Burden, trends and future projections of esophageal cancer among population aged 20-60 years globally, regionally, and nationally from 1990 to 2023
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摘要:
目的 探讨1990－2023年全球、不同区域及国家20~60岁人群食管癌的负担现状、变化趋势、未来预测及危险因素，为食管癌的防控工作提供依据。 方法 基于2023年全球疾病负担研究数据库的数据，采用估计年度百分比变化、Joinpoint回归等方法分析食管癌负担趋势，运用年龄-时期-队列模型和因素分解等方法探究影响因素，并通过贝叶斯年龄-时期-队列模型预测2024－2050年食管癌负担趋势。 结果 1990－2023年，全球20~60岁人群食管癌发病人数、患病人数、死亡人数、伤残调整生命年均呈上升趋势，而各项年龄标化率均呈下降趋势；男性疾病负担更重，不同区域和国家的发病模式存在差异；发病率随年龄增长显著升高。经预测，2024－2050年20~60岁人群食管癌的年龄标化患病率预计持续上升，其余标化率指标则呈先降后升趋势。吸烟、过量饮酒、蔬菜摄入不足及嚼烟是食管癌的主要危险因素，相关死亡率均已随时间显著下降，其中吸烟和过量饮酒相关死亡率的降幅最为明显。 结论 需加强高负担地区食管癌的早期筛查与干预，结合危险因素强化一级预防并开展健康教育，以降低食管癌的发病风险。 Abstract:Objective To investigate the current burden, temporal trends, future projections, and risk factors of esophageal cancer among population aged 20-60 years globally, regionally, and nationally from 1990 to 2023, so as to provide evidence for the prevention and control of esophageal cancer. Methods Based on data from the 2023 Global Burden of Disease Study database, trends in esophageal cancer burden were analyzed using estimated annual percentage change and Joinpoint regression, the influencing factors were examined using age-period-cohort model and breakdown analysis method, and the future projections from 2024 to 2050 were predicted using Bayesian age-period-cohort model. Results From 1990 to 2023, the number of incident cases, the number of prevalent cases, the number of deaths, and disability-adjusted life years of esophageal cancer among population aged 20-60 years showed an increasing trend, while the age-standardized rates presented a decreasing trend; the disease burden was substantially higher in males; the incidence patterns varied across regions and countries; and the incidence significantly increased with age. According to the predictions, the age-standardized prevalence rate of esophageal cancer among population aged 20-60 years was expected to rise continuously from 2024 to 2050, while the other standardized rates were predicted to decrease first and then increase. Smoking, high alcohol consumption, a diet low in vegetables, and chewing tobacco were identified as the main risk factors of esophageal cancer, and the mortality related to these factors had significantly decreased over time, with the most obvious reductions observed for smoking and high alcohol consumption. Conclusion It is necessary to strengthen early screening and intervention of esophageal cancer in areas with a high burden. Primary prevention and health education should be enhanced in combination with risk factors to reduce the incidence risk of esophageal cancer. -
Keywords:
- population aged 20-60 years /
- esophageal neoplasms /
- disease burden /
- projection
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摘要:
目的 探讨1990－2023年全球、不同区域及国家20~60岁人群食管癌的负担现状、变化趋势、未来预测及危险因素，为食管癌的防控工作提供依据。
方法 基于2023年全球疾病负担研究数据库的数据，采用估计年度百分比变化、Joinpoint回归等方法分析食管癌负担趋势，运用年龄-时期-队列模型和因素分解等方法探究影响因素，并通过贝叶斯年龄-时期-队列模型预测2024－2050年食管癌负担趋势。
结果 1990－2023年，全球20~60岁人群食管癌发病人数、患病人数、死亡人数、伤残调整生命年均呈上升趋势，而各项年龄标化率均呈下降趋势；男性疾病负担更重，不同区域和国家的发病模式存在差异；发病率随年龄增长显著升高。经预测，2024－2050年20~60岁人群食管癌的年龄标化患病率预计持续上升，其余标化率指标则呈先降后升趋势。吸烟、过量饮酒、蔬菜摄入不足及嚼烟是食管癌的主要危险因素，相关死亡率均已随时间显著下降，其中吸烟和过量饮酒相关死亡率的降幅最为明显。
结论 需加强高负担地区食管癌的早期筛查与干预，结合危险因素强化一级预防并开展健康教育，以降低食管癌的发病风险。
Abstract:Objective To investigate the current burden, temporal trends, future projections, and risk factors of esophageal cancer among population aged 20-60 years globally, regionally, and nationally from 1990 to 2023, so as to provide evidence for the prevention and control of esophageal cancer.
