整合膀胱癌全球疾病负担、孟德尔随机化分析与医疗质量指数的综合研究

A Comprehensive Study Integrating the Global Burden of Bladder Cancer, Mendelian Randomization Analysis, and Healthcare Quality Index

摘要: 目的：系统分析1990~2021年全球膀胱癌的流行病学趋势、危险因素及分层防控策略。方法：整合全球疾病负担研究(GBD)宏观数据、全基因组关联研究(GWAS)与孟德尔随机化分析(MR)的微观数据，并结合社会人口指数(SDI)分析了全球不同地区、性别、年龄的差异，最后应用贝叶斯模型(BACP)预测2035年膀胱癌疾病负担变化趋势。结论：1990~2021年全球膀胱癌发病率与死亡率总体上升，但年龄标准化发病率(ASIR)、年龄标准化死亡率(ASMR)及年龄标准化伤残调整生命年率(ASDR)均呈下降趋势。其中，男性疾病负担显著高于女性，中低SDI地区发病率与死亡率增速明显。与此同时，高医疗质量指数(QCI)集中于高SDI区域，且QCI在地理分布及性别维度存在显著不平等。宏观与微观数据共同表明，吸烟与高空腹血糖(FBG)是膀胱癌的危险因素，且FBG的归因风险在全球范围内呈上升趋势。BACP预测显示2035年ASIR、ASMR及ASDR将持续降低。结果：实现全球疾病负担的可持续降低，需制定针对性危险因素干预措施，并推进医疗资源的公平分配。

Abstract: Objective: To systematically analyze the global epidemiological trends, risk factors, and stratified prevention and control strategies for bladder cancer from 1990 to 2021. Methods: This study integrated macro-level data from the Global Burden of Disease Study (GBD) with micro-level data from genome-wide association studies (GWAS) and Mendelian randomization (MR) analyses. Variations across different regions, genders, and age groups were examined in conjunction with the Socio-demographic Index (SDI). Finally, the Bayesian Age-Period-Cohort (BAPC) model was applied to project the changing trends in the bladder cancer disease burden up to 2035. Results: From 1990 to 2021, the global incidence and death counts of bladder cancer showed an overall increase. However, the age-standardized incidence rate (ASIR), age-standardized death rate (ASMR), and age-standardized disability-adjusted life year rate (ASDR) all exhibited a declining trend. The disease burden was significantly higher in males than in females, and low to middle-SDI regions experienced a markedly faster growth in incidence and death counts. Concurrently, High Quality of Care Index (QCI) is concentrated in high SDI Index regions, with significant inequalities observed in its geographical distribution and across genders. Both macro and micro evidence confirmed that smoking and high fasting blood glucose (FBG) are risk factors for bladder cancer, and the attributable risk of FBG demonstrated a rising trend worldwide. Projections from the BAPC model indicate a continued decline in ASIR, ASMR, and ASDR by 2035. Conclusion: Achieving a sustainable reduction in the global disease burden of bladder cancer requires the implementation of targeted risk factor interventions and the promotion of equitable allocation of healthcare resources.