Table_3_Global, regional, and national analyses of the burden of colorectal cancer attributable to diet low in milk from 1990 to 2019: longitudinal observational study.docx

BackgroundGlobally, diet low in milk is the third greatest risk factor for colorectal cancer (CRC). However, there has been a lack of detailed worldwide analysis of the burden and trends of CRC attributable to diet low in milk.
ObjectiveWe aim to assess the spatiotemporal trends of CRC-related mortality and disability-adjusted life-years (DALYs) attributable to diet low in milk at the global, regional, and national levels from 1990 to 2019.
MethodsData of mortality, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of CRC attributable to diet low in milk were extracted from the Global Burden of Disease (GBD) 2019 study. The burden of CRC attributable to diet low in milk was estimated using the ASMR and ASDR, while accounting for sex, age, country, and socio-demographic index (SDI). From 1990 to 2019, the estimated annual percentage change (EAPC) was calculated to clarify the temporal trends in the ASMR and ASDR attributable to diet low in milk.
ResultsIn 2019, there were 166,456 (95% UI = 107,221–226,027) deaths and 3,799,297 (95% UI = 2,457,768–5,124,453) DALYs attributable to diet low in milk, accounting for 15.3 and 15.6% of CRC-related deaths and DALYs in 2019. CRC-related deaths and DALYs attributed to diet low in milk increased by 130.5 and 115.4%, from 1990 to 2019. The burden of CRC attributable to diet low in milk varied notably among regions and nations. High-middle SDI regions had the highest ASDR and ASMR of CRC linked to diet low in milk, while there was a slight downward trend high SDI regions. Among geographical regions, East Asia had the highest number of CRC-related deaths and DALYs attributable to diet low in milk. Notably, the burden of CRC was highest in males and the elderly. With coefficients of −0.36 and −0.36, the EAPC in ASMR and ASDR was significantly inversely correlated with the Human Development Index in 2019.
ConclusionGlobally, the number of CRC deaths attributable to diet low in milk has continued to increase over the last 30 years. Therefore, government and authorities should conduct education campaigns to encourage individuals to increase daily milk intake.

### 研究背景
全球范围内，低乳制品摄入是结直肠癌（colorectal cancer, CRC）的第三大危险因素。然而，目前仍缺乏针对低乳制品摄入相关结直肠癌疾病负担与流行趋势的全球详细分析。

### 研究目的
本研究旨在评估1990年至2019年间，全球、区域及国家层面上，低乳制品摄入相关结直肠癌的死亡率与伤残调整寿命年（disability-adjusted life-years, DALYs）的时空分布趋势。

### 研究方法
本研究从2019年全球疾病负担（Global Burden of Disease, GBD）研究数据库中，提取了低乳制品摄入相关结直肠癌的死亡率、DALYs、年龄标准化死亡率（age-standardized mortality rate, ASMR）以及年龄标准化DALY率（age-standardized DALY rate, ASDR）数据。通过ASMR与ASDR估算低乳制品摄入相关结直肠癌的疾病负担，并校正了性别、年龄、国家及社会人口学指数（socio-demographic index, SDI）的混杂效应。1990年至2019年间，本研究计算了估计年度百分比变化（estimated annual percentage change, EAPC），以明确低乳制品摄入相关结直肠癌ASMR与ASDR的时间变化趋势。

### 研究结果
2019年，低乳制品摄入相关结直肠癌共导致166456例死亡病例（95%不确定区间=107221~226027），相关伤残调整寿命年数达3799297（95%不确定区间=2457768~5124453），分别占当年结直肠癌总死亡病例与总伤残调整寿命年数的15.3%与15.6%。1990年至2019年间，低乳制品摄入相关的结直肠癌死亡病例数与伤残调整寿命年数分别增长130.5%与115.4%。不同区域与国家间，低乳制品摄入相关结直肠癌的疾病负担存在显著异质性。中高SDI区域的低乳制品摄入相关结直肠癌ASMR与ASDR均处于最高水平，而高SDI区域则呈现轻微下降趋势。在地理区域中，东亚地区低乳制品摄入相关结直肠癌的死亡病例数与伤残调整寿命年数均为最高。值得注意的是，该疾病负担在男性群体与老年人群中最为突出。2019年，ASMR与ASDR的EAPC分别为-0.36与-0.36，二者均与人类发展指数（Human Development Index, HDI）呈显著负相关。

### 研究结论
全球范围内，过去30年间与低乳制品摄入相关的结直肠癌死亡人数持续攀升。因此，各国政府及卫生主管部门应开展健康教育推广活动，鼓励民众增加每日乳制品摄入量。