Methods Based on data from the 2023 Global Burden of Disease Study database, trends in esophageal cancer burden were analyzed using estimated annual percentage change and Joinpoint regression, the influencing factors were examined using age-period-cohort model and breakdown analysis method, and the future projections from 2024 to 2050 were predicted using Bayesian age-period-cohort model.
Results From 1990 to 2023, the number of incident cases, the number of prevalent cases, the number of deaths, and disability-adjusted life years of esophageal cancer among population aged 20-60 years showed an increasing trend, while the age-standardized rates presented a decreasing trend; the disease burden was substantially higher in males; the incidence patterns varied across regions and countries; and the incidence significantly increased with age. According to the predictions, the age-standardized prevalence rate of esophageal cancer among population aged 20-60 years was expected to rise continuously from 2024 to 2050, while the other standardized rates were predicted to decrease first and then increase. Smoking, high alcohol consumption, a diet low in vegetables, and chewing tobacco were identified as the main risk factors of esophageal cancer, and the mortality related to these factors had significantly decreased over time, with the most obvious reductions observed for smoking and high alcohol consumption.
Conclusion It is necessary to strengthen early screening and intervention of esophageal cancer in areas with a high burden. Primary prevention and health education should be enhanced in combination with risk factors to reduce the incidence risk of esophageal cancer.
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Keywords:
- population aged 20-60 years /
- esophageal neoplasms /
- disease burden /
- projection
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食管癌是全球范围内严重威胁人类健康的消化道恶性肿瘤之一。根据WHO国际癌症研究机构公布的数据，2022年全球新发食管癌病例为511 054例，死亡人数为445 391例；中国新发食管癌病例为224 012例，死亡人数为187 467例，分别占全球发病人数和死亡人数的43.8%与42.1%，均居全球第1位[1-2]。食管癌症状隐匿，多数患者确诊时已进展至中晚期，导致治疗效果差、医疗成本高，因此其预防与早期筛查极具迫切性。现有食管癌的循证证据多基于全年龄段，缺乏特定年龄段的系统性负担评估。本研究基于全球疾病负担研究（Global Burden of Disease Study，GBD）数据库，从发病率、死亡率及危险因素暴露等方面，对1990－2023年全球、不同区域及国家20~60岁人群的食管癌负担进行分析，并开展20~60岁人群食管癌负担和归因风险因素评估。
1 资料和方法
1.1 数据来源与提取
