1990—2021年东北亚5国胆道恶性肿瘤疾病负担及趋势预测

doi:10.3969/j.issn.1674-8115.2026.09.011

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (9): 1260-1271.doi: 10.3969/j.issn.1674-8115.2026.09.011

• 论著 · 公共卫生 • 上一篇

1990—2021年东北亚5国胆道恶性肿瘤疾病负担及趋势预测

董文君, 赵经委, 朱嘉赟, 龚伟, 杨自逸()

上海交通大学医学院附属新华医院普通外科，上海市胆道疾病研究重点实验室，上海市胆道疾病研究中心，上海交通大学医学院胆道疾病研究所，上海 200092

收稿日期:2025-11-27 接受日期:2026-05-25 出版日期:2026-09-28 发布日期:2026-09-28
通讯作者: 杨自逸，主治医师，博士；电子信箱：yangziyi@xinhuamed.com.cn。
基金资助:
国家自然科学基金(82473043);上海交通大学“交大之星”计划医工交叉研究基金青年项目(YG2024QNA19)

Burden and trends of biliary tract cancer in five Northeast Asian countries, 1990-2021

Dong Wenjun, Zhao Jingwei, Zhu Jiayun, Gong Wei, Yang Ziyi()

Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Biliary Tract Disease Research; Shanghai Research Center of Biliary Tract Disease; Biliary Disease Research Institute of Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China

Received:2025-11-27 Accepted:2026-05-25 Online:2026-09-28 Published:2026-09-28
Contact: Yang Ziyi, E-mail: yangziyi@xinhuamed.com.cn.
Supported by:
National Natural Science Foundation of China(82473043);Youth Project of Medical-Engineering Cross Research Fund under the “Star of SJTU” Program of Shanghai Jiao Tong University(YG2024QNA19)

摘要/Abstract

摘要：

目的·评估1990—2021年东北亚5国（中国、日本、韩国、朝鲜及蒙古国）人群胆道恶性肿瘤（biliary tract cancer，BTC）的流行病学特征与健康不平等状况，并预测2035年前疾病负担趋势，为区域防控策略制定提供依据。方法·基于2021年全球疾病负担研究（Global Burden of Disease Study 2021，GBD 2021）数据，提取1990—2021年BTC的发病率、死亡率、伤残调整寿命年（disability-adjusted life year，DALY）、社会人口学指数（socio-demographic index，SDI）及其估计年变化百分比（estimated annual percentage change，EAPC）进行分析，并应用贝叶斯年龄-时期-队列（Bayesian age-period-cohort，BAPC）模型预测2022—2035年疾病负担变化。结果·2021年，5国BTC新发病例88 861例，死亡66 107例，DALY达1 292 121人年。1990—2021年，除中国年龄标准化发病率（age-standardized incidence rate，ASIR）呈上升趋势外，其余4国ASIR及5国年龄标准化死亡率（age-standardized mortality rate，ASMR）、年龄标准化DALY率（age-standardized DALY rate，ASDR）均呈下降趋势，其中韩国ASMR和ASDR的EAPC分别为-2.18%和-2.71%；但5国绝对负担显著上升，其中中国增长最显著。男性和高龄人群为主要高负担群体，发病及死亡高峰分别集中在70~74岁与75~79岁。不同SDI国家间BTC疾病负担仍存在明显差异，但国家间差异较前缩小，健康不平等程度有所减轻。人口老龄化是负担增长的主导因素，中国人口老龄化对发病、死亡及DALY增长的贡献分别为53.21%、81.31%和82.32%。BAPC模型预测至2035年，新发病例将达133 706例，死亡89 852例，DALY为1 586 879人年，较2021年分别增长50.5%、35.9%和22.8%。结论·1990—2021年东北亚5国BTC疾病负担总体呈上升趋势，且男性与高龄人群负担更重；模型预测至2035年病例数、死亡数与DALY仍将继续增加。负担增长主要由人口老龄化驱动，其中中国贡献最大。应依据各国社会发展水平实施分层防控策略，重点加强高危人群早筛早诊、规范化诊疗与监测登记，以降低未来疾病负担。

关键词: 胆道恶性肿瘤, 疾病负担, 人口老龄化, 贝叶斯年龄-时期-队列模型

Abstract:

