老龄化推升全球女性高发癌症负担，不同社会人口指数地区防控成效迥异：基于GBD 2021的1990—2021年趋势分析与2036年预测

何志容; 陈韵竹; 蔡佳芮; 肖成汉; 于川; 刘振谧

doi:10.16016/j.2097-0927.202607083

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老龄化推升全球女性高发癌症负担，不同社会人口指数地区防控成效迥异：基于GBD 2021的1990—2021年趋势分析与2036年预测

公共卫生智库 | 更新时间：2026-10-30

- 老龄化推升全球女性高发癌症负担，不同社会人口指数地区防控成效迥异：基于GBD 2021的1990—2021年趋势分析与2036年预测
- Population aging drives up the global burden of high-incidence cancers in women, with markedly divergent prevention and control effectiveness across regions with different sociodemographic index: a trend analysis from 1990 to 2021 and projection to 2036 based on GBD 2021
- 陆军军医大学学报 2026年48卷第20期页码：2862-2876
- 作者机构：
  
  1.四川大学：华西公共卫生学院，华西第四医院，四川成都
  2.海南省人民医院中心实验室，海南海口
- 作者简介：
  
  刘振谧， E-mail：zhenmiliu@scu.edu.cn
- 基金信息：
  
  国家自然科学基金区域创新发展联合基金项目(U20A20411)
- DOI：10.16016/j.2097-0927.202607083
  中图分类号： R172;R195.4;R73
- 收稿：2026-07-21，
  
  修回：2026-09-02，
  
  录用：2026-09-09，
  
  纸质出版：2026-10-30
- 稿件说明：
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何志容，陈韵竹，蔡佳芮，等.老龄化推升全球女性高发癌症负担，不同社会人口指数地区防控成效迥异：基于GBD 2021的1990—2021年趋势分析与2036年预测［J］.陆军军医大学学报，2026，48（20）：2862-2876.DOI：10.16016/j.2097-0927.202607083.

He Z R，Chen Y Z，Cai J R，et al.Population aging drives up the global burden of high-incidence cancers in women， with markedly divergent prevention and control effectiveness across regions with different sociodemographic index： a trend analysis from 1990 to 2021 and projection to 2036 based on GBD 2021［J］.J Army Med Univ，2026，48（20）：2862-2876.DOI：10.16016/j.2097-0927.202607083.
何志容，陈韵竹，蔡佳芮，等.老龄化推升全球女性高发癌症负担，不同社会人口指数地区防控成效迥异：基于GBD 2021的1990—2021年趋势分析与2036年预测［J］.陆军军医大学学报，2026，48（20）：2862-2876.DOI：10.16016/j.2097-0927.202607083. DOI：

He Z R，Chen Y Z，Cai J R，et al.Population aging drives up the global burden of high-incidence cancers in women， with markedly divergent prevention and control effectiveness across regions with different sociodemographic index： a trend analysis from 1990 to 2021 and projection to 2036 based on GBD 2021［J］.J Army Med Univ，2026，48（20）：2862-2876.DOI：10.16016/j.2097-0927.202607083. DOI：

摘要

目的

全球女性高发癌症正经历负担模式转型，且在不同地区间呈现分化趋势。因此，系统分析其演变趋势并预判未来走向，是优化卫生资源配置的关键前提。乳腺癌、宫颈癌、卵巢癌和子宫癌是全球女性面临的重大健康威胁，分析1990—2021年全球、我国及不同社会人口指数（sociodemographic index，SDI）地区女性高发癌症的疾病负担及其差异，并对未来趋势进行预测，为防控策略提供依据。

方法

基于GBD 2021数据库（

http：//ghdx.healthdata.org

http://ghdx.healthdata.org

）的数据，综合考虑乳腺癌、宫颈癌、卵巢癌、子宫癌4种女性高发癌症主要发病年龄段，本研究提取1990—2021年全球、我国和5个SDI地区（高、中高、中、中低、低）

20~79岁女性的数据进行疾病负担分析。疾病负担相关指标包括年龄标准化发病率、年龄标准化死亡率、年龄标准化伤残调整生命年（disability adjusted life year，DALY）率及年龄标准化病死率及其95%不确定区间（uncertainty intervals，