GBD 2023数据库系统整合了1990－2023年全球204个国家和地区的肿瘤流行病学数据[3]。本研究从GBD官方可视化平台（https://vizhub.healthdata.org/gbd-results/）提取食管癌的流行病学数据，通过以下维度进行分析：首先，按地理层级划分，将数据按全球总体、社会人口指数（socio-demographic index，SDI）分层（低、中低、中、中高、高SDI）、21个GBD特定区域及204个国家和地区进行分析；其次，按目标人群划分20~24岁、25~29岁、30~34岁、35~39岁、40~44岁、45~49岁、50~54岁、55~60岁等8个年龄段进行分层分析，并基于性别（男性、女性）开展亚组分析。
1.2 分析指标
采用以下指标描述20~60岁人群的食管癌负担：发病人数、患病人数、死亡人数和伤残调整生命年（disability-adjusted life year，DALY）的估计值及其95%不确定区间（95% uncertainty interval，95%UI）。基于GBD 2023世界标准人口的年龄结构，计算年龄标化发病率（age-standardized incidence rate，ASIR）、年龄标化患病率（age-standardized prevalence rate，ASPR）、年龄标化死亡率（age-standardized mortality rate，ASMR）和年龄标化DALY率（age-standardized DALY rate，ASDR）。
1.3 统计学处理
采用Microsoft Excel 2021软件和R 4.3.3软件的dplyr、officer、ggplot2包等进行数据处理、统计分析和绘图。检验水准（α）为0.05。具体统计学方法如下。
1.3.1 描述性统计
采用GBD 2023世界标准人口结构进行年龄标准化处理数据，对发病人数、患病人数、死亡人数、DALY及其95%UI，以及ASIR、ASPR、ASMR和ASDR进行描述性统计分析。
1.3.2 时间趋势分析
通过估计年度百分比变化（estimated annual percentage change，EAPC）对数线性回归模型和Joinpoint回归分析计算疾病负担的年度变化趋势及拐点。假设各年份的年龄标化率（age-standardized rate，ASR）自然对数与时间满足y＝α+βx+ε（x表示年份，y表示ASR的自然对数，α为截距，β为斜率，ε为随机误差）。绘制回归曲线得到回归系数b，再根据公式“EAPC＝100%×（exp(b)－1）”计算EAPC及其95%CI。若EAPC及其95%CI下限均＞0，表明相应的ASIR、ASPR、ASMR和ASDR呈上升趋势；反之，若EAPC及其95%CI上限均＜0，则表明相应的ASIR、ASPR、ASMR和ASDR呈下降趋势。采用Joinpoint 5.4.0软件（https://surveillance.cancer.gov/joinpoint/）实施蒙特卡洛置换检验，基于各年度变化百分比（annual percentage change，APC）的几何加权平均值计算平均年度变化百分比（average annual percentage change，AAPC）及其95%CI。若APC和AAPC及其95%CI下限均＞0，表示疾病负担呈上升趋势；若APC和AAPC及其95%CI上限均＜0，则表示呈下降趋势。
1.3.3 健康不平等分析
本研究采用不平等斜率指数（slope index of inequality，SII）与集中指数（concentration index）作为健康不平等评估指标，用来量化社会经济发展水平对疾病负担的影响。其中，SII是衡量健康不平等的绝对不平等指标，其通过加权最小二乘法对ASDR进行回归拟合来估算疾病负担在社会经济发展梯度上的分布趋势[4]；SII值越大表明群体间疾病负担的绝对差异越显著，其中正值提示疾病负担集中于社会经济地位较高群体，负值则提示集中于社会经济地位较低群体。集中指数是一个衡量健康相对不平等的指标[5]，取值范围为－1~1，正值表示疾病负担集中于社会经济地位较高群体，负值则表示集中于社会经济地位较低群体。计算过程中，以SDI作为社会经济地位排序变量，通过构建SDI与ASDR的关联模型量化不同SDI水平地区的疾病负担差异。
1.3.4 年龄-时期-队列（age-period-cohort，APC）分析
运用APC模型框架，通过正交分解法和加权最小二乘法分离年龄效应、时期效应和出生队列效应，采用Wald检验评估模型拟合优度[6]。
1.3.5 因素分解分析
应用人口学分解法，将疾病负担变化分解为年龄结构、人口规模和流行病学变化的贡献，量化各因素的相对影响[7-8]。
1.3.6 贝叶斯年龄-时期-队列（Bayesian age-period-cohort，BAPC）模型分析
本研究采用BAPC模型预测全球2024－2050年的食管癌负担趋势。BAPC模型以APC模型为基础，引入贝叶斯方法，即通过整合未知参数的先验信息与样本数据信息，构建参数的后验分布，并基于该后验分布实现对未知参数的统计推断。BAPC模型相较于其他预测方法具有更好的灵活性和稳健性；为精准分离并平滑年龄、时期和出生队列效应，该模型采用集成嵌套拉普拉斯近似方法完成后验分布的高效计算，并通过交叉验证手段验证模型稳健性，确保了模型推断与预测的可靠性。
2 结果
2.1 全球20~60岁人群食管癌负担及性别差异分析
