Temporal Trends andSex Differences in the Incidence of Esophageal Squamous Cell Carcinoma andAdenocarcinoma from CI5 VIII–XII Data — Global, 1993–2017

Jiayue Li¹;Kexin Sun¹; Qian Zhu¹; Xiaolan Wen¹; XinmeiLin¹; Li Li¹; Ru Chen¹; Rongshou Zheng¹;Wenqiang Wei¹; Shaoming Wang^1,#

1. National Central CancerRegistry Office, National Cancer Center, National Clinical Research Center forCancer, Cancer Hospital, Chinese Academy of Medical Sciences/Peking UnionMedical College, Beijing, China.

^# Corresponding author:Shaoming Wang, wangshaoming@cicams.ac.cn.

Esophageal squamous cellcarcinoma (ESCC) and adenocarcinoma (EAC) are the two primary subtypes ofesophageal cancer. Historically, ESCC incidence has exceeded EAC, particularlyin East Asia, Southern Africa, and parts of South America. However, in recentdecades, EAC incidence has risen markedly in high-income countries due tolifestyle changes. Using the latest Cancer Incidence in Five Continents (CI5)data, we aimed to analyze global temporal trends and sex differences in theburden of ESCC and EAC.We extractedESCC and EAC incidence data from 25 countries in CI5 Volumes VIII-XII (1993–2017)for trend analysis. Age-standardized incidence rates (ASIRs) and ESCC-to-EACASIR ratios were calculated using Segi's World Standard Population, and annualpercentage changes were estimated using Joinpoint regression. Additionally, weevaluated male-to-female ASIR ratios using data from 53 countries in CI5 VolumeXII (2013–2017).Between 1993–2017,ESCC ASIRs declined in 19 countries but increased in Japan, the Czech Republic,Latvia, Denmark, and Lithuania. Conversely, EAC ASIRs increased in 17 countries,with the Republic of Korea being the only country reporting a decline.ESCC-to-EAC ASIR ratios narrowed in most countries, with EAC surpassing ESCCamong males in 10 countries, including the United States, and among femalesonly in the Philippines. From 2013–2017, males exhibited consistently higherASIRs than females for both subtypes, with more pronounced sex differencesobserved for EAC.This studyhighlights the changing epidemiology of ESCC and EAC globally and providesimportant scientific evidence for tailoring prevention and control strategiesbased on regional and histological-specific trends.

基于CI5 VIII–XII卷的食管鳞状细胞癌和食管腺癌发病率的时间趋势和性别差异分析— 全球，1993–2017年

李佳悦¹；孙可欣¹；朱倩¹；温晓岚¹；林欣玫¹；李荔¹；陈茹¹；郑荣寿¹；魏文强¹；王少明^1,#

1. 肿瘤登记办公室，国家癌症中心，国家肿瘤临床医学研究中心，肿瘤医院，中国医学科学院北京协和医学院，北京，中国。

^# 通信作者:王少明，wangshaoming@cicams.ac.cn。

食管鳞状细胞癌（Esophagealsquamous cell carcinoma, ESCC）和食管腺癌（Esophagealadenocarcinoma, EAC）是食管癌的两大主要亚型，其中ESCC的发病率远高于EAC，尤其在东亚、非洲南部和南美洲部分地区。然而，近几十年来，由于生活方式的改变，EAC的发病率在高收入国家显著上升。基于最新的《五大洲癌症发病率》（Cancer Incidence in Five Continents, CI5）数据，我们旨在详细分析全球ESCC和EAC疾病负担的时间趋势和性别差异。本研究选取CI5 VIII-XII卷（1993-2017）中25个国家ESCC和EAC的发病率数据进行时间趋势分析。以Segi's世界标准人口为参照，计算年龄标准化发病率（Age-standardizedincidence rates, ASIRs）和ESCC与EAC的ASIR比值，并采用Joinpoint回归模型估计年度变化百分比。此外，我们基于CI5 XII卷（2013-2017）中53个国家的癌症登记数据评估ESCC和EAC的男女ASIR比值。1993至2017年间，ESCC的ASIRs在19个国家中呈现下降趋势，但日本、捷克共和国、拉脱维亚、丹麦和立陶宛ESCC的ASIRs增加。相反，EAC的ASIRs在17个国家中明显上升，仅在韩国呈现下降趋势。在大多数国家中，ESCC与EAC的ASIR比值逐渐缩小，在包括美国在内的10个国家的男性以及菲律宾的女性中，EAC的ASIRs已超过ESCC。2013至2017年间，男性ESCC和EAC的ASIRs显著高于女性，且EAC的性别差异更为明显。本研究阐述了全球范围内ESCC和EAC流行病学特征的变化趋势，为针对不同地区和病理亚型制定精准的预防与控制策略提供了重要科学依据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.082