）。通过拟合线性回归模型ln（y）=α+βx+ε估算年估计变化百分比（estimated annual percentage changes，EAPC）及其95%

，采用年龄-时期-队列（age-period-cohort，APC）模型用于分解疾病发病率或死亡率的时间趋势中年龄、时期和出生队列的独立效应，采用贝叶斯年龄-时期-队列（Bayesian age-period-cohort，BAPC）模型预测未来15年全球及我国4种女性高发癌症的疾病负担。

结果

2021年，乳腺癌的年龄标准化发病率在全球［46.40/10万（95%

：43.26/10万~49.56/10万）］和我国［37.00/10万（95%

：28.23/10万~46.95/10万）］均居首位，远高于宫颈癌、子宫癌和卵巢癌；全球卵巢癌年龄标准化病死率最高，我国亦以卵巢癌年龄标准化病死率居于首位。疾病负担存在显著地区差异：高SDI地区乳腺癌、卵巢癌和子宫癌年龄标准化发病率最高，低SDI地区宫颈癌年龄标准化发病率及卵巢癌年龄标准化病死率最高。1990—2021年，全球乳腺癌和子宫癌年龄标准化发病率呈上升趋势，宫颈癌与卵巢癌呈下降趋势；在全球和我国范围内，4种疾病年龄标准化死亡率、年龄标准化DALY率和年龄标准化病死率都在下降；在5个SDI地区，4种疾病的年龄标准化病死率都在下降。APC模型显示，年龄效应表现为4种女性高发癌症的年龄标准化DALY率和年龄标准化发病率随年龄增长呈现先升后降的趋势，年龄标准化死亡率呈现持续上升趋势；时期效应表现为大部分女性高发癌症负担随时间推移呈现上升趋势，而宫颈癌年龄标准化DALY率随时间推移呈现下降趋势；队列效应表现为随出生队列推移，全球4种女性高发癌症年龄标准化发病率、年龄标准化DALY率、年龄标准化死亡率都呈现逐渐降低的趋势。BAPC预测2036年全球乳腺癌和卵巢癌年龄标准化发病率将持续上升（分别达48.59/10万和6.89/10万），乳腺癌年龄标准化DALY率升至472.25/10万；我国乳腺癌、卵巢癌、子宫癌的年龄标准化发病率、年龄标准化死亡率及年龄标准化DALY率均呈攀升趋势。

结论

乳腺癌、宫颈癌、卵巢癌和子宫癌负担总体下降但地区分化明显，高SDI地区以乳腺癌、卵巢癌和子宫癌为主，低SDI地区宫颈癌负担突出；老龄化是疾病负担上升的主要驱动因素，疾病风险随出生队列推移而下降。预计未来的全球乳腺癌和卵巢癌发病率将持续上升，我国乳腺癌、卵巢癌和子宫癌负担也将攀升，需采取差异化防控措施。对策　高SDI地区宜以生活方式干预为主导，大力倡导均衡膳食、健康体重管理及规律体育运动等主动健康行为；低SDI地区则需优先制定筛查技术指南，重点推动HPV疫苗纳入国家免疫规划，并加快构建基层“即筛即治”服务网络；以我国为代表的中SDI国家，应在深入推进加速消除宫颈癌行动计划、将“两癌”免费筛查纳入基本公共卫生服务的基础上，进一步建立分层分类的精准筛查体系，同步强化区域资源统筹配置，促进健康服务可及性与公平性的协同提升。

Abstract

Objective

Common cancers in women worldwide are undergoing a transition in burden patterns

with divergent trends across regions. Therefore

systematically analyzing their evolution trends and predicting future trajectories is a key prerequisite for optimizing health resource allocation. Breast

cervical

ovarian

and uterine cancers pose major health threats to women worldwide. This study aimed to analyze the disease burden of female high-incidence cancers and differences across global

Chinese

and different sociodemographic index (SDI) regions from 1990 to 2021

and to predict future trends

thereby providing evidence for prevention and control strategies.