1990－2023年，全球20~60岁人群食管癌发病人数从133 437.46例增长至169 647.15例，而ASIR、ASPR、ASMR和ASDR均呈显著下降趋势。其中ASIR从6.03/10万降低至3.71/10万，EAPC为－2.06%（95%CI －2.31%~－1.80%）；ASPR从12.38/10万降低至8.65/10万，EAPC为－1.66%（95%CI －1.92%~－1.41%）；ASMR从5.14/10万降低至3.06/10万，EAPC为－2.18%（95%CI －2.45%~－1.91%）；ASDR从199.94/10万降低至121.93/10万，EAPC为－2.13%（95%CI －2.41%~－1.86%）。在性别方面，1990年和2023年全球20~60岁男性的食管癌ASIR、ASPR、ASMR和ASDR均高于女性；1990－2023年，全球20~60岁男性、女性的食管癌负担均呈下降趋势。见表 1。
表 1 1990－2023年全球20~60岁人群的食管癌负担变化Table 1 Esophageal cancer burden among population aged 20-60 years globally from 1990 to 2023Indicator 1990 2023 EAPC (95%CI)/% Number (95%UI) ASR (95%UI)/(×10－5) Number (95%UI) ASR (95%UI)/(×10－5) Total Incidence 133 437.46 (107 953.94, 149 427.58) 6.03 (4.88, 6.75) 169 647.15 (147 682.44, 196 508.69) 3.71 (3.22, 4.31) －2.06 (－2.31, －1.80) Prevalence 276 283.85 (222 118.73, 311 013.91) 12.38 (9.96, 13.92) 392 699.45 (340 815.17, 457 863.69) 8.65 (7.50, 10.11) －1.66 (－1.92, －1.41) Mortality 113 272.57 (94 430.18, 130 388.63) 5.14 (4.29, 5.91) 140 502.20 (118 295.41, 168 744.09) 3.06 (2.57, 3.68) －2.18 (－2.45, －1.91) DALY 4 445 634.84 (3 699 746.35, 5 113 567.81) 199.94 (166.58, 229.90) 5 547 832.61 (4 656 241.59, 6 674 213.05) 121.93 (102.18, 146.85) －2.13 (－2.41, －1.86) Female Incidence 33 818.68 (22 121.71, 41 607.83) 3.07 (2.00, 3.77) 46 798.56 (34 836.21, 62 884.53) 2.07 (1.54, 2.79) －1.21 (－1.02, －1.35) Prevalence 73 725.66 (48 430.57, 91 119.34) 6.61 (4.32, 8.15) 113 343.65 (84 586.35, 150 412.88) 5.08 (3.77, 6.76) －0.88 (－0.75, －0.92) Mortality 27 814.70 (18 317.42, 34 970.04) 2.54 (1.67, 3.19) 38 287.26 (27 762.46, 53 125.19) 1.69 (1.22, 2.35) －1.28 (－1.15, －1.39) DALY 1 103 089.21 (735 381.19, 1 390 792.16) 99.53 (66.15, 125.33) 1 563 765.48 (1 123 972.77, 2 186 431.96) 69.74 (49.92, 97.83) －1.05 (－0.98, －1.16) Male Incidence 99 618.78 (81 946.60, 115 187.78) 8.93 (7.35, 10.31) 122 848.59 (103 962.18, 146 566.92) 5.36 (4.53, 6.40) －1.38 (－1.25, －1.64) Prevalence 202 558.19 (166 172.49, 233 887.32) 18.03 (14.82, 20.79) 279 355.80 (236 849.93, 333 876.15) 12.25 (10.37, 14.66) －1.15 (－1.08, －1.29) Mortality 85 457.87 (69 052.21, 101 792.97) 7.68 (6.21, 9.15) 102 214.94 (82 809.69, 127 207.86) 4.45 (3.60, 5.54) －1.45 (－1.32, －1.72) DALY 3 342 545.63 (2 703 498.24, 3 983 350.30) 298.10 (241.31, 354.88) 3 984 067.13 (3 217 896.98, 4 968 383.54) 174.38 (140.65, 217.69) －1.42 (－1.30, －1.68) 95%UI: 95% uncertainty interval; ASR: Age-standardized rate; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval; DALY: Disability-adjusted life year. 2.2 不同区域20~60岁人群食管癌负担分析
