【摘要】 目的 分析1990—2021年间全球吸烟归因前列腺癌(PCa)死亡率及疾病负担的时空演变规律，预测未来PCa变化趋势，为优化区域性PCa防控政策及戒烟干预提供循证依据。方法 基于2021年全球疾病负担研究(GBD)获得1990—2021年间全球204个国家和21个地区PCa的年度死亡率、伤残调整寿命年(DALYs)、寿命损失年(YLLs)、伤残损失健康生命年(YLDs)的病例数及年龄标准化率(ASRs)。采用年估计变化百分比(EAPC)评估全球、不同区域、不同社会人口指数(SDI)地区、不同年龄段的吸烟归因PCa死亡率及疾病负担。采用自回归移动平均模型(ARIMA)预测吸烟归因PCa疾病负担到2050年各指标的变化趋势。结果 2021年，与吸烟相关的PCa导致全球12 992人死亡，比1990年增长了30.74%。1990—2021年，与吸烟相关的PCa全球年龄标准化死亡率(ASMR)、年龄标准化DALYs(ASDR)、年龄标准化YLDs(ASYR)和年龄标准化YLLs(ASLR)均下降，EAPC分别为-1.43(95%CI:-1.77～-1.12)、-1.39(95%CI:-1.66～-1.12)、-0.41(95%CI:-0.67～-0.15)和-1.51(95%CI:-1.78～-1.23)。2021年，PCa疾病死亡人数最多的是亚洲地区(死亡人数4663例),其次是欧洲地区(死亡人数4647例),大洋洲地区的死亡人数最少(死亡人数9例)。1990—2021年，大部分地区PCa死亡率普遍呈下降趋势。1990—2021年，高SDI地区的ASMR、ASDR及ASLR的降幅最大，EAPC为-3.17(95%CI:-3.31～-3.02)、-2.91(95%CI:-3.02～-2.83)和-3.22(95%CI:-3.35～-3.09)。高SDI地区ASYR呈下降趋势，其余分区呈增长趋势，其中以中低SDI地区增幅最为明显(EAPC:1.26,95%CI:1.19～1.33)。2021年，吸烟归因PCa死亡人数在70～74岁及75～79岁较集中，分别为2312及2278例。1990—2021年，ASMR、ASDR及ASLR整体呈下降趋势，以35～39岁最为明显，EAPC分别为-2.84(95%CI:-3.21～-1.83)、-2.77(95%CI:-3.13～-1.75)及-2.84(95%CI:-3.14～-1.71)。预测至2050年，各疾病负担指标持续下降，后期趋于平稳。结论 尽管过去30年间全球吸烟归因PCa的疾病负担呈现一定程度的下降趋势，然而负担呈现显著地域失衡，未来中低SDI国家及地区仍面临严峻挑战。尽快推行更严格的控烟政策是减少吸烟健康危害的关键。更多还原

【Abstract】 Objective To analyze the spatiotemporal evolution patterns of mortality and disease burden of smoking-related prostate cancer(PCa) from 1990 to 2021 and to predict the future trends, so as to provide evidence-based insights for optimizing regional PCa prevention policies and smoking cessation interventions.Methods Based on data from the Global Burden of Disease Study(GBD) 2021,annual mortality, disability-adjusted life years(DALYs),years of life lost(YLLs),years lived with disability(YLDs),and age-standardized rates(ASRs) for PCa across 204 countries and 21 regions from 1990 to 2021 were obtained.Estimated annual percentage change(EAPC) was used to assess the disease burden and mortality of smoking-related PCa across global, regional, socio-demographic index(SDI),and age groups.An autoregressive integrated moving average(ARIMA) model was employed to predict trends in these indicators up to 2050.Results In 2021,smoking-related PCa caused 12 992 global deaths, a 30.74% increase compared to 1990.However, from 1990 to 2021,the global age-standardized mortality rate(ASMR),age-standardized DALYs rate(ASDR),age-standardized YLDs rate(ASYR),and age-standardized YLLs rate(ASLR) for smoking-related PCa declined, with EAPCs being-1.43(95%CI:-1.77—-1.12),-1.39(95%CI:-1.66—-1.12),-0.41(95%CI:-0.67—-0.15) and-1.51(95%CI:-1.78—-1.23).In 2021,the region with the highest number of deaths from PCa was Asia(4663 deaths),followed by Europe(4647 deaths),and Oceania had the lowest number of deaths(9 deaths).From 1990 to 2021,the mortality rate of PCa in most regions generally showed a downward trend.High SDI regions showed the most significant declines in ASMR,ASDR,and ASLR [EAPCs:-3.17(95%CI:-3.31—-3.02),-2.91(95%CI:-3.02—-2.83),and-3.22(95%CI:-3.35—-3.09)].For ASYR,only high-SDI regions exhibited a decline, whereas low-middle-SDI regions saw the largest increase [EAPC: 1.26(95%CI:1.19—1.33)].In 2021,the number of PCa deaths was more concentrated in the age groups of 70-74 and 75-79,with 2312 and 2278 deaths, respectively.From 1990 to 2021,ASMR,ASDR,and ASLR showed an overall downward trend, EAPC were-2.84(95%CI:-3.21—-1.83),-2.77(95%CI:-3.13—-1.75),and-2.84(95%CI:-3.14—-1.71),with the most significant decline observed in individuals aged 35-39.Projections to 2050 indicated continuing declines in all burden metrics, which would stabilize in later years.Conclusion Despite a global decline in smoking-related PCa burden over the past three decades, significant regional disparities persist, with low-and middle-income countries facing ongoing challenges.Implementing stricter tobacco control policies is critical to mitigating smoking-related health risks.更多还原