding the challenges of delivering radiotherapy in low- and middle-income countries in Africa.

Ige，T.等人，《了解在非洲中低收入国家进行放射治疗的挑战》。

J. Cancer Policy

J、癌症政策

, 100372 (2023).

Article

文章

PubMed

Google Scholar

谷歌学者

Wells, J. C. et al. An analysis of contemporary oncology randomized clinical trials from low/middle-income vs high-income countries.

Wells，J.C.等人，《低收入/中等收入国家与高收入国家当代肿瘤学随机临床试验分析》。

JAMA Oncol.

我是叔叔

, 379–385 (2021).

Article

文章

PubMed

Google Scholar

谷歌学者

Park, B. K. et al. Trends in treatment patterns and survival outcomes in pancreatic cancer: a nationwide population-based study in Korea.

Park，B.K.等人，《胰腺癌治疗模式和生存结果的趋势：韩国一项全国性的基于人群的研究》。

Eur. J. Cancer

Eur. J. 癌症

189

, 112932 (2023).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Neoptolemos, J. P. et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.

Neoptolemos，J.P.等人。吉西他滨和卡培他滨辅助治疗与吉西他滨单药治疗在切除胰腺癌患者中的比较（ESPAC-4）：一项多中心，开放标签，随机，3期临床试验。

Lancet

柳叶刀

389

, 1011–1024 (2017).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Seo, S. H., Cho, S., Yoo, S. H., Keam, B. & Shin, A. Changes in the utilization of health care services by cancer patients during the COVID-19 pandemic.

Seo，S.H.，Cho，S.，Yoo，S.H.，Keam，B。＆Shin，A。新型冠状病毒肺炎期间癌症患者利用医疗保健服务的变化。

Yonsei Med. J.

延世与J。

, 463–470 (2023).

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Greenwood, E. & Swanton, C. Consequences of COVID-19 for cancer care—a CRUK perspective.

Greenwood，E。＆Swanton，C。新型冠状病毒对癌症护理的影响-克鲁克的观点。

Nat. Rev. Clin. Oncol.

国家修订临床。Oncol公司。

, 3–4 (2021).

Article

文章

PubMed

Google Scholar

谷歌学者

Yang, J. et al. Early screening and diagnosis strategies of pancreatic cancer: a comprehensive review.

Yang，J。等人。胰腺癌的早期筛查和诊断策略：综合综述。

Cancer Commun.

常见癌症。

, 1257–1274 (2021).

Article

文章

CAS

中科院

Google Scholar

谷歌学者

Stoffel, E. M., Brand, R. E. & Goggins, M. Pancreatic cancer: changing epidemiology and new approaches to risk assessment, early detection, and prevention.

Stoffel，E.M.，Brand，R.E。＆Goggins，M。胰腺癌：改变流行病学和风险评估，早期发现和预防的新方法。

Gastroenterology

胃肠病学

164

, 752–765 (2023).

Article

文章

PubMed

Google Scholar

谷歌学者

Abe, T. et al. Gene variants that affect levels of circulating tumor markers increase identification of patients with pancreatic cancer.

Abe，T。等人。影响循环肿瘤标志物水平的基因变异增加了胰腺癌患者的鉴定。

Clin. Gastroenterol. Hepatol.

克林Gastroenterol。肝脏

, 1161–1169.e1165 (2020).

，1161–1169.e1165（2020）。

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Huang, B. et al. Artificial intelligence in pancreatic cancer.

Huang，B.等。人工智能在胰腺癌中的应用。

Theranostics

治疗诊断科技

, 6931–6954 (2022).

Article

文章

CAS

中科院

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Tsang, E. S. et al. Delving into early-onset pancreatic ductal adenocarcinoma: how does age fit in?

Tsang，E.S.等人深入研究早发性胰腺导管腺癌：年龄如何适应？

Clin. Cancer Res.

临床。癌症研究。

, 246–254 (2021).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Ogobuiro, I. et al. Multiomic characterization reveals a distinct molecular landscape in young-onset pancreatic cancer.

Ogobuiro，I。等人。多组学表征揭示了年轻发病胰腺癌的独特分子景观。

JCO Precis. Oncol.

JCO Precis。叔叔

, e2300152 (2023).

，e2300152（2023）。

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

US Preventive Services Task Force, et al. Screening for pancreatic cancer: US Preventive Services Task Force Reaffirmation Recommendation Statement.

美国预防服务工作组等。胰腺癌筛查：美国预防服务工作组重申建议声明。

JAMA

322

, 438–444 (2019).

Article

文章

Google Scholar

谷歌学者

Canto, M. I. et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer.

Canto，M.I.等人，《国际胰腺癌筛查（CAPS）联盟关于家族性胰腺癌风险增加患者管理的峰会》。

Gut

肠道

, 339–347 (2013).

Article

文章

PubMed

Google Scholar

谷歌学者

Ilic, M. & Ilic, I. Epidemiology of pancreatic cancer.

Ilic，M。＆Ilic，I。胰腺癌的流行病学。

World J. Gastroenterol.