2.2.1 不同SDI水平地区食管癌负担
相较于1990年，2023年高、中高、中SDI地区20~60岁人群的食管癌ASIR、ASPR、ASMR和ASDR均下降，中低SDI地区ASIR、ASPR、ASMR和ASDR均上升，低SDI地区ASMR和ASDR也呈上升趋势（表 2）。
表 2 1990－2023年全球不同SDI水平地区20~60岁人群食管癌负担Table 2 Burden of esophageal cancer among population aged 20-60 years in different SDI level regions globally from 1990 to 2023Indicator 1990 2023 EAPC (95%CI)/% Number (95%UI) ASR (95%UI)/(×10－5) Number (95%UI) ASR (95%UI)/(×10－5) Incidence High SDI 58 584.03 (49 392.74, 65 646.45) 5.70 (4.80, 6.38) 56 237.57 (49 248.89, 64 258.32) 3.16 (2.77, 3.61) －2.23 (－2.56, －1.90) High-middle SDI 50 122.79 (32 901.93, 59 685.42) 11.34 (7.44, 13.49) 45 449.86 (39 253.64, 53 340.65) 4.22 (3.64, 4.95) －3.89 (－4.29, －3.49) Middle SDI 5 993.45 (5 118.00, 7 026.39) 2.81 (2.40, 3.29) 10 698.87 (8 743.91, 13 831.75) 1.97 (1.61, 2.55) －1.32 (－1.44, －1.20) Low-middle SDI 7 968.32 (6 060.63, 10 089.39) 3.12 (2.37, 3.94) 27 784.87 (19 970.15, 37 076.73) 4.94 (3.56, 6.58) 1.36 (0.94, 1.78) Low SDI 9 727.49 (6 966.69, 13 115.13) 3.91 (2.80, 5.25) 27 996.17 (20 553.67, 39 798.70) 4.53 (3.33, 6.45) 0.14 (－0.11, 0.38) Prevalence High SDI 125 335.63 (105 488.60, 140 673.14) 12.17 (10.24, 13.65) 144 837.84 (125 551.29, 166 233.19) 8.36 (7.23, 9.61) －1.57 (－1.90, －1.23) High-middle SDI 101 668.21 (65 913.46, 120 943.60) 22.71 (14.72, 26.97) 103 940.74 (88 788.87, 122 543.17) 9.81 (8.36, 11.58) －3.45 (－3.84, －3.06) Middle SDI 11 874.07 (10 104.36, 13 938.70) 5.49 (4.68, 6.44) 22 899.15 (18 553.52, 29 828.80) 4.23 (3.43, 5.51) －1.06 (－1.18, －0.93) Low-middle SDI 15 803.96 (12 032.74, 20 091.40) 6.11 (4.66, 7.75) 58 595.69 (41 749.58, 78 645.67) 10.32 (7.38, 13.82) 1.54 (1.11, 1.98) Low SDI 19 312.00 (13 832.24, 26 119.57) 7.64 (5.48, 10.30) 58 730.66 (42 735.26, 83 792.03) 9.31 (6.78, 13.26) 0.27 (－0.00, 0.55) Mortality High SDI 49 032.48 (41 476.10, 56 957.97) 4.77 (4.04, 5.54) 43 202.83 (36 608.05, 52 416.60) 2.39 (2.03, 2.90) －2.57 (－2.91, －2.24) High-middle SDI 43 420.78 (29 943.74, 52 997.02) 9.88 (6.82, 12.05) 37 271.75 (30 718.35, 45 987.13) 3.43 (2.83, 4.23) －4.12 (－4.53, －3.70) Middle SDI 5 163.19 (4 351.34, 6 146.00) 2.43 (2.05, 2.89) 9 226.75 (7 314.67, 11 927.87) 1.70 (1.35, 2.20) －1.34 (－1.48, －1.20) Low-middle SDI 6 843.26 (5 215.11, 8 658.47) 2.69 (2.06, 3.41) 25 126.09 (18 055.96, 33 892.64) 4.49 (3.23, 6.05) 1.51 (1.06, 1.95) Low SDI 7 951.72 (5 708.72, 10 503.77) 3.21 (2.31, 4.24) 24 529.00 (17 879.33, 33 869.07) 