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全球宫颈癌疾病负担

参考文献

  1. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, Bray F: Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health 2020, 8(2):e191-e203.
  2. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F: Cancer statistics for the year 2020: An overview. International Journal of Cancer 2021.
 

我国宫颈癌疾病负担

参考文献

  1. Estimated numbers (incidence and mortality) of cancer of cervix uteri from 2020 to 2040, females, age [0-85+], China[DB/OL]. [https://gco.iarc.fr/tomorrow/en/dataviz/trends?mode=cancer&types=0_1&group_populations=0&multiple_populations=0&multiple_cancers=1&sexes=2&cancers=23&populations=160]
  2. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in China. Summary Report. [https://hpvcentre.net/statistics/reports/CHN.pdf?t=1674053488539]
  3. 中国国家卫生健康委员会. 宫颈癌诊疗指南（2022年版）.

[http://www.nhc.gov.cn/yzygj/s2911/202204/a0e67177df1f439898683e1333957c74/files/361f086b71214c4e8336fa7d251dc020.pdf]

  1. Zheng R, Sun K, Zhang S, al. e: Report of cancer epidemiology in China, 2015. Chinese Jounral of Oncology 2019, 01:19-28.
  2. 黄留叶, 赵雪莲, 赵方辉: 宫颈癌的发病与死亡变化趋势及其预防策略进展. 肿瘤综合治疗电子杂志 2021, 7(2):21-25.
  3. Zhang S, Sun K, Zheng R, Zeng H, Wang S, Chen R, Wei W, He J: Cancer incidence and mortality in China, 2015. Journal of the National Cancer Center 2021, 1(1):2-11.
  4. 张韶凯, 赵方辉, 乔友林: 中国宫颈癌防治研究 20 年历程与成就. 中华流行病学杂志 2020, 41(6):809-812.
  5. 包鹤龄, 刘韫宁, 王黎君, 方利文, 丛舒, 周脉耕, 王临虹: 中国 2006-2012 年子宫颈癌死亡情况与变化趋势分析. 中华流行病学杂志 2017, 38(1):58-64.
  6. 胡尚英, 郑荣寿, 赵方辉, 张思维, 陈万青, 乔友林: 1989 至 2008 年中国女性子宫颈癌发病和死亡趋势分析. 中国医学科学院学报 2014, 36(2):119-125.
  7. Li X, Zheng R, Li X, Shan H, Wu Q, Wang Y, Chen W: Trends of incidence rate and age at diagnosis for cervical cancer in China, from 2000 to 2014. Chinese Journal of Cancer Research 2017, 29(6):477.
  8. GBD 2019 https://vizhub.healthdata.org/gbd-results/
  9. Cancer Today [https://gco.iarc.fr/]
  10. Xia C, Ding C, Zheng R, Zhang S, Zeng H, Wang J, Liao Y, Zhang N, Yang Z, Chen W: Trends in geographical disparities for cervical cancer mortality in China from 1973 to 2013: a subnational spatio-temporal study. Chinese journal of cancer research 2017, 29(6):487-495.
 

消除宫颈癌的全球行动计划

参考文献

  1. Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, Martin D, Simms KT, Bénard É, Boily M-C: Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. The Lancet 2020, 395(10224):575-590.
  2. Xia C, Xu X, Zhao X, Hu S, Qiao Y, Zhang Y, Hutubessy R, Basu P, Broutet N, Jit M et al: Effectiveness and cost-effectiveness of eliminating cervical cancer through a tailored optimal pathway: a modeling study. BMC Medicine 2021, 19(1):62.
 

HPV病毒

参考文献

  1. 王华庆, 赵方辉, 赵昀: 子宫颈癌等人乳头瘤病毒相关疾病免疫预防专家共识. 中华预防医学杂志 2019, 53(8):761-803.
  2. 张韶凯, 赵方辉, 乔友林: 中国宫颈癌防治研究 20 年历程与成就. 中华流行病学杂志 2020, 41(6):809-812.
  3. 赵方辉, 戎寿德, 乔友林, 李楠, 吴令英, 张洵: 山西省襄垣县妇女人乳头状瘤病毒感染与宫颈癌关系的研究. 中华流行病学杂志 2001, 22(5):375-378.
  4. Shi J-F, Belinson JL, Zhao F-H, Pretorius RG, Li J, Ma J-F, Chen F, Xiang W, Pan Q-J, Zhang X: Human papillomavirus testing for cervical cancer screening: results from a 6-year prospective study in rural China. American journal of epidemiology 2009, 170(6):708-716.
  5. Zhao FH, Lewkowitz AK, Hu SY, Chen F, Li LY, Zhang QM, Wu RF, Li CQ, Wei LH, Xu AD: Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: A pooled analysis of 17 population‐based studies. International journal of cancer 2012, 131(12):2929-2938.
 

全球HPV感染负担

参考文献

  1. de Sanjosé S, Diaz M, Castellsagué X, Clifford G, Bruni L, Muñoz N, Bosch FX: Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis 2007, 7(7):453-459.
  2. Kombe Kombe AJ, Li B, Zahid A, Mengist HM, Bounda G-A, Zhou Y, Jin T: Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front Public Health 2021, 8:552028-552028.
  3. Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, S. dS: Human papillomavirus and related diseases in the world. In: Summary Report. ICO/IARC Information Centre on HPV and Cencer (HPV Information Centre); 2019.
  4. Bruni L, Diaz M, Castellsagué M, Ferrer E, Bosch FX, de Sanjosé S: Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. Journal of Infectious Diseases 2010, 202(12):1789-1799.
  5. Forman D, de Martel C, Lacey CJ, Soerjomataram I, Lortet-Tieulent J, Bruni L, Vignat J, Ferlay J, Bray F, Plummer M et al: Global Burden of Human Papillomavirus and Related Diseases. Vaccine 2012, 30:F12-F23.
  6. Guan P, Howell‐Jones R, Li N, Bruni L, De Sanjosé S, Franceschi S, Clifford GM: Human papillomavirus types in 115,789 HPV‐positive women: a meta‐analysis from cervical infection to cancer. International journal of cancer 2012, 131(10):2349-2359.
  7. Mondiale de la Santé O, Organization WH: Human papillomavirus vaccines: WHO position paper, May 2017. Weekly Epidemiological Record= Relevé épidémiologique hebdomadaire 2017, 92(19):241-268.
  8. 李宜珂, 陈思伊, 黄小芬, 方亚, 赵勤俭: 人乳头瘤病毒疫苗的临床效用及其经济学研究. 现代预防医学 2018, 45(15).
 