Decomposition Analysis of Urban-RuralDisparities in Healthy Life Expectancy Among Older Adults — China, 2010–2020

Shuai Guo^1,&; Jiatong Gao^2,&;Yuling Li¹; Zuliyaer Talifu¹; Xu Wen^3,#;Xiaoying Zheng^1,#

1.    Department of Ageing andHealth, School of Population Medicine and Public Health, Chinese Academy ofMedical Sciences/Peking Union Medical College, Beijing, China; Chinese Academyof Medical Sciences-APEC Health Science Academy (CAMS-HeSAy), Beijing, China;

2.    School of PopulationMedicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing, China;

3.     College of Biochemical Engineering, Beijing UnionUniversity, Beijing, China.

^& Joint first authors.

^# Corresponding author:Xiaoying Zheng, zhengxiaoying@sph.pumc.edu.com; Xu Wen, shtwenxu@buu.edu.cn.

AsChina's population rapidly ages, concerns have emerged about whether increasedlongevity among older adults is accompanied by improvements in health status. Thisstudy analyzed data from the 2010 and 2020 Chinese censuses to estimate healthylife expectancy (HLE) at age 60 and examined changes in urban-rural disparitiesand their driving factors. We applied the Sullivan method to estimate gender-and residence-specific HLE, while using the continuous change decompositionmethod to analyze how mortality and health status contributed to urban-ruraldifferences. Between 2010 and 2020, both the absolute years of HLE and itsproportion of total life expectancy increased, with the urban-rural gapnarrowing over time. However, the primary driver of urban-rural HLE disparitieshas shifted from mortality levels to health status, a pattern more pronouncedamong men. Decomposition analysis further reveals that compared to 2010, thekey age groups contributing to urban-rural HLE disparities in 2020 have shiftedto older ages, reflecting a transition in health inequalities as the populationages. These findings suggest that while HLE among China's older population hasimproved, the nature of health inequalities is evolving. Future public healthpolicies should place greater emphasis on addressing non-fatal healthconditions, particularly in rural areas and among the oldest-old, by improvingthe accessibility and quality of health services to promote healthy aging andreduce urban-rural health disparities.

老年人健康预期寿命城乡差异的分解研究—中国，2010–2020年

郭帅^1,&；高嘉彤^2,&；李宇玲¹；祖力亚尔·塔力甫¹；温煦^3,#；郑晓瑛^1,#

1.人口健康与老龄科学系，群医学及公共卫生学院，中国医学科学院北京协和医学院；中国医学科学院APEC健康科学研究院（CAMS-HeSAy），北京，中国；

2. 群医学及公共卫生学院，中国医学科学院北京协和医学院，北京，中国；

3. 生物化学工程学院，北京联合大学，北京，中国。

^&共同第一作者。

^# 通信作者：郑晓瑛，zhengxiaoying@sph.pumc.edu.cn；温煦，shtwenxu@buu.edu.cn。

随着中国人口迅速老龄化，人们越来越关注在长寿的同时，老年人的健康状况是否同样改善。本研究基于2010年和2020年中国人口普查数据，计算了中国60岁老年人口的健康预期寿命（healthy life expectancy，HLE），分析了城乡差异的变化趋势及其驱动因素。采用Sullivan法估算分性别-分城乡HLE，并使用连续变化分解法解析HLE的城乡差异，探讨死亡率与健康状况对差异的贡献。2010年至2020年间，中国老年人口HLE的绝对年数和相对占比均有所提高，城乡HLE差距呈缩小趋势。然而，城乡HLE差距的主要驱动因素由死亡水平转向健康状况，且上述模式在男性群体中更加明显。分解分析进一步表明，相比2010年，2020年城乡HLE差距的主要贡献年龄段有所推迟，反映了健康差异随着人口老龄化而转移的趋势。研究结果表明，尽管中国老年人口HLE有所提升，但健康不平等的形态正在发生转变。未来公共卫生政策应更加关注非致命健康问题，特别是在农村地区和高龄老年人群体中，提升健康服务的可及性和质量，以促进健康老龄化和缩小城乡健康不平等。

