Cancer is a leading cause of mortality worldwide. By 2040, over 30 million new cancers are predicted, with the greatest cancer burden in low-income countries. In 2015, the UN passed the Sustainable Development Goal 3.4 (SDG 3.4) to tackle the rising burden of non-communicable diseases, which calls for a reduction by a third in premature mortality from non-communicable diseases, including cancer, by 2030. However, there is a paucity of data on premature mortality rates by cancer type. In this study, we examine annual rates of change for cancer-specific premature mortality and classify whether countries are on track to reach SDG 3.4 targets. This is a retrospective, cross-sectional, population-based study investigating premature mortality trends from 2000–19 using the WHO Global Health Estimates data. All cancers combined and thirteen individual cancers in 183 countries were examined by WHO region, World Bank income level, and sex. The risk of premature mortality was calculated for ages 30–69 years, independent of other competing causes of death, using standard life table methods. The primary objective was to compute average annual rate of change in premature mortality from 2000 to 2019. Secondary objectives assessed whether this annual rate of change would be sufficient to reach SDG 3.4. targets for premature mortality by 2030. This study was conducted using data retrieved for the years 2000–19. Premature mortality rates decreased in 138 (75%) of 183 countries across all World Bank income levels and WHO regions, however only eight (4%) countries are likely to meet the SDG 3.4 targets for all cancers combined. Cancers where early detection strategies exist, such as breast and colorectal cancer, have higher declining premature mortality rates in high-income countries (breast cancer 48 [89%] of 54 and colorectal cancer 45 [83%]) than in low-income countries (seven [24%] of 29 and four [14%]). Cancers with primary prevention programmes, such as cervical cancer, have more countries with declining premature mortality rates (high-income countries 50 [93%] of 54 and low-income countries 26 [90%] of 29). Sex-related disparities in premature mortality rates vary across WHO regions, World Bank income groups, and by cancer type. There is a greater reduction in premature mortality for all cancers combined and for individual cancer types in high-income countries compared with lower-middle-income and low-income countries. However, most countries will not reach the SDG 3.4 target. Cancers with early detection strategies in place, such as breast and colorectal cancers, are performing poorly in premature mortality compared with cancers with primary prevention measures, such as cervical cancer. Investments toward prevention, early detection, and treatment can potentially accelerate declines in premature mortality. WHO.

中文翻译：

---

2000-19 年 183 个国家按癌症类型、性别、世界卫生组织地区和世界银行收入水平划分的过早死亡趋势：一项回顾性、横断面、基于人群的研究


癌症是全世界死亡的主要原因。到 2040 年，预计将出现超过 3000 万种新癌症，其中低收入国家的癌症负担最大。 2015年，联合国通过了可持续发展目标3.4（SDG 3.4），以应对日益增加的非传染性疾病负担，其中要求到2​​030年将包括癌症在内的非传染性疾病导致的过早死亡率减少三分之一。然而，缺乏按癌症类型划分的过早死亡率的数据。在这项研究中，我们研究了特定癌症过早死亡率的年度变化率，并对各国是否有望实现可持续发展目标 3.4 进行分类。这是一项回顾性、横断面、基于人群的研究，使用世界卫生组织全球健康估计数据调查 2000-19 年过早死亡趋势。根据世界卫生组织地区、世界银行收入水平和性别对 183 个国家的所有癌症进行了综合检查，并对 13 种单独癌症进行了检查。使用标准生命表方法计算 30-69 岁年龄段的过早死亡风险，独立于其他竞争性死亡原因。主要目标是计算 2000 年至 2019 年过早死亡率的平均年变化率。次要目标评估这一年变化率是否足以实现可持续发展目标 3.4。到 2030 年过早死亡的目标。这项研究是使用 2000-19 年检索的数据进行的。在世界银行所有收入水平和世卫组织区域的 183 个国家中，有 138 个国家（75%）的过早死亡率有所下降，但只有八个国家（4%）可能实现针对所有癌症的可持续发展目标 3.4 目标。 存在早期检测策略的癌症，例如乳腺癌和结直肠癌，高收入国家的过早死亡率下降幅度更高（54 例中乳腺癌为 48 例 [89%]，结直肠癌为 45 例 [83%]）高于低收入国家（29 人中有 7 人 [24%]，4 人 [14%]）。制定了初级预防计划的癌症（例如宫颈癌）的过早死亡率下降的国家较多（54 个国家中有 50 个[93%]是高收入国家，29 个国家中有 26 个是低收入国家[90%]）。过早死亡率的性别差异因世卫组织各区域、世界银行收入组和癌症类型而异。与中低收入和低收入国家相比，高收入国家所有癌症的总和以及个别癌症类型的过早死亡率都有更大程度的降低。然而，大多数国家将无法实现可持续发展目标3.4。与采取一级预防措施的癌症（如宫颈癌）相比，采取早期检测策略的癌症（如乳腺癌和结直肠癌）的过早死亡率表现较差。对预防、早期发现和治疗的投资可能会加速过早死亡率的下降。 WHO。