我国HPV感染的流行情况

参考文献

  1. 王华庆, 赵方辉, 赵昀: 子宫颈癌等人乳头瘤病毒相关疾病免疫预防专家共识. 中华预防医学杂志 2019, 53(8):761-803.
  2. Zhao FH, Lewkowitz AK, Hu SY, Chen F, Li LY, Zhang QM, Wu RF, Li CQ, Wei LH, Xu AD: Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: A pooled analysis of 17 population‐based studies. International journal of cancer 2012, 131(12):2929-2938.
  3. Zhu B, Liu Y, Zuo T, Cui X, Li M, Zhang J, Yu H, Piao H: The prevalence, trends, and geographical distribution of human papillomavirus infection in China: The pooled analysis of 1.7 million women. Cancer medicine 2019, 8(11):5373-5385.
  4. 单玮, 张涛, 张铁军, 赵根明: 我国女性人乳头瘤病毒 (HPV) 感染的流行病学现状. 中华疾病控制杂志 2017, 21(1):89-93.
  5. 余艳琴, 富诗岚, 徐慧芳, 韦梦娜, 陈琦, 胡尚英, 赵方辉, 乔友林: 中国大陆女性体检人群中人乳头瘤病毒型别感染率及九价疫苗中 HPV 各型别分布的系统评价. 肿瘤预防与治疗 2019, 32(2):103-113.
  6. 张韶凯, 赵方辉, 乔友林: 中国宫颈癌防治研究 20 年历程与成就. 中华流行病学杂志 2020, 41(6):809-812.
  7. 韦梦娜, 余艳琴, 徐慧芳, 富诗岚, 胡尚英, 赵方辉, 乔友林: 中国大陆地区不同宫颈病变人群中人乳头瘤病毒感染率及型别分布的系统研究. 中国肿瘤临床与康复 2020, 2.
  8. Zhang J, Cheng K, Wang Z: Prevalence and distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia in China: a meta-analysis. Archives of Gynecology and Obstetrics 2020:1-9.
  9. Wu E-Q, Liu B, Cui J-F, Chen W, Wang J-B, Lu L, Niyazi M, Zhao C, Ren S-D, Li C-Q: Prevalence of type-specific human papillomavirus and pap results in Chinese women: a multi-center, population-based cross-sectional study. Cancer causes & control 2013, 24(4):795-803.
  10. Chen W, Molijn A, Enqi W, Zhang X, Jenkins D, Yu X, Quint W, Schmidt JE, Li J, Pirog E: The variable clinicopathological categories and role of human papillomavirus in cervical adenocarcinoma: A hospital based nation‐wide multi‐center retrospective study across China. International journal of cancer 2016, 139(12):2687-2697.
 