4.01 (2.93, 5.54) 0.39 (0.13, 0.65) DALY High SDI 1 902 361.42 (1 610 117.14, 2 212 738.28) 185.17 (156.78, 215.28) 1 634 482.54 (1 388 942.21, 1 978 600.27) 91.99 (78.27, 111.23) －2.63 (－2.97, －2.28) High-middle SDI 1 690 551.59 (1 162 096.48, 2 064 399.01) 379.75 (261.14, 463.34) 1 443 685.71 (1 190 173.00, 1 773 330.90) 134.92 (111.16, 165.48) －4.05 (－4.46, －3.64) Middle SDI 205 490.94 (173 023.38, 244 403.73) 95.21 (80.21, 113.26) 363 137.03 (287 658.97, 469 783.18) 66.97 (53.05, 86.65) －1.31 (－1.44, －1.17) Low-middle SDI 279 430.04 (212 603.86, 353 789.58) 107.95 (82.24, 136.57) 1 041 414.34 (741 889.77, 1 408 470.54) 183.91 (131.42, 248.43) 1.57 (1.12, 2.03) Low SDI 334 655.68 (239 262.18, 442 694.25) 131.92 (94.61, 174.19) 1 021 337.74 (743 724.85, 1 413 572.98) 163.01 (118.80, 225.44) 0.34 (0.07, 0.61) SDI: Socio-demographic index; 95%UI: 95% uncertainty interval; ASR: Age-standardized rate; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval. 2.2.2 不同GBD地区食管癌负担
2023年20~60岁人群食管癌负担最高的地区为东非撒哈拉以南地区，最低为拉丁美洲安第斯地区。在疾病负担变化趋势方面，南亚地区和加勒比地区的ASIR、ASPR、ASMR和ASDR均呈上升趋势，其他GBD地区的食管癌4项ASR大多呈降低趋势，其中中亚地区ASIR与ASPR降低最显著，东亚地区ASMR与ASDR降低最显著。见附表 1（印刷版未展示）。
附表 1 1990－2023年21个GBD地区的20~60岁人群食管癌疾病负担Region ASIR ASPR ASMR ASDR 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% East Asia 14.87 (10.24, 17.67) 5.07 (4.13, 6.21) －4.10 (－4.56, －3.65) 29.84 (20.23, 35.60) 12.64 (10.30, 15.55) －3.43 (－3.87, －3.00) 12.88 (9.26, 16.00) 3.97 (3.02, 5.27) －4.44 (－4.91, －3.97) 496.01 (354.80, 615.96) 153.13 (116.88, 202.73) －4.45 (－4.93, －3.97) Southeast Asia 2.14 (1.62, 2.77) 2.29 (1.85, 2.92) 0.07 (－0.02, 0.16) 4.30 (3.26, 5.57) 5.01 (4.03, 6.38) 1.60 (1.16, 2.04) 1.81 (1.39, 2.31) 1.95 (1.55, 2.50) 0.09 (－0.01, 0.18) 72.41 (55.40, 92.73) 77.73 (61.39, 100.05) 0.05 (－0.04, 0.15) Oceania 1.47 (0.91, 2.17) 1.47 (0.95, 2.26) －0.18 (－0.26, －0.11) 2.92 (1.80, 4.33) 3.12 (2.00, 4.82) －0.02 (－0.09, 0.06) 1.21 (0.75, 1.73) 1.27 (0.82, 1.98) －0.09 (－0.17, －0.01) 49.31 (30.52, 71.05) 52.21 (33.71, 81.68) －0.03 (－0.11, 0.05) Central Asia 8.15 (7.57, 8.68) 2.31 (2.11, 2.55) －4.13 (－4.40, －3.86) 15.96 (14.75, 17.08) 4.73 (4.28, 5.25) －3.98 (－4.26, －3.70) 7.09 (6.59, 7.53) 1.98 (1.79, 2.20) －4.19 (－4.45, －3.94) 277.97 (257.80, 295.62) 77.97 (70.38, 86.64) －4.19 (－4.44, －3.94) Central Europe 2.55 (2.42, 2.68) 1.85 (1.72, 1.99) －1.24 (－1.50, －0.99) 4.96 (4.70, 5.23) 3.85 (3.55, 4.16) －1.07 (－1.32, －0.81) 