For more information:https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.083

The Cascade of Care for Diabetes andRisk of Functional Limitation — China, 2011–2020

Yihao Zhao^1,&;Ziyang Ren^2,&; Panliang Zhong¹; Yugang Li³;Ruitai Shao¹; Xiaoying Zheng^4,#; Enying Gong^1,#;Zhiqiang Song⁵

1. Department of Chronic diseases, Schoolof Population Medicine and Public Health, Chinese Academy of Medical Sciences/PekingUnion Medical College, Beijing, China; Chinese Academy of Medical Sciences-APECHealth Science Academy (CAMS-HeSAy), Beijing, China.

2. Department of Epidemiology and HealthStatistics, School of Public Health, Peking University, Beijing, China.

3. Chinese Academy of Medical Sciences,Beijing, China.

4. Department of Ageing and Health, Schoolof Population Medicine and Public Health, Chinese Academy of MedicalSciences/Peking Union Medical College, Beijing, China; Chinese Academy ofMedical Sciences-APEC Health Science Academy (CAMS-HeSAy), Beijing, China.

5. Department of Gastroenterology, PekingUniversity Third Hospital, Beijing, China.

^&Joint first authors.

^# Corresponding author:Xiaoying Zheng, zhengxiaoying@sph.pumc.edu.cn;Enying Gong, gongenying@cams.cn.

Diabetes, if not treated well, can resultin severe clinical complications and physical limitation. This studyinvestigates gaps in the Cascade of Care (CoC) for diabetes among individualsaged 45 and older in China and its association with the risk of functionallimitations. Using data from the China Health and Retirement Longitudinal Study(CHARLS) from 2011 to 2020, the study analyzes the association between CoC andlimitations in activities of daily living (ADLs) and instrumental activities ofdaily living (IADLs) through generalized estimating equations and Coxproportional hazards models. The CoC for diabetes includes five stages, withthe largest gap in the awareness stage (59.6%) and smaller gaps in thetransition from awareness to treatment (13.8%) and treatment-to-control (9.0%).Individuals in stages 1, 2, and 3 of the CoC have a significantly higher riskof ADL/IADL limitations, particularly in stage 3. The findings highlight poordiabetes management in China, especially in awareness and treatment stages, andshow that low awareness, treatment, and glycemic control are linked to higherfuture risk of functional limitations. Early diagnosis and effective diabetesmanagement are crucial to reducing these risks.

