【摘要】 目的 分析1990—2021年中国膀胱癌发病率和死亡率的变化趋势，评估2021年中国膀胱癌发病与死亡的现状，基于年龄-时期-队列模型探讨中国膀胱癌发病和死亡的年龄、时期和队列效应，并预测未来膀胱癌的标化发病率和标化死亡率变化趋势，为膀胱癌防控策略的制定提供科学依据。方法 数据来自2021年全球疾病负担（Global Burden of Disease Study2021, GBD 2021）数据库，通过Joinpoint回归模型计算膀胱癌年度百分比变化（annual percent change, APC）和平均APC(average APC, AAPC)。采用年龄-时期-队列模型评估膀胱癌发病与死亡的年龄、时期和队列效应。采用Nordpred预测模型预测2022—2045年中国膀胱癌的标化发病率和标化死亡率。结果 2021年中国膀胱癌标化发病率为5.14/10万，标化死亡率为2.34/10万。1990—2021年中国标化发病率呈现逐年上升的趋势，平均每年上升0.30%(95%CI:0.08%～0.52%,P=0.007)。同期标化死亡率呈现逐年下降的趋势，平均每年下降1.26%(95%CI:-1.51%～-1.01%,P<0.01)。年龄-时期-队列模型结果显示，中国膀胱癌的发病率和死亡率均随着年龄的增长显著上升，发病率和死亡率分别在85～90岁和90～94岁达到峰值，男性的发病率和死亡率均远高于女性。1992—2021年中国膀胱癌的时期发病风险总体呈现逐年上升趋势，其中男性发病风险持续增加，而女性发病风险逐年下降。同时，中国膀胱癌的死亡风险总体呈现下降趋势。随着出生队列的推移，膀胱癌的发病风险呈现出先下降后略微上升的变化趋势，而死亡风险则持续下降。预测结果显示，中国膀胱癌标化发病率从2022年的7.11/10万上升至2045年的7.90/10万，标化死亡率从2022年的3.18/10万下降至2045年的3.01/10万。结论 男性和高龄人群的膀胱癌风险依然显著较高。未来的膀胱癌防控应重点关注高风险人群的早期筛查和干预，加强健康教育和生活方式管理。特别是在老龄化加剧的背景下，需进一步提升基层医疗服务能力，推动早期诊断和精准治疗的普及，以降低膀胱癌的疾病负担。更多还原

【Abstract】 Objective To analyze the trend of the incidence and mortality of bladder cancer in China from 1990 to 2021, evaluate the incidence and mortality of bladder cancer in China in 2021, explore the age, period, and cohort effects on the incidence and mortality of bladder cancer in China based on the age-period-cohort model, and predict the trend of the age-standardized incidence and mortality rates of bladder cancer in the future, so as to provide scientific basis for the formulation of the prevention and control strategies of bladder cancer. Methods The data in this study were from the Global Burden of Disease Study 2021(GBD 2021) database. The annual percentage change(APC) and average APC(AAPC) of bladder cancer were calculated by the Joinpoint regression model. The age-period-cohort model was used to evaluate the age, period, and cohort effects on the incidence and mortality of bladder cancer. The Nordpred prediction model was used to predict the age-standardized incidence and mortality rates of bladder cancer in China from 2022 to 2045. Results In 2021, the age-standardized incidence rate of bladder cancer in China was 5.14/100 000, and the age-standardized mortality rate was 2.34/100 000. From 1990 to 2021, the age-standardized incidence rate showed an increasing trend year by year, with an average annual increase of 0.30%(95% CI: 0.08%-0.52%, P=0.007), while the age-standardized mortality rate showed a decreasing trend year by year, with an average annual decrease of 1.26%(95% CI:-1.51%-1.01%, P<0.01). The age-period-cohort model showed that the incidence and mortality of bladder cancer in China increased significantly with age. The incidence and mortality peaked at 85-90 years old and 90-94 years old, respectively. The incidence and mortality of men were much higher than those of women. From 1992 to 2021, the incidence risk of bladder cancer in China showed an increasing trend year by year in the overall population and males, and a decreasing trend in females. At the same time, the mortality risk showed a significant downward trend in the overall population. Across successive birth cohorts, the death risk of bladder cancer showed a declining trend, while the incidence risk showed a decreasing trend in older birth cohorts, and a slightly increasing trend in younger birth cohorts. The predicted age-standardized incidence rate of bladder cancer in China increased from 7.11/100 000 in 2022 to 7.90/100 000 in 2045, and the predicted age-standardized mortality rate decreased from 3.18/100 000 in 2022 to 3.01/100 000 in 2045. Conclusions The risk of bladder cancer is still significantly higher in men and elderly people. The prevention and control of bladder cancer in the future should focus on the early screening and intervention of high-risk groups, and strengthen health education and lifestyle management. Especially in the context of increasing aging, it is necessary to further improve the ability of primary medical services, and promote the popularization of early diagnosis and precise treatment to reduce the disease burden of bladder cancer.更多还原