Objective ·To evaluate the epidemiological characteristics and health inequalities of biliary tract cancer in five Northeast Asian countries (China, Japan, Republic of Korea, Democratic People′s Republic of Korea, and Mongolia) from 1990 to 2021, and to project disease burden trends through 2035, providing evidence for regional prevention and control strategies. Methods ·Data were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Incidence, mortality, disability-adjusted life years (DALYs), sociodemographic index (SDI), and estimated annual percentage change (EAPC) for biliary tract cancer from 1990 to 2021 were analyzed. A Bayesian age-period-cohort (BAPC) model was applied to predict changes in disease burden from 2022 to 2035. Results ·In 2021, there were 88 861 new cases, 66 107 deaths, and 1 292 121 person-year (DALYs) attributable to biliary tract cancer in the five countries. From 1990 to 2021, the age-standardized incidence rate (ASIR) increased in China but declined in the other four countries, while the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) declined in all five countries; the Republic of Korea showed EAPCs of -2.18% for ASMR and -2.71% for ASDR. Nevertheless, the absolute burden in the 5 countries continued to rise, with China showing the most pronounced increase. Males and older adults were the main high-burden groups, with incidence and mortality peaking in the 70‒74 and 75‒79 age groups, respectively. The burden of BTC remained heterogeneous across countries with different SDI levels, while between-country disparities narrowed over time and health inequalities decreased. Population aging was the dominant driver of burden growth, and in China, it contributed 53.21% of the increase in incidence, 81.31% in mortality, and 82.32% in DALYs. The BAPC model projected that by 2035, new cases, deaths, and DALYs would reach 133 706, 89 852, and 1 586 879, respectively, representing increases of 50.5%, 35.9%, and 22.8% compared with 2021. Conclusion ·From 1990 to 2021, the burden of biliary tract cancer in five Northeast Asian countries generally increased, with a heavier burden in males and older age groups. Projections suggest that the numbers of incident cases, deaths, and DALYs will continue to rise through 2035. Population aging is the primary driver of this growth, with China contributing the most. Tailored, SDI-stratified prevention and control strategies, including strengthening high-risk screening, early diagnosis, standardized treatment, and surveillance/registry quality, are needed to reduce the future burden.

Key words: biliary tract cancer, disease burden, population aging, Bayesian age-period-cohort (BAPC) model

中图分类号:

R735.72

董文君, 赵经委, 朱嘉赟, 龚伟, 杨自逸. 1990—2021年东北亚5国胆道恶性肿瘤疾病负担及趋势预测[J]. 上海交通大学学报（医学版）, 2026, 46(9): 1260-1271.

Dong Wenjun, Zhao Jingwei, Zhu Jiayun, Gong Wei, Yang Ziyi. Burden and trends of biliary tract cancer in five Northeast Asian countries, 1990-2021[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(9): 1260-1271.

图/表 8

表1 1990—2021年东北亚5国BTC发病、死亡及DALY的时间趋势

Tab 1 Temporal trends in incidence， mortality， and DALYs of BTC in five Northeast Asian countries， 1990-2021