糖尿病级联护理与功能限制风险—中国，2011–2020年

赵艺皓^1,&；任子扬^2,&；钟盼亮¹；李玉刚³；邵瑞太¹；郑晓瑛^4,#；宫恩莹^1,#；宋志强⁵

1. 慢病学系，群医学及公共卫生学院，中国医学科学院北京协和医学院；中国医学科学院APEC健康科学研究院（CAMS-HeSAy），北京，中国；

2. 流行病学与卫生统计学系，公共卫生学院，北京大学，北京，中国；

3. 中国医学科学院，北京，中国；

4. 人口健康与老龄科学系，群医学及公共卫生学院，中国医学科学院北京协和医学院；中国医学科学院APEC健康科学研究院（CAMS-HeSAy），北京，中国；

5. 消化内科，北京大学第三医院，北京，中国。

^&共同第一作者。

^# 通讯作者:郑晓瑛，zhengxiaoying@sph.pumc.edu.cn；宫恩莹，gongenying@cams.cn。

糖尿病如果治疗不当，会导致严重的临床并发症和身体功能限制。本研究调查了中国 45 岁及以上人群中糖尿病级联护理（CoC）的不足及其与功能限制风险的关联。本研究利用2011-2020年中国健康与退休纵向研究（CHARLS）数据，通过广义估计方程和Cox比例危险模型分析了CoC与日常生活活动（ADLs）和工具性日常生活活动（IADLs）限制的关联。糖尿病级联护理包括五个阶段，其中认知阶段的差距最大（59.6%），从知晓到接受治疗（13.8%）和从接受治疗到血糖得到控制（9.0%）的差距较小。处于CoC第1、2和3阶段的个体出现ADL/IADL受限的风险明显较高，尤其是在第3阶段。研究结果强调了中国糖尿病管理不善的问题，尤其是在知晓和治疗阶段，也表明认识不足、治疗不力和血糖控制不佳与未来功能受限的风险较高有关。因此，早期诊断和有效的糖尿病管理对降低这些风险至关重要。

For more information:https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.084

Epidemiological Analysis of the Declineof Myocarditis Burden — China, 1992–2021

ShengnanWang¹;Xiangfeng Zhu¹; Yanwu Nie¹; Zeyu Xiao¹; MingzhuHuang¹; Zhimin Yao^2,#; Lei Wu^1,#

1. School of Public Health,Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health,Jiangxi Medical College, Nanchang University, NanchangCity, Jiangxi Province, China;

2. Shanggao County Centerfor Disease Control and Prevention, Yichun City, Jiangxi Province, China.

^# Correspondingauthors: Zhimin Yao, yao_zhimin@163.com, Lei Wu, leiwu@ncu.edu.cn.

Myocarditis is a common cardiovasculardisease that can lead to severe complications. This study investigates theepidemiological characteristics of myocarditis in China by analyzing incidence,mortality, and disability-adjusted life years (DALYs) trends from 1992 to 2021.Using the Global Burden of Disease (GBD) 2021 database, this study analyzed myocarditisincidence, mortality, DALYs, age-standardized rates, and average annualpercentage change (AAPC) from 1992 to 2021. An average percentage change (APC)model was applied to assess the impact of age, period, and birth cohort onmyocarditis mortality risk. Disease burden comparisons were made acrossdifferent age and gender groups in China.Compared to 1992, China saw a decline in age-standardized incidence,mortality, and DALYs rates of myocarditis in 2021. From 1992 to 2021, the AAPCin the standardized incidence rate, mortality rate, and DALYs rate ofmyocarditis in China were -0.223 [95% confidence interval (CI): -0.234, -0.212],-0.525 (95%CI: -0.861, -0.187), and-1.958 (95%CI: -2.219, -1.696),respectively. Males had higher rates than females, with faster declinesobserved in females. Risk factors for myocarditis mortality included beingunder 5 or over 70 years old, living in 2002-2016, and belonging to birthcohorts before 1957. APC model results were similar for males and females.Although China’s myocarditisdisease burden is decreasing, its age-standardized mortality and DALYs ratesremain above global levels. Continued vigilance in prevention and control isessential. Priority should be given to primary and secondary prevention forindividuals under 5, over 70, and males, with a focus on health education andmanagement.

