PO.PS01.02 · 人群科学
美国恶性胸腔积液死亡率的上升，1999-2020：人群水平的趋势与差异
Rising mortality from malignant pleural Effusion in the United States, 1999-2020: Population-level trends and disparities
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摘要 Abstract
中文摘要
恶性胸腔积液（MPE）提示肿瘤广泛累及胸膜腔，往往反映侵袭性疾病特征和晚期癌症进展。尽管其在多种实体瘤中具有临床和预后重要性，但归因于MPE的全国死亡率模式仍未得到充分表征。我们进行了一项基于人群的分析，以界定美国MPE相关死亡的人口学和时间趋势。方法：使用CDC WONDER多重死因数据（1999-2020），我们识别出将MPE（ICD-10 C78.2）列为促成死因的美国死亡病例。计算总体以及按性别、种族、族裔、年龄、地区和城市化水平的年龄校正死亡率（AAMR；每100,000人；2000年美国标准人口）。采用对数线性建模和加权BIC模型选择的Joinpoint回归评估时间趋势。报告了每一段的年度百分比变化（APC）估计值和95%置信区间。结果：1999-2020年间共发生68,700例MPE相关死亡。全国AAMR从0.68增至每100,000人1.40。最优模型识别出两个拐点（2001年、2007年）。早期的适度上升（APC 1999-2001：+6.7%，95% CI -2.9至15.4）之后是短暂下降（2001-2007：-4.1%，-9.8至8.9）。2007-2020年，死亡率显著上升，APC为+6.4%（95% CI 5.2-7.8；p<0.01）。女性占死亡的58%；女性AAMR从0.68增至每100,000人1.44，具有三个趋势段（APC 1999-2001：+9.6%；2001-2007：-4.2%；2007-2020：+6.3%，p<0.01）。男性AAMR从0.66增至每100,000人1.33，在2007年有单个拐点（APC 1999-2007：-3.1%；2007-2020：+6.3%，均p<0.01）。大多数死者为≥65岁（70%）。在整个研究期间，种族分布包括White（83%）、Black（12%）和Asian/Pacific Islander（4%）；6%为Hispanic。死亡率在中型和小型都市区最高。所有死亡中50%发生在医院，28%在家中，8%在临终关怀机构。结论：美国MPE相关死亡率在二十年间显著增加，2007年后持续上升。按年龄、种族和城市化程度的持续差异凸显了脆弱人群以及早期癌症检测、系统治疗可及性和姑息资源方面的持续不平等。这些发现表明晚期恶性疾病负担日益加重，支持更早进行肿瘤学干预、改善转移监测以及采用兼顾肿瘤控制和胸膜积液的治疗的必要性。MPE死亡率的攀升进一步支持开发超越以传统引流为中心的管理的疾病修饰性干预措施。
查看英文原文 English abstract
Malignant pleural effusion (MPE) indicates extensive tumor involvement of the pleural space and often reflects aggressive disease characteristics and advanced cancer progression. Despite its clinical and prognostic importance across multiple solid tumors, national mortality patterns attributable to MPE remain poorly characterized. We performed a population-based analysis to define demographic and temporal trends in MPE-related deaths in the United States.Methods: Using CDC WONDER Multiple Cause-of-Death data (1999-2020), we identified U.S. deaths listing MPE (ICD-10 C78.2) as a contributing cause. Age-adjusted mortality rates (AAMR; per 100,000; 2000 U.S. standard population) were calculated overall and by sex, race, ethnicity, age, region, and urbanization level. Temporal trends were assessed with Joinpoint regression using log-linear modeling and Weighted BIC for model selection. Annual percent change (APC) estimates and 95% confidence intervals were reported for each segment.Results: A total of 68,700 MPE-related deaths occurred from 1999-2020. The national AAMR increased from 0.68 to 1.40 per 100,000. The optimal model identified two joinpoints (2001, 2007). A modest early increase (APC 1999-2001: +6.7%, 95% CI -2.9 to 15.4) was followed by a transient decline (2001-2007: -4.1%, -9.8 to 8.9). From 2007-2020, mortality rose significantly with an APC of +6.4% (95% CI 5.2-7.8; p<0.01). Females accounted for 58% of deaths; female AAMR rose from 0.68 to 1.44 per 100,000 with three trend segments (APC 1999-2001: +9.6%; 2001-2007: -4.2%; 2007-2020: +6.3%, p<0.01). Male AAMR increased from 0.66 to 1.33 per 100,000, with a single joinpoint at 2007 (APC 1999-2007: −3.1%; 2007-2020: +6.3%, both p<0.01). Most decedents were ≥65 years (70%). Across the study period, racial distribution included White (83%), Black (12%), and Asian/Pacific Islander (4%); 6% were Hispanic. Mortality rates were highest in medium and small metropolitan regions. 50% of all deaths occurred in hospitals, 28% at home, and 8% in hospice facilities. Conclusions: MPE-associated mortality in the U.S. has increased markedly over two decades, with a sustained rise after 2007. Persistent disparities by age, race, and urbanization highlight vulnerable populations and ongoing inequities in early cancer detection, access to systemic therapy, and palliative resources. These findings illustrate a growing burden of advanced malignant disease and support the need for earlier oncologic intervention, improved metastatic surveillance, and therapies that address both tumor control and pleural fluid accumulation. The escalation of MPE mortality further supports the development of disease-modifying interventions beyond conventional drainage-centered management.
利益披露 Disclosure
A. Z. Sorathia, None..
D. Patel, None..
B. Aldroubi, None..
M. Patrick, None.