疫苗的免疫原性、保护效力及安全性

参考文献

  1. 中华医学会妇科肿瘤学分会, 中国优生科学协会阴道镜和宫颈病理学分会: 人乳头瘤病毒疫苗临床应用中国专家共识. 中国医学前沿杂志 2021, 13(2):1-12.
  2. Zhu F, Li J, Hu Y, Zhang X, Yang X, Zhao H, Wang J, Yang J, Xia G, Dai Q: Immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine in healthy Chinese girls and women aged 9 to 45 years: results from 2 randomized controlled trials. Human vaccines & immunotherapeutics 2014, 10(7):1795-1806.
  3. Apter D, Wheeler CM, Paavonen J, Castellsagué X, Garland SM, Skinner SR, Naud P, Salmerón J, Chow S-N, Kitchener HC: Efficacy of HPV-16/18 AS04-adjuvanted vaccine against cervical infection and precancer in young women: final event-driven analysis of the randomised, double-blind PATRICIA trial. Clinical and Vaccine Immunology 2015.
  4. Lehtinen M, Paavonen J, Wheeler CM, Jaisamrarn U, Garland SM, Castellsagué X, Skinner SR, Apter D, Naud P, Salmerón J: Overall efficacy of HPV-16/18 AS04-adjuvanted vaccine against grade 3 or greater cervical intraepithelial neoplasia: 4-year end-of-study analysis of the randomised, double-blind PATRICIA trial. The lancet oncology 2012, 13(1):89-99.
  5. Wheeler CM, Skinner SR, Del Rosario-Raymundo MR, Garland SM, Chatterjee A, Lazcano-Ponce E, Salmerón J, McNeil S, Stapleton JT, Bouchard C et al: Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years: 7-year follow-up of the phase 3, double-blind, randomised controlled VIVIANE study. Lancet Infect Dis 2016, 16(10):1154-1168.
  6. Zhu FC, Chen W, Hu YM, Hong Y, Li J, Zhang X, Zhang YJ, Pan QJ, Zhao FH, Yu JX et al: Efficacy, immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine in healthy Chinese women aged 18-25 years: results from a randomized controlled trial. Int J Cancer 2014, 135(11):2612-2622.
  7. Zhu FC, Hu SY, Hong Y, Hu YM, Zhang X, Zhang YJ, Pan QJ, Zhang WH, Zhao FH, Zhang CF et al: Efficacy, immunogenicity and safety of the AS04-HPV-16/18 vaccine in Chinese women aged 18-25 years: End-of-study results from a phase II/III, randomised, controlled trial. Cancer Med 2019, 8(14):6195-6211.
  8. Qiao YL, Wu T, Li RC, Hu YM, Wei LH, Li CG, Chen W, Huang SJ, Zhao FH, Li MQ et al: Efficacy, Safety, and Immunogenicity of an Escherichia coli-Produced Bivalent Human Papillomavirus Vaccine: An Interim Analysis of a Randomized Clinical Trial. J Natl Cancer Inst 2020, 112(2):145-153.
  9. Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GW, Ferris DG, Steben M, Bryan J et al: Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007, 356(19):1928-1943.
  10. Quadrivalent Vaccine against Human Papillomavirus to Prevent High-Grade Cervical Lesions. New England Journal of Medicine 2007, 356(19):1915-1927.
  11. Kjaer SK, Nygård M, Dillner J, Brooke Marshall J, Radley D, Li M, Munk C, Hansen BT, Sigurdardottir LG, Hortlund M et al: A 12-Year Follow-up on the Long-Term Effectiveness of the Quadrivalent Human Papillomavirus Vaccine in 4 Nordic Countries. Clin Infect Dis 2018, 66(3):339-345.
  12. Wei L, Xie X, Liu J, Zhao Y, Chen W, Zhao C, Wang S, Liao X, Shou Q, Qiu Y et al: Efficacy of quadrivalent human papillomavirus vaccine against persistent infection and genital disease in Chinese women: A randomized, placebo-controlled trial with 78-month follow-up. Vaccine 2019, 37(27):3617-3624.
  13. Chen W, Zhao Y, Xie X, Liu J, Li J, Zhao C, Wang S, Liao X, Shou Q, Zheng M et al: Safety of a quadrivalent human papillomavirus vaccine in a Phase 3, randomized, double-blind, placebo-controlled clinical trial among Chinese women during 90 months of follow-up. Vaccine 2019, 37(6):889-897.
  14. Olsson SE, Restrepo JA, Reina JC, Pitisuttithum P, Ulied A, Varman M, Van Damme P, Moreira ED, Jr., Ferris D, Block S et al: Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: Interim analysis after 8 years of follow-up. Papillomavirus Res 2020, 10:100203.
  15. Joura EA, Giuliano AR, Iversen O-E, Bouchard C, Mao C, Mehlsen J, Moreira Jr ED, Ngan Y, Petersen LK, Lazcano-Ponce E: A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. New England Journal of Medicine 2015, 372(8):711-723.
  16. Garland SM, Pitisuttithum P, Ngan HYS, Cho CH, Lee CY, Chen CA, Yang YC, Chu TY, Twu NF, Samakoses R et al: Efficacy, Immunogenicity, and Safety of a 9-Valent Human Papillomavirus Vaccine: Subgroup Analysis of Participants From Asian Countries. The Journal of Infectious Diseases 2018, 218(1):95-108.
  17. Huh WK, Joura EA, Giuliano AR, Iversen O-E, de Andrade RP, Ault KA, Bartholomew D, Cestero RM, Fedrizzi EN, Hirschberg AL et al: Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16–26 years: a randomised, double-blind trial. The Lancet 2017, 390(10108):2143-2159.
  18. Joura EA, Ulied A, Vandermeulen C, Rua Figueroa M, Seppä I, Hernandez Aguado JJ, Ahonen A, Reich O, Virta M, Perino A et al: Immunogenicity and safety of a nine-valent human papillomavirus vaccine in women 27–45 years of age compared to women 16–26 years of age: An open-label phase 3 study. Vaccine 2021, 39(20):2800-2809.
  19. Bergman H, Buckley BS, Villanueva G, Petkovic J, Garritty C, Lutje V, Riveros‐Balta AX, Low N, Henschke N: Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV‐related disease in females and males. Cochrane Database of Systematic Reviews 2019(11).
  20. Mikamo H, Yamagishi Y, Murata S, Yokokawa R, Han SR, Wakana A, Sawata M, Tanaka Y: Efficacy, safety, and immunogenicity of a quadrivalent HPV vaccine in Japanese men: A randomized, Phase 3, placebo-controlled study. Vaccine 2019, 37(12):1651-1658.
  21. Lehtinen M, Söderlund‐Strand A, Vänskä S, Luostarinen T, Eriksson T, Natunen K, Apter D, Baussano I, Harjula K, Hokkanen M: Impact of gender‐neutral or girls‐only vaccination against human papillomavirus—Results of a community‐randomized clinical trial (I). International journal of cancer 2018, 142(5):949-958.
  22. Basu P, Brisson M, Campos N, Clarke E, Drolet M, Gallagher K, Henão R, Ana M, Howard N, Hutubessy R: Review of the current published evidence on single-dose HPV vaccination 2nd Edition. 2019.
  23. Zizza A, Banchelli F, Guido M, Marotta C, Di Gennaro F, Mazzucco W, Pistotti V, D’Amico R: Efficacy and safety of human papillomavirus vaccination in HIV-infected patients: a systematic review and meta-analysis. Scientific Reports 2021, 11(1):4954.
  24. Denny L, Hendricks B, Gordon C, Thomas F, Hezareh M, Dobbelaere K, Durand C, Hervé C, Descamps D: Safety and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine in HIV-positive women in South Africa: a partially-blind randomised placebo-controlled study. Vaccine 2013, 31(48):5745-5753.
  25. Kojic EM, Kang M, Cespedes MS, Umbleja T, Godfrey C, Allen RT, Firnhaber C, Grinsztejn B, Palefsky JM, Webster-Cyriaque JY et al: Immunogenicity and safety of the quadrivalent human papillomavirus vaccine in HIV-1-infected women. Clin Infect Dis 2014, 59(1):127-135.
  26. Kreimer AR, Sampson JN, Porras C, Schiller JT, Kemp T, Herrero R, Wagner S, Boland J, Schussler J, Lowy DR et al: Evaluation of Durability of a Single Dose of the Bivalent HPV Vaccine: The CVT Trial. JNCI: Journal of the National Cancer Institute 2020, 112(10):1038-1046.
  27. Sankaranarayanan R, Joshi S, Muwonge R, Esmy PO, Basu P, Prabhu P, Bhatla N, Nene BM, Shaw J, Poli URR: Can a single dose of human papillomavirus (HPV) vaccine prevent cervical cancer? Early findings from an Indian study. Vaccine 2018, 36(32):4783-4791.
  28. Iversen O-E, Miranda MJ, Ulied A, Soerdal T, Lazarus E, Chokephaibulkit K, Block SL, Skrivanek A, Azurah AGN, Fong SM: Immunogenicity of the 9-valent HPV vaccine using 2-dose regimens in girls and boys vs a 3-dose regimen in women. Jama 2016, 316(22):2411-2421.
  29. Association GOSoCM: 人乳头瘤病毒疫苗临床应用中国专家共识. 中国医学前沿杂志 2021, 13(2):1-12.
  30. Descamps D, Hardt K, Spiessens B, Izurieta P, Verstraeten T, Breuer T, Dubin G: Safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine for cervical cancer prevention: a pooled analysis of 11 clinical trials. Hum Vaccin 2009, 5(5):332-340.
 