2.23 (2.12, 2.35) 1.58 (1.46, 1.70) －1.31 (－1.56, －1.05) 87.43 (83.08, 92.00) 60.74 (56.13, 65.53) －1.41 (－1.66, －1.16) Eastern Europe 3.26 (2.93, 3.61) 2.31 (2.09, 2.56) －1.26 (－1.44, －1.07) 6.40 (5.76, 7.11) 4.95 (4.43, 5.53) －0.90 (－1.12, －0.67) 2.84 (2.55, 3.12) 1.91 (1.72, 2.10) －1.41 (－1.59, －1.23) 109.11 (98.15, 119.99) 73.49 (66.10, 80.96) －1.42 (－1.60, －1.23) High-income Asia Pacific 3.70 (3.33, 4.03) 1.88 (1.63, 2.14) －2.46 (－2.72, －2.19) 10.40 (9.11, 11.70) 7.82 (6.46, 9.18) －1.20 (－1.60, －0.79) 2.61 (2.36, 2.82) 0.96 (0.86, 1.06) －3.53 (－3.71, －3.35) 99.67 (89.49, 107.84) 36.65 (32.88, 40.80) －3.52 (－3.69, －3.36) Australasia 2.22 (2.01, 2.44) 2.09 (1.83, 2.39) －0.19 (－0.42, 0.04) 5.84 (5.09, 6.72) 7.05 (5.85, 8.42) 0.57 (0.26, 0.88) 1.64 (1.50, 1.79) 1.30 (1.16, 1.46) －0.73 (－0.92, －0.55) 62.93 (57.20, 68.90) 50.46 (44.68, 56.75) －0.72 (－0.91, －0.53) Western Europe 3.54 (3.36, 3.74) 2.35 (2.10, 2.58) －1.46 (－1.64, －1.28) 8.15 (7.54, 8.91) 7.13 (6.15, 8.26) －0.56 (－0.78, －0.34) 2.86 (2.72, 2.99) 1.60 (1.46, 1.71) －2.02 (－2.18, －1.85) 111.36 (106.12, 116.73) 61.81 (56.38, 66.39) －2.07 (－2.23, －1.90) Southern Latin America 4.04 (3.78, 4.32) 1.77 (1.56, 2.00) －2.68 (－2.86, －2.51) 8.19 (7.61, 8.84) 4.13 (3.57, 4.72) －2.31 (－2.49, －2.13) 3.48 (3.27, 3.70) 1.41 (1.24, 1.58) －2.87 (－3.04, －2.70) 134.04 (125.62, 142.78) 55.16 (48.53, 61.72) －2.85 (－3.02, －2.67) High-income North America 2.69 (2.45, 2.96) 2.27 (2.02, 2.54) －0.64 (－0.78, －0.49) 6.92 (6.09, 7.91) 6.66 (5.69, 7.76) －0.27 (－0.46, －0.09) 2.03 (1.87, 2.20) 1.59 (1.44, 1.75) －0.86 (－0.98, －0.73) 78.34 (72.06, 85.10) 61.99 (55.96, 68.56) －0.84 (－0.96, －0.71) Caribbean 2.49 (2.27, 2.71) 2.53 (2.13, 2.98) 0.47 (0.28, 0.66) 5.10 (4.62, 5.59) 5.34 (4.49, 6.31) 0.55 (0.37, 0.73) 2.11 (1.92, 2.30) 2.18 (1.81, 2.60) 0.49 (0.30, 0.68) 83.61 (75.86, 91.59) 85.43 (70.85, 102.45) 0.44 (0.25, 0.64) Andean Latin America 0.97 (0.82, 1.13) 0.56 (0.46, 0.69) －1.79 (－1.98, －1.61) 1.96 (1.64, 2.28) 1.25 (1.01, 1.54) －1.53 (－1.71, －1.34) 0.83 (0.69, 0.96) 0.47 (0.38, 0.57) －1.74 (－2.00, －1.47) 33.45 (28.05, 38.89) 18.92 (15.35, 23.10) －1.76－1.76 (－2.02, －1.50) Central Latin America 1.34 (1.22, 1.47) 0.75 (0.67, 0.84) －1.53 (－1.63, －1.42) 2.73 (2.48, 3.01) 1.67 (1.48, 1.89) －1.27 (－1.37, －1.18) 1.16 (1.06, 1.26) 0.63 (0.56, 0.69) －1.63 (－1.75, －1.51) 46.21 (42.21, 50.54) 25.16 (22.67, 27.87) －1.63 (－1.75, －1.51) Tropical