PO.PS01.05 · 人群科学
2010年至2023年墨西哥甲状腺切除术的基于人群的研究
A population-based study on thyroidectomies in Mexico from 2010 to 2023
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景。甲状腺癌是墨西哥第四常见的癌症。随着诊断检测手段日益普及，过度诊断及随后的过度治疗有所增加。此外，21世纪初许多高收入国家观察到全甲状腺切除术相对于部分甲状腺切除术占比不断上升。人们对中低收入国家甲状腺切除术的频率和手术方式了解有限。我们旨在按性别、年龄组、手术类型（全甲状腺切除术和部分甲状腺切除术）和出院诊断，估计墨西哥甲状腺切除术的时间趋势和地理格局。
方法。我们使用卫生部收集的、涵盖2010年至2023年无医疗保险人群的全国医院出院数据库。我们识别了施行全（ICD-9：064X、0650、0652）或部分（ICD-9：0639、0651）甲状腺切除术的医院出院记录。我们将出院诊断分为四组：恶性肿瘤、良性肿瘤、甲状腺肿及甲状腺相关疾病，以及与甲状腺无关的其他诊断。我们按墨西哥各区域（北部、中部、东南部、西部和墨西哥城）和三个时间段（2010-2012、2013-2018和2018-2023）分别计算男性和女性的粗发病率和年龄标准化发病率。
结果。甲状腺切除术的全国标准化率为女性4.8/100,000、男性0.74/100,000。整个研究期间该率呈下降趋势，尤其是在患甲状腺肿的女性中。总体而言，因恶性疾病而行甲状腺切除术的率保持稳定，然而，比较三个时间段，因恶性肿瘤行甲状腺切除术的百分比在女性（34.3%、36.0%和45.2%）和男性（36.6%、43.6%和51.7%）中均有所上升。我们观察到显著的区域差异，墨西哥城的率最高（女性17.9/100,000），中部区域最低。研究期间全甲状腺切除术的比例在女性中从49%升至63%，在男性中从47%升至66%。
结论。墨西哥甲状腺切除术的下降趋势可能是指南变化的结果。我们的结果并未揭示甲状腺癌的过度诊断，但显示出采取更保守外科治疗的潜力。
查看英文原文 English abstract
Background . Thyroid cancer is the fourth most common cancer in Mexico. Overdiagnosis and subsequent overtreatment have increased as diagnostic tests have become more readily available. Also, an increasing share of total thyroidectomies relative to partial thyroidectomies was observed in many high-income countries in the early 2000s. There is limited understanding of the frequency of thyroidectomies and surgical approach in low- and middle-income countries. We aimed to estimate time trends and geographic patterns of thyroidectomies in Mexico by sex, age groups, type of procedure (total and partial thyroidectomies), and discharge diagnosis.
Methods . We used a national hospital discharge database collected by the Ministry of Health for individuals without health insurance coverage from 2010 to 2023. We identified hospital discharges where a total (ICD-9: 064X, 0650, 0652) or partial (ICD-9: 0639, 0651) thyroidectomy were performed. We classified discharge diagnoses into four groups: malignant neoplasms, benign tumors, goiter and thyroid-related morbidities, and other diagnoses unrelated to the thyroid. We calculated crude and age-standardized incidence rates for men and women by region in Mexico (North, Central, Southeast, West, and Mexico City) and for three time periods: 2010-2012, 2013-2018, and 2018-2023.
Results . The national standardized rate of thyroidectomies was 4.8 per 100,000 in women and 0.74 in men. The rate showed a downward trend throughout the period, particularly among women with goiter. Overall, the rate of thyroidectomies for malignant disease remained stable, however, the percentage of thyroidectomies for malignant tumors increased in both women (34.3%, 36.0%, and 45.2%) and men (36.6%, 43.6%, and 51.7%) when comparing the three periods. We observed important regional differences, with the highest rate in Mexico City (17.9 per 100,000 in women) and the lowest in the central region. The proportion of total thyroidectomies in the examined period increased from 49% to 63% in women and from 47% to 66% in men.
Conclusions . The downward trend in thyroidectomies in Mexico may be the result in changing guidelines. Our results do not reveal thyroid cancer overdiagnosis but show potential for more conservative surgical treatment.
利益披露 Disclosure
A. Cortes-Valencia, None..
G. Garfias-Becerril, None..
L. S. Palacio-Mejia, None..
E. M. Flores-Salas, None..
J. E. Hernandez-Avila, None..
M. Lajous, None.