HPV疫苗接种成本效益

参考文献

  1. Okeah BO, Ridyard CH: Factors influencing the cost-effectiveness outcomes of HPV vaccination and screening interventions in low-to-middle-income countries (LMICs): a systematic review. Applied Health Economics and Health Policy 2020, 18:641-654.
  2. 王华庆, 赵方辉, 赵昀: 子宫颈癌等人乳头瘤病毒相关疾病免疫预防专家共识. 中华预防医学杂志 2019, 53(8):761-803.
  3. Mo X, Tobe RG, Wang L, Liu X, Wu B, Luo H, Nagata C, Mori R, Nakayama T: Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China. BMC infectious diseases 2017, 17(1):1-12.
  4. Jit M, Brisson M, Portnoy A, Hutubessy R: Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study. The Lancet Global Health 2014, 2(7):e406-e414.
  5. Liu Y-J, Zhang Q, Hu S-Y, Zhao F-H: Effect of vaccination age on cost-effectiveness of human papillomavirus vaccination against cervical cancer in China. BMC Cancer 2016, 16(1):164.
  6. Zhang Q, Liu Y-J, Hu S-Y, Zhao F-H: Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China. BMC cancer 2016, 16(1):848-848.
  7. Mo X, Gai Tobe R, Wang L, Liu X, Wu B, Luo H, Nagata C, Mori R, Nakayama T: Cost-effectiveness analysis of different types of human papillomavirus vaccination combined with a cervical cancer screening program in mainland China. BMC Infect Dis 2017, 17(1):502.
  8. Zou Z, Fairley CK, Ong JJ, Hocking J, Canfell K, Ma X, Chow EP, Xu X, Zhang L, Zhuang G: Domestic HPV vaccine price and economic returns for cervical cancer prevention in China: a cost-effectiveness analysis. The Lancet Global Health 2020, 8(10):e1335-e1344.
  9. Mahumud RA, Alam K, Keramat SA, Ormsby GM, Dunn J, Gow J: Cost-effectiveness evaluations of the 9-Valent human papillomavirus (HPV) vaccine: Evidence from a systematic review. PloS one 2020, 15(6):e0233499.
  10. Ng SS, Hutubessy R, Chaiyakunapruk N: Systematic review of cost-effectiveness studies of human papillomavirus (HPV) vaccination: 9-Valent vaccine, gender-neutral and multiple age cohort vaccination. Vaccine 2018, 36(19):2529-2544.
  11. Lee VJ, Tay SK, Teoh YL, Tok MY: Cost-effectiveness of different human papillomavirus vaccines in Singapore. BMC Public Health 2011, 11(1):1-11.
  12. Jit M, Choi YH, Edmunds WJ: Economic evaluation of human papillomavirus vaccination in the United Kingdom. Bmj 2008, 337.
  13. Soe NN, Ong JJ, Ma X, Fairley CK, Latt PM, Jing J, Cheng F, Zhang L: Should human papillomavirus vaccination target women over age 26, heterosexual men and men who have sex with men? A targeted literature review of cost-effectiveness. Human vaccines & immunotherapeutics 2018, 14(12):3010-3018.
  14. Sinisgalli E, Bellini I, Indiani L, Sala A, Bechini A, Bonanni P, Boccalini S: HPV vaccination for boys? A systematic review of economic studies. Epidemiol Prev 2015, 39(4 Suppl 1):51-58.
  15. Yahia M-BBH, Jouin-Bortolotti A, Dervaux B: Extending the human papillomavirus vaccination programme to include males in high-income countries: a systematic review of the cost-effectiveness studies. Clinical drug investigation 2015, 35(8):471-485.
  16. Setiawan D, Wondimu A, Ong K, Van Hoek AJ, Postma MJ: Cost Effectiveness of Human Papillomavirus Vaccination for Men Who have Sex with Men; Reviewing the Available Evidence. PharmacoEconomics 2018, 36(8):929-939.
  17. Linertová R, Guirado-Fuentes C, Medina JM, Imaz-Iglesia I, Rodríguez-Rodríguez L, Carmona-Rodríguez M: Cost-effectiveness of extending the HPV vaccination to boys: a systematic review. J Epidemiol Community Health 2021.
  18. Abidi S, Labani S, Singh A, Asthana S, Ajmera P: Economic evaluation of human papillomavirus vaccination in the Global South: a systematic review. International Journal of Public Health 2020:1-15.
  19. 李宜珂, 陈思伊, 黄小芬, 方亚, 赵勤俭: 人乳头瘤病毒疫苗的临床效用及其经济学研究. 现代预防医学 2018, 45(15).
 

HPV疫苗筹资模式

参考文献

  1. UNICEF: Human Papillomavirus Vaccine: Supply and Demand Update. Accessed 26th March 2020, 2020.
  2. 来晓真, 方海: 美、英、德、日四国免疫规划概况及疫苗筹资启示. 中华医学杂志 2020, 100(2):85-89.
  3. Zhao F-H, Tiggelaar SM, Hu S-Y, Zhao N, Hong Y, Niyazi M, Gao X-H, Ju L-R, Zhang L-Q, Feng X-X: A multi-center survey of HPV knowledge and attitudes toward HPV vaccination among women, government officials, and medical personnel in China. Asian Pacific journal of cancer prevention: APJCP 2012, 13(5):2369.
  4. Zhu S, Chang J, Hayat K, Li P, Ji W, Fang Y: Parental preferences for HPV vaccination in junior middle school girls in China: A discrete choice experiment. Vaccine 2020, 38(52):8310-8317.
  5. Hu S, Xu X, Zhang Y, Liu Y, Yang C, Wang Y, Wang Y, Yu Y, Hong Y, Zhang X: A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: implications for vaccine roll-out in mainland China. Vaccine 2021, 39(1):35-44.
 