Methods

Based on data from the GBD 2021 database (

http://ghdx.healthdata.org

)

and taking into account the primary age ranges of the 4 female high-incidence cancers (breast

cervical

ovarian

and uterine cancers)

this study extracted data of women aged 20 to 79 years from global

Chinese

and 5 SDI regions (high

high-middle

middle

low-middle

and low) from 1990 to 2021 for disease burden analysis. The disease burden-related indicators included age-standardized incidence rate

age-standardized mortality rate

age-standardized disability-adjusted life year (DALY) rate

and age-standardized case fatality rate

along with their 95% uncertainty intervals (

). Estimated annual percentage changes (EAPC) and their 95%

were calculated by fitting a linear regression model ln(y)=α+βx+ε. An age-period-cohort (APC) model was used to decompose the independent effects of age

period

and birth cohort on the temporal trends of disease incidence or mortality. A Bayesian age-period-cohort (BAPC) model was employed to predict the disease burden of the 4 female common cancers globally and in China over the next 15 years.

Results

In 2021

the age-standardized incidence rate of breast cancer ranked first both globally [46.40 per 100 000 (95%

: 43.26 to 49.56 per 100 000)

]

and in China [37.00 per 100 000 (95%

: 28.23 to 46.95 per 100 000)

]

far exceeding those of cervical

uterine

and ovarian cancers. The age-standardized case fatality rate of ovarian cancer was the highest in the world

and that of ovarian cancer ranked first in China. There were significa

nt regional differences in disease burden: the age-standardized incidence rates of breast cancer

ovarian cancer

and uterine cancer were the highest in high SDI regions

while the age-standardized incidence rate of cervical cancer and the age-standardized case fatality rates of ovarian cancer were the highest in low SDI regions. From 1990 to 2021

the age-standardized incidence rates of breast cancer and uterine cancer showed an upward trend globally

while those of cervical cancer and ovarian cancer showed a downward trend; globally and in China

the age-standardized mortality rates

age-standardized DALY rates

and age-standardized fatality rates of the 4 diseases all decreased; in the 5 SDI regions

the age-standardized fatality rates of the 4 diseases all decreased. The APC model showed that the age effect manifested as the age-standardized DALY rates and age-standardized incidence rates of the 4 common cancers in women first increased and then decreased with age

while the age-standardized mortality rate showed a continuous upward trend; the period effect manifested as the burden of most common cancers in women showed an upward trend over time

while the age-standardized DALY rate of cervical cancer showed a downward trend over time; the cohort effect manifested as with the advancement of birth cohorts

the age-standardized incidence rates

age-standardized DALY rates

and age-standardized mortality rates of the 4 common cancers in women globally all showed a gradual downward trend. The BAPC model predicted that by 2036

the age-standardized incidence rates of breast cancer and ovarian cancer globally will continue to rise (reaching 48.59/100 000 and 6.89/100 000

respectively)

and the age-standardized DALY rate of breast cancer will rise to 472.25/100 000; in China

the age-standardized incidence rates

age-standardized mortality rates

and age-standardized DALY rates of breast cancer

ovarian cancer

and uterine cancer all showed upward trends.

Conclusion

From 1990 to 2021

the burden of the 4 female common cancers has generally declined overall but showed marked regional divergence. High-SDI regions are dominated by breast

ovarian

and uterine cancers

whereas the burden of cervical cancer is prominent in low-SDI regions. Aging is the primary driver of the increase in disease burden

and disease risk decreases with the advancement of birth cohorts. It is predicted that the incidence rates of breast cancer and ovarian cancer globally will continue to rise in the future

and the burdens of breast cancer

ovarian cancer

and uterine cancer in China will all increase

requiring the implementation of differentiated prevention and control measures. Countermeasures　High SDI regions should focus on lifestyle intervention

vigorously advocating active health behaviors such as balanced diet

healthy weight management

and regular physical exercise; low SDI regions need to prioritize the development of screening guidelines

focus on promoting the inclusion of HPV vaccine in national immunization programs

and accelerate the construction of a primary-level “screen-and-treat” service network; middle SDI countries represented by China should

on the basis of further advancing the action plan for accelerated elimination of cervical cancer and incorporating free screening for “two cancers” into basic public health services

further establish a stratified and classified precision screening system

simultaneously strengthen regional resource coordination and allocation

and promote the coordinated improvement of health service accessibility and equity.

关键词

Keywords

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