心肌炎疾病负担下降流行病学分析—中国，1992–2021年

王胜南¹；朱祥峰¹；聂艳武¹；肖泽宇¹；黄明珠¹；姚志敏^2,#；吴磊^1,#

1. 公共卫生学院，疾病预防与公共卫生江西省重点实验室，南昌大学，南昌市，江西省，中国；

2. 上高县疾病预防控制中心，宜春市，江西省，中国。

^# 通信作者：姚志敏，yao_zhimin@163.com；吴磊，leiwu@ncu.edu.cn。

心肌炎是心血管疾病中常见的一种，可导致严重的并发症。本研究旨在通过分析1992-2021年的发病率、死亡率、伤残调整寿命年（disability-adjustedlife years, DALYs）趋势来研究中国心肌炎的流行特征。使用全球疾病负担2021（GBD2021）数据库，比较分析这段时期内年心肌炎的发病率、死亡率、DALYs以及标化率和平均年度百分比变化率（average annualpercentage change，AAPC）等指标，构建年龄-时期-队列（age-period-cohort , APC）模型，分析年龄、时期和出生队列效应对心肌炎死亡风险的影响，并比较我国不同年龄和性别群体的心肌炎疾病负担情况。与1992年相比，2021年中国人群心肌炎年龄标化发病率、年龄标化死亡率、年龄标化 DALYs 率呈现下降趋势。1992–2021年，我国心肌炎的标化发病率、标化死亡率及标化 DALYs 率的AAPC 分别为-0.223[95% confidence interval (CI)：-0.234, -0.212]、-0.525（95% CI：-0.861, -0.187）和 -1.958（95% CI：-2.219, -1.696）；标化DALYs率、标化死亡率、标化发病率均为男性高于女性，且女性下降速度快于男性；年龄在5岁以下或70岁以上、时期为2002-2016年、出生队列早于1957年均是心肌炎死亡的危险因素；男性与女性的APC模型分析结果相近。我国心肌炎防疾病负担总体呈下降趋势，但年龄标化死亡率与DALYs率仍高于全球水平，因此对心肌炎防治工作仍不能掉以轻心；建议将年龄小于5岁及大于70岁人群以及男性群体作为一级预防和二级预防的重点人群，积极开展健康教育和健康管理。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.085

Burden of Musculoskeletal Disorders —Global and BRICS+ Nations, 1990–2021

Bo Liang¹; Yue Wei¹; Heming Pei²; GongChen^1,#; Lijun Pei¹

1. Institute of Population Research, PekingUniversity, Beijing, China;

2. Department of Epidemiology, MailmanSchool of Public Health, Columbia University, New York City, NY, USA.

^# Corresponding authors: Gong Chen, chengong@pku.edu.cn.

Thisstudy evaluated the disease burden and trends of musculoskeletal (MSK)disorders globally and in the BRICS+ countries from 1990 to 2021. Data from theGlobal Burden of Disease (GBD) 2021 database were usedto assess disease burden through incidence rate, prevalence rate, disability-adjusted life years (DALYs) rate, and average annual percentage change (AAPC). In 2021,Brazil had the highest age-standardized DALYs of MSK disorders (2,267/100,000),while China had the lowest (1,616/100,000), with DALYs consistently higher infemales than males. From 1990 to 2021, the largest decrease in age-standardizedDALYs occurred in China (-2.35%), while the largest increase was observed inSaudi Arabia (10.74%). Among disease types, low back pain (LBP) was the leadingcause of MSK disorder burden, while gout had the least impact. Age-standardizedDALYs in China showed a downward trend, with no significant changes in Braziland South Africa, and an upward trend in other countries, most notably in SaudiArabia. MSK disorders imposed a substantial burden on BRICS+ countries,particularly in Brazil and Iran. These findings highlight the importance offormulating targeted healthcare policies and allocating resources rationally toaddress the varying patterns of MSK disorder burden across these nations.

肌肉骨骼疾病的疾病负担—全球和金砖国家，1990–2021年

梁博¹；魏玥¹；裴赫铭²；陈功^1,#；裴丽君¹

1. 人口研究所，北京大学，北京，中国；

2. 梅尔曼公共卫生学院，哥伦比亚大学，纽约市，纽约州，美国。

^# 通信作者：陈功，chengong@pku.edu.cn。

本研究评估了1990年-2021年间全球及金砖国家（BRICS+）的肌肉骨骼（MSK）疾病负担及其变化趋势。数据来自全球疾病负担（GBD）2021数据库，通过发病率、患病率和伤残调整生命年率（DALYs）和平均年度百分比变化（AAPC）评估疾病负担。2021年的金砖国家中，巴西MSK疾病的年龄标准化DALYs最高(2,267/100,000)，而中国最低(1,616/100,000)，女性高于男性。1990-2021年，中国年龄标准化DALYs降幅最大（-2.35%），沙特阿拉伯增幅最大（10.74%）。从疾病类型看，下腰痛（LBP）是导致MSK疾病负担的首要原因，而痛风的影响最小。中国的年龄标准化DALYs呈下降趋势，巴西和南非无明显变化，其他国家呈上升趋势，沙特阿拉伯上升最明显。MSK疾病给金砖国家带来沉重负担，巴西和伊朗的情况尤为突出。鉴于各国差异化的肌肉骨骼疾病负担格局，制定针对性的医疗卫生政策并合理分配医疗资源十分必要。

For more information:https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.081