影响疫苗接种意愿和行为的主要因素

参考文献

  1. Karafillakis E, Simas C, Jarrett C, Verger P, Peretti-Watel P, Dib F, De Angelis S, Takacs J, Ali KA, Pastore Celentano L et al: HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe. Hum Vaccin Immunother 2019, 15(7-8):1615-1627.
  2. Wigle J, Coast E, Watson-Jones D: Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects. Vaccine 2013, 31(37):3811-3817.
  3. Wijayanti KE, Schütze H, MacPhail C, Braunack-Mayer A: Parents’ knowledge, beliefs, acceptance and uptake of the HPV vaccine in members of The Association of Southeast Asian Nations (ASEAN): A systematic review of quantitative and qualitative studies. Vaccine 2021, 39(17):2335-2343.
  4. Oh J-K, Lim MK, Yun EH, Lee E-H, Shin H-R: Awareness of and attitude towards human papillomavirus infection and vaccination for cervical cancer prevention among adult males and females in Korea: a nationwide interview survey. Vaccine 2010, 28(7):1854-1860.
  5. Santhanes D, Yong CP, Yap YY, Saw PS, Chaiyakunapruk N, Khan TM: Factors influencing intention to obtain the HPV vaccine in South East Asian and Western Pacific regions: A systematic review and meta-analysis. Scientific Reports 2018, 8(1):3640.
  6. Juntasopeepun P, Thana K: Parental acceptance of HPV vaccines in Chiang Mai, Thailand. International Journal of Gynecology & Obstetrics 2018, 142(3):343-348.
  7. Cover JK, Nghi NQ, LaMontagne DS, Huyen DTT, Hien NT: Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination. BMC public health 2012, 12(1):1-14.
  8. Yu Y, Xu M, Sun J, Li R, Li M, Wang J, Zhang D, Xu A: Human papillomavirus infection and vaccination: awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China. PloS one 2016, 11(1):e0146741.
  9. Madhivanan P, Krupp K, Yashodha M, Marlow L, Klausner JD, Reingold AL: Attitudes toward HPV vaccination among parents of adolescent girls in Mysore, India. Vaccine 2009, 27(38):5203-5208.
  10. Ngorsuraches S, Nawanukool K, Petcharamanee K, Poopantrakool U: Parents’ preferences and willingness-to-pay for human papilloma virus vaccines in Thailand. Journal of pharmaceutical policy and practice 2015, 8(1):1-9.
  11. Dahlström LA, Tran TN, Lundholm C, Young C, Sundström K, Sparén P: Attitudes to HPV vaccination among parents of children aged 12‐15 years—A population‐based survey in Sweden. International journal of cancer 2010, 126(2):500-507.
  12. Jaspers L, Budiningsih S, Wolterbeek R, Henderson FC, Peters AAW: Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: A cross-sectional study. Vaccine 2011, 29(44):7785-7793.
  13. Wong LP: Preventing cervical cancer through human papillomavirus vaccination: perspective from focus groups. Journal of lower genital tract disease 2009, 13(2):85-93.
  14. Tsu VD: Overcoming barriers and ensuring access to HPV vaccines in low-income countries. American journal of law & medicine 2009, 35(2-3):401-413.
  15. Garland SM, Cuzick J, Domingo EJ, Goldie SJ, Kim Y-T, Konno R, Parkin DM, Qiao Y-L, Sankaranarayanan R, Stern PL: Recommendations for cervical cancer prevention in Asia Pacific. Vaccine 2008, 26:M89-M98.
 

我国人群HPV疫苗的知晓率、接种意愿

参考文献

  1. Zhang Y, Wang Y, Liu L, Fan Y, Liu Z, Wang Y, Nie S: Awareness and knowledge about human papillomavirus vaccination and its acceptance in China: a meta-analysis of 58 observational studies. BMC Public Health 2016, 16(1):216.
  2. Zhao F-H, Tiggelaar SM, Hu S-Y, Zhao N, Hong Y, Niyazi M, Gao X-H, Ju L-R, Zhang L-Q, Feng X-X: A multi-center survey of HPV knowledge and attitudes toward HPV vaccination among women, government officials, and medical personnel in China. Asian Pacific journal of cancer prevention: APJCP 2012, 13(5):2369.
  3. Zhang X, Wang Z, Ren Z, Li Z, Ma W, Gao X, Zhang R, Qiao Y, Li J: HPV vaccine acceptability and willingness-related factors among Chinese adolescents: a nation-wide study. Hum Vaccin Immunother 2021, 17(4):1025-1032.
  4. Hu S, Xu X, Zhang Y, Liu Y, Yang C, Wang Y, Wang Y, Yu Y, Hong Y, Zhang X: A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: implications for vaccine roll-out in mainland China. Vaccine 2021, 39(1):35-44.
  5. Chen L, Song Y, Ruan G, Zhang Q, Lin F, Zhang J, Wu T, An J, Dong B, Sun P: Knowledge and attitudes regarding HPV and vaccination among Chinese women aged 20 to 35 years in Fujian province: a cross-sectional study. Cancer Control 2018, 25(1):1073274818775356.
  6. Qin S, Fu J-X, Chen M-Z, Meng Y-T, Xu C, Luo Y: Acceptability of vaccination against human papillomavirus among women aged 20 to 45 in rural Hunan province, China: a cross-sectional study. Vaccine 2020, 38(30):4732-4739.
  7. You D, Han L, Li L, Hu J, Zimet GD, Alias H, Danaee M, Cai L, Zeng F, Wong LP: Human Papillomavirus (HPV) Vaccine Uptake and the Willingness to Receive the HPV Vaccination among Female College Students in China: A Multicenter Study. Vaccines (Basel) 2020, 8(1).
 