世界J.胃肠病学。

, 9694–9705 (2016).

Article

文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Eguchi, H., Kobayashi, S., Gotoh, K., Noda, T. & Doki, Y. Characteristics of early-onset pancreatic cancer and its association with familial pancreatic cancer and hereditary pancreatic cancer syndromes.

Eguchi，H.，Kobayashi，S.，Gotoh，K.，Noda，T。＆Doki，Y。早发性胰腺癌的特征及其与家族性胰腺癌和遗传性胰腺癌综合征的关系。

Ann. Gastroenterol. Surg.

安。肠胃病。外科。

, 229–233 (2020).

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019.

GBD 2019人口统计合作者。1950-2019年204个国家和地区的全球年龄性别特定生育率，死亡率，健康预期寿命（HALE）和人口估计：2019年全球疾病负担研究的综合人口统计分析。

Lancet

柳叶刀

396

, 1160–1203 (2020).

Article

文章

Google Scholar

谷歌学者

He, H. et al. Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017.

He，H.等人，《全球、地区和国家精神分裂症发病率和DALYs趋势：2017年全球疾病负担研究结果》。

Epidemiol. Psychiatr. Sci.

流行病。精神病医生。科学。

, e91 (2020).

，e91（2020）。

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

Kim, H. J., Fay, M. P., Feuer, E. J. & Midthune, D. N. Permutation tests for joinpoint regression with applications to cancer rates.

Kim，H.J.，Fay，M.P.，Feuer，E.J。＆Midthune，D.N。联合点回归的置换检验及其在癌症发病率中的应用。

Stat. Med.

统计医学。

, 335–351 (2000).

Article

文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Irimata, K. E. et al. Guidance for selecting model options in the National Cancer Institute Joinpoint Regression Software.

Irimata，K.E.等人，《美国国家癌症研究所Joinpoint回归软件中选择模型选项的指南》。

Vital Health Stat.

生命健康统计。

, 1–22 (2022).

Clegg, L. X., Hankey, B. F., Tiwari, R., Feuer, E. J. & Edwards, B. K. Estimating average annual per cent change in trend analysis.

Clegg，L.X.，Hankey，B.F.，Tiwari，R.，Feuer，E.J。＆Edwards，B.K。估计趋势分析中的平均年变化率。

Stat. Med.

统计医学。

, 3670–3682 (2009).

Article

文章

PubMed

PubMed Central

PubMed 中央

Google Scholar

谷歌学者

National Geographical Information Resource Directory Service System. National Geomatics Center of China.

国家地理信息资源目录服务系统。中国国家地理信息中心。

http://www.webmap.cn/main.do?method=index

(2024). Accessed June 13, 2024.

（2024年）。2024年6月13日访问。

Download references

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Acknowledgements

致谢

We thank the collaborators of the Global Burden of Disease (GBD) Study 2021 for their work. We thank all the individuals who contributed to the GBD 2021 for their extensive support in finding, cataloging, and analyzing data and facilitating communications.

我们感谢2021年全球疾病负担（GBD）研究的合作者所做的工作。我们感谢所有为GBD 2021做出贡献的个人，感谢他们在发现，编目和分析数据以及促进沟通方面的广泛支持。

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These authors contributed equally: Zongbiao Tan, Yang Meng, Yanrui Wu.

这些作者做出了同样的贡献：谭宗彪，杨蒙，吴燕瑞。

Authors and Affiliations

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Department of Gastroenterology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China

武汉大学人民医院消化内科，武汉解放路238号，430060

Zongbiao Tan, Yanrui Wu, Haodong He, Yu Pu, Jixiang Zhang & Weiguo Dong

谭宗彪、吴延瑞、何浩东、于璞、张吉祥和董伟国

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510060, China

Yang Meng

杨萌（音）

Department of General Practice, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, China

武汉大学人民医院全科，武汉解放路238号

Junhai Zhen

陈俊海

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Zongbiao Tan

陈宗宝

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Yang Meng

杨萌（音）

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吴延润

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Haodong He

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Weiguo Dong

董卫国

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Contributions

捐款

Conception and design: Z.B.T., Y.M., and Y.R.W.; Administrative support: W.G.D., J.X.Z.; Provision of study materials or patients: J.H.Z. and J.X.Z.; Collection and assembly of data: Y.P. and H.D.H.; Data analysis and interpretation: Z.B.T., Y.M., Y.R.W., and J.H.Z.; Manuscript writing: all authors; Final approval of manuscript: all authors..

概念和设计：Z.B.T.，Y.M。和Y.R.W。；行政支持：W.G.D.，J.X.Z。；提供研究材料或患者：J.H.Z.和J.X.Z。；数据的收集和组装：Y.P.和H.D.H。；。；手稿写作：所有作者；稿件的最终批准：所有作者。。

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Jixiang Zhang

张吉祥

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Weiguo Dong

董卫国

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Tan, Z., Meng, Y., Wu, Y.

谭，Z，孟，Y，吴，Y。

et al.