台湾人群肝癌多方面干预的长期效果

StephenW

Long-term Effectiveness of Population-wide Multifaceted Interventions for Hepatocellular Carcinoma in Taiwan
Sih-Han Liao  1 , Chi-Ling Chen  2 , Chen-Yang Hsu  3 , Kuo-Liong Chien  4 , Jia-Horng Kao  5 , Pei-Jer Chen  5 , Tony Hsiu-Hsi Chen  3 , Chien-Hung Chen  6
Affiliations
Affiliations

    1
    Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
    2
    Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
    3
    Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
    4
    Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    5
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
    6
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: [email protected].

    PMID: 33689789 DOI: 10.1016/j.jhep.2021.02.029

Abstract

Background & aims: Taiwan has launched a series of population-wide interventions on hepatocellular carcinoma (HCC) related to hepatitis B and C virus infection since 1984. It therefore provides a natural opportunity to evaluate whether the reduction of HCC incidence, to a greater extent, and the improvement of case-fatality, to a lesser extent, or vice versa make contribution to the resultant mortality reduction given each intervention program.

Methods: Population-based registry data on HCC mortality and incidence of individuals aged 0 to 84 years between 1979 and 2016 were collected before (period 1) and after intervention with three periods, universal hepatitis B vaccination from 1984 (period 2), universal health care from 1995 (period 3), and viral hepatitis therapy from 2003 (period 4). A Bayesian Poisson regression model for decomposing mortality rate was developed to estimate respective contributions to the reduction of incidence and case-fatality rate by various age groups.

Results: The mortality trends of children, young- and middle-aged groups substantially declined but there was only a slight decrease in the elderly group. The declining trends of mortality were in part explained by incidence reduction and in part by a remarkable decline in case-fatality rate attributed to universal health care. Hepatitis B vaccination led to 35.9% (26.8% to 44.4%) reduction of incidence for aged 30 years or below, whereas antiviral therapy made contribution to the reduction of 14.9% (11.8% to 17.9%) and 15.4% (14.1% to 16.6%) for aged 30-49 years and 50-69 years, respectively.

Conclusions: Vaccination and anti-viral therapy were effective in reducing HCC incidence and mortality for the young and middle-aged groups when the case-fatality was improved due to universal health care for all age groups.

Keywords: Bayesian Poisson regression model; Mortality rate decomposition method; Preventive strategy.

Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

StephenW

台湾人群肝癌多方面干预的长期效果
廖始汉1，陈志玲2，许晨阳3，钱国良4，高嘉鸿5，陈佩杰5，陈小希3，陈建雄6
隶属关系
隶属关系

    1个
    国立台湾大学癌症中心医学系，台湾台北；台湾台北国立台湾大学医院内科消化内科国立台湾大学公共卫生学院流行病学和预防医学研究所，台湾台北。
    2个
    国立台湾大学医学院临床医学研究所，台湾台北。
    3
    国立台湾大学公共卫生学院流行病学和预防医学研究所，台湾台北。
    4
    国立台湾大学公共卫生学院流行病学和预防医学研究所，台湾台北；国立台湾大学附属医院内科心内科，台湾台北。
    5
    台湾台北国立台湾大学医院内科消化内科国立台湾大学医学院临床医学研究所，台湾台北。
    6
    台湾台北国立台湾大学医院内科消化内科台湾国立台湾大学医院云林分院内科；国立台湾大学医学院，台湾台北。电子地址：[email protected]。

    PMID：33689789 DOI：10.1016 / j.jhep.2021.02.029

抽象的

背景与目的：台湾自1984年以来就针对乙型和丙型肝炎病毒感染的肝细胞癌开展了一系列针对人群的干预措施。因此，它提供了一个自然的机会来评估是否在更大程度上降低了HCC的发生，以及每个案例中病死率的改善（在较小程度上）或反之亦然，这有助于降低死亡率。

方法：在1979年至2016年期间（第一期）和干预后三个时期，1984年开始的全民乙肝疫苗接种（第二期），全民健康状况收集1979年至2016年间HCC死亡率和0至84岁个体发病率的人群登记数据。 1995年开始治疗（第3期），2003年开始进行病毒性肝炎治疗（第4期）。建立了用于分解死亡率的贝叶斯Poisson回归模型，以估计各个年龄段在降低发病率和病死率上的各自贡献。

结果：儿童，青年和中年组的死亡率趋势显着下降，而老年组仅略有下降。死亡率的下降趋势部分是由于发病率降低，部分是由于全民保健导致的病死率显着下降。乙肝疫苗接种可降低30岁或30岁以下人群的发病率35.9％（26.8％至44.4％），而抗病毒治疗有助于降低14.9％（11.8％至17.9％）和15.4％（14.1％至16.6） ％）分别为30-49岁和50-69岁。

结论：当所有年龄组的全民医疗保健使病死率提高时，接种疫苗和抗病毒治疗可有效降低年轻和中年组的HCC发生率和死亡率。

关键词：贝叶斯泊松回归模型死亡率分解法；预防策略。

版权所有©2021欧洲肝脏研究协会。由Elsevier B.V.出版，保留所有权利。

StephenW

https://www.journal-of-hepatolog ... 8278(21)00163-X/pdf