提高HPV疫苗覆盖率的主要干预策略

参考文献

  1. World Health Organization: Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020.
  2. Batista Ferrer H, Audrey S, Trotter C, Hickman M: An appraisal of theoretical approaches to examining behaviours in relation to Human Papillomavirus (HPV) vaccination of young women. Preventive Medicine 2015, 81:122-131.
  3. Abdullahi LH, Kagina BM, Ndze VN, Hussey GD, Wiysonge CS: Improving vaccination uptake among adolescents. Cochrane Database of Systematic Reviews 2020(1).
  4. Jaca A, Mathebula L, Iweze A, Pienaar E, Wiysonge CS: A systematic review of strategies for reducing missed opportunities for vaccination. Vaccine 2018, 36(21):2921-2927.
  5. Dempsey AF, Zimet GD: Interventions to Improve Adolescent Vaccination: What May Work and What Still Needs to Be Tested. Vaccine 2015, 33:D106-D113.
  6. Fu LY, Bonhomme L-A, Cooper SC, Joseph JG, Zimet GD: Educational interventions to increase HPV vaccination acceptance: A systematic review. Vaccine 2014, 32(17):1901-1920.
  7. Acampora A, Grossi A, Barbara A, Colamesta V, Causio FA, Calabrò GE, Boccia S, de Waure C: Increasing HPV vaccination uptake among adolescents: A systematic review. International journal of environmental research and public health 2020, 17(21):7997.
  8. Odone A, Ferrari A, Spagnoli F, Visciarelli S, Shefer A, Pasquarella C, Signorelli C: Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage: a systematic review. Human vaccines & immunotherapeutics 2015, 11(1):72-82.
  9. Smulian EA, Mitchell KR, Stokley S: Interventions to increase HPV vaccination coverage: a systematic review. Human vaccines & immunotherapeutics 2016, 12(6):1566-1588.
  10. Ilozumba O, Schmidt P, Ket JCF, Jaspers M: Can mHealth interventions contribute to increased HPV vaccination uptake? A systematic review. Preventive Medicine Reports 2021, 21:101289.
  11. Forster AS, Cornelius V, Rockliffe L, Marlow LAV, Bedford H, Waller J: A cluster randomised feasibility study of an adolescent incentive intervention to increase uptake of HPV vaccination. British Journal of Cancer 2017, 117(8):1121-1127.
  12. Mantzari E, Vogt F, Marteau TM: Financial incentives for increasing uptake of HPV vaccinations: a randomized controlled trial. Health Psychology 2015, 34(2):160.
  13. Wigham S, Ternent L, Bryant A, Robalino S, Sniehotta FF, Adams J: Parental financial incentives for increasing preschool vaccination uptake: systematic review. Pediatrics 2014, 134(4):e1117-e1128.
  14. Oh NL, Biddell CB, Rhodes BE, Brewer NT: Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Preventive Medicine 2021, 148:106554.
  15. Gilkey MB, Dayton AM, Moss JL, Sparks AC, Grimshaw AH, Bowling JM, Brewer NT: Increasing provision of adolescent vaccines in primary care: a randomized controlled trial. Pediatrics 2014, 134(2):e346-e353.
  16. Wigle J, Coast E, Watson-Jones D: Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects. Vaccine 2013, 31(37):3811-3817.
  17. Harper DM, Verdenius I, Harris GD, Barnett AL, Rosemergey BE, Arey AM, Wall J, Malnar GJ: The influence of free quadrivalent human papillomavirus vaccine (HPV4) on the timely completion of the three dose series. Preventive Medicine 2014, 61:20-25.
 

干预的实施成本及成本效益

参考文献

  1. Smulian EA, Mitchell KR, Stokley S: Interventions to increase HPV vaccination coverage: a systematic review. Human vaccines & immunotherapeutics 2016, 12(6):1566-1588.
  2. Spencer JC, Brewer NT, Trogdon JG, Weinberger M, Coyne-Beasley T, Wheeler SB: Cost-effectiveness of interventions to increase HPV vaccine uptake. Pediatrics 2020, 146(6).
 

在我国开展的推广HPV疫苗覆盖的干预性研究

参考文献

  1. Chan SS, Cheung TH, Lo WK, Chung TK: Women’s attitudes on human papillomavirus vaccination to their daughters. J Adolesc Health 2007, 41(2):204-207.
  2. Kwan TT, Tam KF, Lee PW, Chan KK, Ngan HY: The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls. Patient Educ Couns 2011, 84(1):118-122.
  3. Zhang X, Liu C-r, Wang Z-z, Ren Z-f, Feng X-x, Ma W, Gao X-h, Zhang R, Brown MD, Qiao Y-l et al: Effect of a school-based educational intervention on HPV and HPV vaccine knowledge and willingness to be vaccinated among Chinese adolescents : a multi-center intervention follow-up study. Vaccine 2020, 38(20):3665-3670.
 

纳入国家免疫规划的国家情况

参考文献

  1. Gallagher KE, LaMontagne DS, Watson-Jones D: Status of HPV vaccine introduction and barriers to country uptake. Vaccine 2018, 36(32):4761-4767.
  2. Tsu VD, LaMontagne DS, Atuhebwe P, Bloem PN, Ndiaye C: National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects. Preventive medicine 2021, 144:106335-106335.
 

全球疫苗接种情况

参考文献

  1. Bruni L, Saura-Lázaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, Afsar OZ, LaMontagne DS, Mosina L, Contreras M: HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019. Preventive Medicine 2021, 144:106399.
  2. Gallagher KE, LaMontagne DS, Watson-Jones D: Status of HPV vaccine introduction and barriers to country uptake. Vaccine 2018, 36(32):4761-4767.
 

疫苗纳入人群免疫项目的效果

  1. Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, Sundström K, Dillner J, Sparén P: HPV vaccination and the risk of invasive cervical cancer. New England Journal of Medicine 2020, 383(14):1340-1348.
  2. Drolet M, Bénard É, Pérez N, Brisson M, Ali H, Boily M-C, Baldo V, Brassard P, Brotherton JML, Callander D et al: Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. The Lancet 2019, 394(10197):497-509.
 

