智利中的胆囊切除术和消化癌：时间序列中断和汇总数据分析的互补结果
Cholecystectomy and digestive cancer in Chile: Complementary results from interrupted time series and aggregated data analyses
影响因子:4.70000
分区:医学2区 / 肿瘤学2区
发表日期:2025 Jan 01
作者:
Constanza Gonzalez, Alfonso García-Pérez, Bruno Nervi, César Munoz, Erik Morales, Hector Losada, Gina Merino-Pereira, Francisco Rothhammer, Justo Lorenzo Bermejo
摘要
智利的胆囊癌（GBC）死亡率是全球最高的。 2006年，智利政府启动了一项计划，保证适用于35-49岁患者的胆囊手术（胆囊切除术）。我们评估了该计划对消化癌死亡率的影响。在对2002年至2018年的住院和死亡率数据进行了中断的时间序列分析后，智利统计统计与信息部公开可用，我们计算了自10年以来没有胆囊的个人比例的变化。然后，我们估计年龄，性别，地区和日历年度标准化死亡率（SMR），这是没有胆囊的个体比例的变化的函数。引入卫生计划后，胆囊切除术率每年每年100,000人的45次手术（95％CI 19-72）。由于10年以来，没有胆囊的个体比例每增加1％，与GBC死亡率降低了0.73％（95％CI -1.05％至-0.38％），但负相关仅限于60岁以上的妇女，南部智利和年龄超过60岁。我们还发现，伴随胆汁外的胆汁疾病和胆汁疾病的癌症的癌症和肠外疾病的癌症的癌症降低。总而言之，在成立12年后，智利胆囊切除术计划明显改变了胆囊切除术率。基于汇总数据的结果表明，由于胆囊和其他消化系统癌症，没有胆囊的个体的比例与死亡率之间存在负相关性，这需要使用个体级别的纵向数据验证，以减少生态偏见的潜在影响。
Abstract
Gallbladder cancer (GBC) mortality in Chile is among the highest worldwide. In 2006, the Chilean government launched a programme guaranteeing access to gallbladder surgery (cholecystectomy) for patients aged 35-49 years. We evaluated the impact of this programme on digestive cancer mortality. After conducting an interrupted time series analysis of hospitalisation and mortality data from 2002 to 2018 publicly available from the Chilean Department of Health Statistics and Information, we calculated the change in the proportion of individuals without gallbladder since 10 years. We then estimated age, gender, region, and calendar-year standardised mortality ratios (SMRs) as a function of the change in the proportion of individuals without gallbladder. The cholecystectomy rate increased by 45 operations per 100,000 persons per year (95%CI 19-72) after the introduction of the health programme. Each 1% increase in the proportion of individuals without gallbladder since 10 years was associated with a 0.73% decrease in GBC mortality (95% CI -1.05% to -0.38%), but the negative correlation was limited to women, southern Chile and age over 60. We also found decreasing mortality rates for extrahepatic bile duct, liver, oesophageal and stomach cancer with increasing proportions of individuals without gallbladder. To conclude, 12 years after its inception, the Chilean cholecystectomy programme has markedly and heterogeneously changed cholecystectomy rates. Results based on aggregate data indicate a negative correlation between the proportion of individuals without gallbladder and mortality due to gallbladder and other digestive cancers, which requires validation using individual-level longitudinal data to reduce the potential impact of ecological bias.