Country	Indicator	1990		2021		1990-2021
Country	Indicator	Number	ASIR/ASMR/ASDR (95%UI)/(×10^-5)	Number	ASIR/ASMR/ASDR(95%UI)/(×10^-5)	EAPC(95%CI)/%
China	Incidence	17 077 (13 003‒21 744)	2.19 (1.68‒2.79)	51 720 (35 618‒66 848)	2.49 (1.71‒3.21)	0.50 (0.40‒0.60)
	Death	17 251 (13 213‒22 143)	2.32 (1.78‒2.97)	37 833 (26 653‒49 262)	1.85 (1.29‒2.40)	-0.75 (-0.86‒-0.65)
	DALY	452 349 (341 842‒581 398)	52.61 (39.99‒67.15)	857 504 (601 927‒1 121 113)	40.38 (28.21‒52.61)	-0.87 (-0.96‒-0.78)
Japan	Incidence	15 703 (14 504‒16 419)	9.37 (8.60‒9.82)	28 939 (23 552‒32 108)	6.26 (5.34‒6.79)	-1.35 (-1.42‒-1.29)
	Death	13 406 (12 384‒13 953)	8.05 (7.39‒8.41)	22 132 (18 034‒24 522)	4.57 (3.90‒4.96)	-1.95 (-2.00‒-1.91)
	DALY	276 961 (261 454‒285 666)	162.13 (152.67‒167.42)	317 770 (271 464‒344 318)	81.20 (72.71‒86.20)	-2.35 (-2.40‒-2.31)
Republic of Korea	Incidence	2 782 (1 848‒3 459)	10.51 (7.16‒13.14)	7 661 (4 783‒9 725)	8.12 (5.06‒10.31)	-0.80 (-0.88‒-0.73)
	Death	2 828 (1 886‒3 546)	11.18 (7.73‒13.90)	5 615 (3 526‒7 089)	5.97 (3.73‒7.55)	-2.18 (-2.28‒-2.07)
	DALY	70 622 (45 474‒88 384)	237.21 (156.74‒295.81)	103 165 (66 117‒130 309)	109.19 (70.36‒137.25)	-2.71 (-2.81‒-2.61)
Democratic People′s Republic of Korea	Incidence	268 (184‒450)	1.73 (1.19‒2.88)	481 (324‒853)	1.46 (0.98‒2.60)	-0.45 (-0.52‒-0.38)
	Death	271 (187‒451)	1.82 (1.25‒3.00)	466 (316‒834)	1.44 (0.97‒2.57)	-0.68 (-0.75‒-0.62)
	DALY	7 461 (5 056‒12 317)	43.9 (30.33‒72.86)	11 973 (7 927‒20 589)	35.43 (23.53‒61.23)	-0.62 (-0.67‒-0.57)
Mongolia	Incidence	36 (24‒53)	3.40 (2.27‒5.03)	60 (44‒88)	2.69 (1.95‒4.01)	-0.99 (-1.21‒-0.78)
	Death	37 (25‒55)	3.57 (2.38‒5.29)	61 (45‒91)	2.85 (2.06‒4.27)	-0.97 (-1.17‒-0.77)
	DALY	1 070 (671‒1 567)	95.80 (61.34‒140.90)	1 709 (1 242‒2 486)	68.43 (49.82‒101.33)	-1.37 (-1.61‒-1.12)

表1 1990—2021年东北亚5国BTC发病、死亡及DALY的时间趋势

Tab 1 Temporal trends in incidence， mortality， and DALYs of BTC in five Northeast Asian countries， 1990-2021

Country	Indicator	1990		2021		1990-2021
Country	Indicator	Number	ASIR/ASMR/ASDR (95%UI)/(×10^-5)	Number	ASIR/ASMR/ASDR(95%UI)/(×10^-5)	EAPC(95%CI)/%
China	Incidence	17 077 (13 003‒21 744)	2.19 (1.68‒2.79)	51 720 (35 618‒66 848)	2.49 (1.71‒3.21)	0.50 (0.40‒0.60)
	Death	17 251 (13 213‒22 143)	2.32 (1.78‒2.97)	37 833 (26 653‒49 262)	1.85 (1.29‒2.40)	-0.75 (-0.86‒-0.65)
	DALY	452 349 (341 842‒581 398)	52.61 (39.99‒67.15)	857 504 (601 927‒1 121 113)	40.38 (28.21‒52.61)	-0.87 (-0.96‒-0.78)
Japan	Incidence	15 703 (14 504‒16 419)	9.37 (8.60‒9.82)	28 939 (23 552‒32 108)	6.26 (5.34‒6.79)	-1.35 (-1.42‒-1.29)
	Death	13 406 (12 384‒13 953)	8.05 (7.39‒8.41)	22 132 (18 034‒24 522)	4.57 (3.90‒4.96)	-1.95 (-2.00‒-1.91)
	DALY	276 961 (261 454‒285 666)	162.13 (152.67‒167.42)	317 770 (271 464‒344 318)	81.20 (72.71‒86.20)	-2.35 (-2.40‒-2.31)
Republic of Korea	Incidence	2 782 (1 848‒3 459)	10.51 (7.16‒13.14)	7 661 (4 783‒9 725)	8.12 (5.06‒10.31)	-0.80 (-0.88‒-0.73)
	Death	2 828 (1 886‒3 546)	11.18 (7.73‒13.90)	5 615 (3 526‒7 089)	5.97 (3.73‒7.55)	-2.18 (-2.28‒-2.07)
	DALY	70 622 (45 474‒88 384)	237.21 (156.74‒295.81)	103 165 (66 117‒130 309)	109.19 (70.36‒137.25)	-2.71 (-2.81‒-2.61)
Democratic People′s Republic of Korea	Incidence	268 (184‒450)	1.73 (1.19‒2.88)	481 (324‒853)	1.46 (0.98‒2.60)	-0.45 (-0.52‒-0.38)
	Death	271 (187‒451)	1.82 (1.25‒3.00)	466 (316‒834)	1.44 (0.97‒2.57)	-0.68 (-0.75‒-0.62)
	DALY	7 461 (5 056‒12 317)	43.9 (30.33‒72.86)	11 973 (7 927‒20 589)	35.43 (23.53‒61.23)	-0.62 (-0.67‒-0.57)
Mongolia	Incidence	36 (24‒53)	3.40 (2.27‒5.03)	60 (44‒88)	2.69 (1.95‒4.01)	-0.99 (-1.21‒-0.78)
	Death	37 (25‒55)	3.57 (2.38‒5.29)	61 (45‒91)	2.85 (2.06‒4.27)	-0.97 (-1.17‒-0.77)
	DALY	1 070 (671‒1 567)	95.80 (61.34‒140.90)	1 709 (1 242‒2 486)	68.43 (49.82‒101.33)	-1.37 (-1.61‒-1.12)