我国开展HPV疫苗试点

参考文献

[1] 中国家庭报. 健康中国行动| 健康城市建设推动健康中国行动创新模式试点工作在山东济南启动 [EB/OL]. (2021- 09 – 22)[2023-8-22].

https://www.cfnews.org.cn/newsinfo/1933768.html.

[2] “玫瑰行动”助力青春期女生健康教育[EB/OL].(2023-08-23)[2023-8-24].https://www.cwdf.org.cn/index.php?m=content&c=index&a=show&catid=26&id=4913

[3] http://wjw.nmg.gov.cn/ztlm/dqzt/jknmgxd/jknmgxd_gzdt/202212/t20221209_2185887.html

[4] http://m.people.cn/n4/2022/0129/c3770-15420539.html

[5] https://mp.weixin.qq.com/s/exgUWbzubGcBVj1iR1JrCA

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代表性地区的基本情况、接种政策及效果、宣传推动情况

(1) 成都市

 

基本情况

成都市2022年度GDP为20817.5亿元，排名全国城市第七。成都市出台了《健康城市建设推动健康中国行动创新模式成都市宫颈癌综合防控试点工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为13-14岁在校且无HPV疫苗接种史女生。免疫程序为国产二价0-6二剂次、进口二价0-1-6三剂次、进口四价0-2-6三剂次。资助政策为国产二价疫苗（沃泽惠）免费，其它疫苗补贴600元/人，并自付20元/剂接种费。疫苗接种按照属地化管理原则，由学校所在地预防接种单位负责。截至2022年1月，目标人群首针接种率达90.04%[14]。

宣传推动

成都市开展多形式、多载体的健康教育宣传。形式包括讲座、知晓日、义诊咨询、专题课程、专题活动等，载体包括宣传册、宣传栏、展板、电视、微信、视频号、抖音平台等，覆盖相关医疗机构300余、社区300余个、和公众场所90余个。面向适龄女孩及监护人、适龄女性及全体市民开展广泛宣教，宣传材料发放至近9万名群众，讲座活动覆盖近2万名群众。宣教内容包括HPV疫苗接种、两癌防控、其它女性常见疾病防控等。

(2) 济南市

 

基本情况

济南市2022年度GDP为12027.5亿元，位列全国城市排名20。2021年，济南市出台《健康城市建设推动健康中国行动创新模式试点一济南市宫颈癌综合防治工作方案（2021—2025年）》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为≤14周岁且无HPV疫苗接种史的在校七年级女生。免疫程序为国产二价0-6二剂次。资助政策免费接种。疫苗接种按照属地化管理原则，安排分班级分时段前往学校所在地的预防接种单位进行接种。截至2022年11月，目标人群首针接种率达
94.4%[15].

宣传推动

济南市开展多形式、多载体的健康教育宣传。形式包括采访、线上线下专题活动，载体包括网络媒体、纸媒、科普展板、宣传手册、子宫颈癌与HPV疫苗知识读本、济南HPV疫苗接种手册，宣教人群广泛涵盖全体市民，宣教内容包括HPV疫苗接种、两癌防控等知识。

(3) 鄂尔多斯市

 

基本情况

鄂尔多斯市2022年度GDP为5613.44亿元，全国地级市第45位。2021年，鄂尔多斯市出台了《健康城市建设推动健康鄂尔多斯行动创新模式工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

2020年8月，鄂尔多斯市在准格尔旗率先开展HPV疫苗免费接种项目。目标人群为全市当年13-18岁在校且无HPV疫苗接种史女生。免疫程序为进口二价0-1-6三剂次，

2023年起调整为13-14岁女孩0-6二剂次。资助政策为疫苗免费，自付20元/剂接种费。组织方式为疫苗接种服务中心根据任务安排联系学校，有规划的通知适龄女孩前来完成HPV疫苗接种。截至2022年11月，目标人群首针接种率接近70%［16］。

2022年8月，启动准格尔旗和达拉特旗高三女生接种四价和九价HPV疫苗的试点工作，利用暑假时间展开接种，力争在2023年年底达成90%的接种目标［17］。自鄂尔多斯之后，由政府主导的HPV疫苗惠民行动在多地等涌现。值得注意的是，近年来多主体参与到HPV疫苗支持项目，如慈善总会、医院、妇联等为主体单位牵头组织开展了一些公益活动。

宣传推动

鄂尔多斯市开展多形式、多载体的健康教育宣传。形式包括讲座、知晓日、义诊咨询、专题课程、专题活动等，载体包括宣传册、宣传栏、展板、电视、微信、视频号、抖音平台等，宣教人群广泛涵盖在校女孩及监护人，适龄女性及全体市民。宣教内容包括HPV疫苗接种、两癌防控、其它女性常见疾病防控等。

(4) 西安市

 

基本情况

西安市2022年度GDP为11486.51亿元，排名全国第22位。2021年，西安市出台了《西安市健康城市建设推动健康中国行动创新模式试点宫颈癌综合防治工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为全市年龄满13周岁（初中）在校女生。免疫程序为国产二价0-6二剂次，进口二价0-1-6三剂次，进口四价和进口九价0-2-6三剂次。接种政策为自愿自费。各区（县）合理设立HPV疫苗专项疫苗接种门诊承担接种任务，并及时将接种信息统一录入儿童免疫规划信息平台。

宣传推动

西安市出台了《西安市宫颈癌综合防治宣传方案》（市健办发〔2022〕12号）。通过媒体宣传、社区活动、义诊等形式，宣传册、宣传栏、展板、电视、微信公众号、报纸等载体普及宫颈癌防治相关知识。

(5) 西藏自治区

 

基本情况

西藏自治区2022年度GDP为2132.64亿元，经济总量整体规模相对其他省份较小，人均GDP处于全国中等偏下水平。2022年出台《西藏自治区妇女“两癌”综合防治工作实施方案》等系列政策推动适龄女孩HPV疫苗接种。

接种政策及效果

目标人群为13-14岁在校女生。免疫程序为国产二价0-6二剂次。资助政策为免费。由学校组织，接种者在商定接种时间携带个人身份证明材料与法定监护人一同前往定点接种单位接种。

宣传推动

充分利用网络、电视、广播、报刊等媒介，以群众喜闻乐见的宣传方式，对适龄在校女生HPV疫苗接种工作的意义及内容进行广泛宣传。

近年来各地HPV疫苗惠民项目信息

“疾病负担”指标解读

疾病负担（burden of disease, BOD）是指疾病造成的失能（伤残）、生活质量下降和过早死亡对健康和社会造成的总损失，包括疾病的流行病学负担和经济负担两个方面。

 

在疾病的流行病学方面，衡量疾病负担的常用指标包括传统指标和综合指标。

 

传统指标

传统疾病负担的衡量指标包括：用于描述和反映健康状况与水平的常规指标，如死亡人数、伤残人数和患病人数等绝对数指标；以及用来比较不同特征人群疾病分布差异的指标，如发病率、伤残率、患病率、死亡率、门诊和住院率等相对数指标。

 

上述传统疾病负担的衡量指标基本上只考虑了人口的生存数量，而忽略了生存质量，不够全面；但优势在于资料相对计算方便，结果直观，可用于各种疾病的一般性描述。

 

综合指标

疾病负担不等同于死亡人数，综合指标弥补了传统指标的单一性，且可以让各种不同疾病造成的负担之间相互比较。

 

潜在寿命损失年（YPLL）：通过疾病造成的寿命损失来估计疾病负担的大小。但忽略了疾病造成的失能对生存质量的影响。

 

伤残调整寿命年(DALYs)：将死亡和失能相结合，用一个指标来描述疾病的这两方面的负担。它包括因早死造成健康生命年的损失（YLL）和因伤残造成健康生命年的损失（YLD），即DALY=YLL+YLD。目前，DALY是国内外一致公认的最具代表性、运用最多的疾病负担评价指标。

 

健康期望寿命（HALE）：指具有良好健康状态的生命年以及个体在比较舒适的状态下生活的平均预期时间，综合考虑生命的质量和数量两方面。

 

 

随着疾病负担研究的深入，其测量范围从流行病学负担扩大到经济负担。

 

疾病经济负担是由于发病、伤残（失能）和过早死亡给患者本人、家庭以及社会带来的经济损失，和由于预防治疗疾病所消耗的经济资源。

详细见：疾病的“经济负担”怎么计算？

 

参考资料：

陈文. 卫生经济学 [M]. 人民卫生出版社. 2017.

李茜瑶,周莹,黄辉等.疾病负担研究进展[J].中国公共卫生,2018,34(05):777-780.

什么是“年龄标化”？

在流行病学研究中，年龄是多种疾病的危险因素。以发病率为例，该指标反映了一定时期内，特定人群中癌症新发病例的情况。由于年龄是癌症发生的一个重要影响因素，年龄越大，发病率就越高。

 

如果两个国家的人群年龄结构相差很大，例如A市老年人口比例更大，B市年轻人口占比更高，直接比较两地癌症发病率的高低，我们不能确定发病率较高的市，是因为年龄构成不同还是因为其他影响因素（如饮食习惯、环境等）所导致。因此，需要用“年龄标化”的统计学方法，进一步处理数据，排除年龄影响因素的干扰，再来比较两地的发病率数据。

 

以发病率为例，即把原始数据套到一个“标准年龄结构人群里”，计算出”年龄标化发病率“，这样人群结构不同的A市和B市，就能在同一个指标尺度下进行“发病率”比较。年龄标化通常有“中标率”，即我国各地基于某一年份的中国人口年龄结构构成作为标准计算，国内不同地区的疾病数据比较采用的是“中标率”；另一种是“世标率”，即用世界标准人口构成机型标化计算，适用于国与国之间的指标比较。

 

同样地，以死亡率为例，应特别注意各之间地人口构成的差异。用标准化死亡率进行比较才能得出正确结论。如甲、乙两地在未标化前的肺癌死亡率相同，但实际上乙地人群的肺癌死亡率要明显地高于甲地，其原因在于甲地男性老年人口居多，而肺癌的死亡率又与年龄和性别有关，所以用未标化率进行比较时，就会得出甲乙两地肺癌死亡率相同的错误结论。

 

参考资料：

 

张科宏教授：年龄标化的患病率 – 丁香公开课 (dxy.cn)

科学网—癌症（粗）发病率与标化发病率的区别 – 杨雷的博文 (sciencenet.cn)

WHO年龄标化死亡率定义及计算方法

沈洪兵，齐秀英. 流行病学 [M]. 人民卫生出版社. 2015.

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疾病的“经济负担”怎么计算？

疾病经济负担是由于发病、伤残（失能）和过早死亡给患者本人、家庭以及社会带来的经济损失，和由于预防治疗疾病的费用。通过计算疾病的经济负担，可以从经济层面上研究或比较不同疾病对人群健康的影响。

总疾病经济负担包括直接疾病经济负担、间接疾病经济负担和无形疾病经济负担。

直接经济负担：指直接用于预防和治疗疾病的总费用，包括直接医疗经济负担和直接非医疗经济负担两部分。直接医疗经济负担是指在医药保健部门购买卫生服务的花费，主要包括门诊费（如挂号费、检查费、处置费、诊断费、急救费等）、住院费（如手术费、治疗费等）和药费等。直接非医疗经济负担包括和疾病有关的营养费、交通费、住宿费、膳食费、陪护费和财产损失等。

间接经济负担：指由于发病、伤残（失能）和过早死亡给患者本人和社会带来的有效劳动力损失而导致的经济损失。具体包括：劳动工作时间损失、个人工作能力和效率降低造成的损失、陪护病人时损失的劳动工作时间、精神损失等。

无形经济负担：指患者及亲友因疾病在心理、精神和生活上遭受的痛苦、悲哀、不便等生活质量下降而产生的无形损失。

 

参考资料：

陈文. 卫生经济学 [M]. 人民卫生出版社. 2017.

李茜瑶,周莹,黄辉等.疾病负担研究进展[J].中国公共卫生,2018,34(05):777-780.