图1 1990—2021年东北亚5国BTC的发病、死亡及DALY变化趋势Note： A. Number of incident cases and ASIR. B. Number of deaths and ASMR. C. DALYs and ASDR. Bars represent absolute numbers, and lines represent age-standardized rates.

Fig 1 Trends in incidence, deaths, and DALYs of BTC in the five Northeast Asian countries from 1990 to 2021

图2 1990—2021年东北亚5国BTC发病、患病、死亡及DALY负担按性别分层的变化趋势Note： A. ASRs of incidence, prevalence, mortality, and DALYs in 1990 and 2021. B. Numbers of incident cases, prevalent cases, deaths, and DALYs in 1990 and 2021. C. Temporal trends in ASRs stratified by sex. D. Temporal trends in the numbers of incident cases, prevalent cases, deaths, and DALYs stratified by sex.

Fig 2 Sex-stratified trends in incidence, prevalence, mortality, and DALYs of BTC in five Northeast Asian countries from 1990 to 2021

图3 1990—2021年东北亚5国BTC发病、患病、死亡及DALY年龄别率与绝对数量的年龄分布Note： A. Age-specific incidence rate, prevalence rate, mortality rate, and DALY rate by age group. B. Numbers of incident cases, prevalent cases, deaths, and DALYs by age group. Colors represent the five Northeast Asian countries.

Fig 3 Age-specific incidence, prevalence, mortality, and DALY rates and corresponding absolute numbers of BTC in five Northeast Asian countries from 1990 to 2021

图4 1990—2021年东北亚5国BTC发病数、死亡数及DALY按年龄分层的变化趋势Note： A. Temporal trends in the number of incident cases by age group. B. Temporal trends in the number of deaths by age group. C. Temporal trends in DALYs by age group.

Fig 4 Trends in incident cases, deaths, and DALYs for BTC in the five Northeast Asian countries from 1990 to 2021, stratified by age

图5 1990年与2021年BTC疾病负担粗率与SDI排序之间的关系Note： A and B, incidence; C and D, mortality; E and F, DALYs. Panels A, C, and E show the associations between crude rates and relative SDI rank; panels B, D, and F show the corresponding concentration curves. Each dot represents a country or territory, with dot size indicating population size. Blue and red represent 1990 and 2021, respectively.

Fig 5 Relationship between crude rates of BTC burden and SDI rank in 1990 and 2021

图6 1990—2021年全球及东北亚5国BTC发病数变化的分解分析Note： Changes in incident cases were decomposed into the effects of population aging, population growth, and epidemiological change. The black dots indicate the overall change in incident cases.

Fig 6 Decomposition analysis of changes in incident BTC cases in the global population and the five Northeast Asian countries

图7 BAPC模型预测2022—2035年东北亚5国BTC发病、患病、死亡及DALY变化趋势Note： A. Incident cases and ASIR. B. Prevalent cases and ASPR. C. Deaths and ASMR. D. DALYs and ASDR. Solid and dotted lines represent observed and predicted values, respectively. The vertical dashed line indicates the start of the prediction period.

Fig 7 BAPC model-predicted trends in incidence, prevalence, mortality, and DALYs of BTC in five Northeast Asian countries, 2022-2035

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1990—2021年东北亚5国胆道恶性肿瘤疾病负担及趋势预测

Burden and trends of biliary tract cancer in five Northeast Asian countries, 1990-2021

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