Latin America 4.77 (4.28, 5.25) 3.06 (2.83, 3.30) －1.10 (－1.30, －0.90) 9.43 (8.43, 10.40) 6.44 (5.91, 6.99) －0.93 (－1.12, －0.74) 4.16 (3.74, 4.57) 2.58 (2.39, 2.79) －1.17 (－1.37, －0.97) 163.20 (146.70, 179.46) 100.93 (93.44, 109.29) －1.20 (－1.40, －0.99) North Africa and Middle East 1.31 (0.93, 1.69) 0.96 (0.74, 1.26) －1.25 (－1.35, －1.14) 2.67 (1.88, 3.47) 2.36 (1.80, 3.12) －0.72 (－0.84, －0.59) 1.11 (0.80, 1.43) 0.76 (0.58, 0.99) －1.43 (－1.54, －1.32) 44.24 (31.53, 56.84) 30.57 (23.24, 39.72) －1.42 (－1.53, －1.31) South Asia 3.04 (2.29, 3.93) 5.14 (3.82, 6.78) 1.39 (0.97, 1.80) 5.93 (4.47, 7.70) 10.84 (8.03, 14.47) 1.60 (1.16, 2.04) 2.62 (1.98, 3.43) 4.66 (3.41, 6.14) 1.55 (1.09, 2.01) 104.97 (79.13, 137.68) 190.05 (138.16, 250.57) 1.59 (1.13, 2.06) Central Sub-Saharan Africa 4.67 (2.53, 6.63) 4.93 (3.19, 7.33) 0.06 (－0.20, 0.31) 9.02 (4.88, 12.83) 9.79 (6.34, 14.52) 0.14 (－0.13, 0.42) 3.99 (2.33, 5.59) 4.38 (2.84, 6.49) 0.11 (－0.14, 0.36) 163.04 (94.94, 228.47) 176.94 (115.14, 263.08) 0.09 (－0.17, 0.35) Eastern Sub-Saharan Africa 9.31 (6.52, 12.78) 8.97 (6.75, 12.30) －0.16 (－0.36, 0.04) 18.19 (12.71, 25.15) 18.02 (13.56, 24.75) －0.07 (－0.30, 0.17) 7.62 (5.34, 10.10) 7.94 (5.88, 10.86) 0.07 (－0.12, 0.25) 314.26 (219.43, 417.95) 323.34 (239.47, 442.14) 0.01 (－0.19, 0.21) Southern Sub-Saharan Africa 11.43 (8.68, 14.79) 7.60 (6.15, 9.53) －1.80 (－2.10, －1.51) 22.03 (16.69, 28.52) 14.73 (11.86, 18.60) －1.76 (－2.09, －1.42) 9.85 (7.27, 12.98) 5.10 (4.01, 6.49) －2.48 (－2.74, －2.22) 379.82 (279.81, 501.56) 198.45 (155.55, 253.70) －2.45 (－2.71, －2.20) Western Sub-Saharan Africa 1.31 (0.92, 1.76) 1.28 (0.89, 1.81) －0.16 (－0.38, 0.05) 2.52 (1.78, 3.40) 2.53 (1.77, 3.60) －0.07 (－0.31, 0.16) 1.16 (0.82, 1.56) 1.15 (0.79, 1.65) －0.08 (－0.29, 0.13) 45.91 (32.52, 61.87) 46.12 (31.52, 65.96) －0.05 (－0.27, 0.17) GBD: Global Burden of Disease Study; ASIR: Age-standardized incidence rate; 95%UI: 95% uncertainty interval; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized DALY rate; DALY: Disability-adjusted life year. 2.3 不同国家和地区20~60岁人群食管癌负担分析
1990－2023年，204个国家和地区中，63%（128/204）的国家和地区20~60岁人群食管癌ASIR呈下降趋势，37%（76/204）呈上升或平稳趋势；51%（104/204）的国家和地区ASPR呈下降趋势，49%（100/204）呈上升或平稳趋势；64%（130/204）的国家和地区ASMR呈下降趋势，36%（74/204）呈上升或平稳趋势；63%（129/204）的国家和地区ASDR呈下降趋势，37%（75/204）呈上升或平稳趋势。其中北马里亚纳群岛20~60岁人群的食管癌负担增幅最明显，而阿联酋的疾病负担降幅最明显。1990－2023年，中国大陆地区20~60岁人群的食管癌ASIR、ASPR、ASMR和ASDR均显著下降，其中ASDR降幅最大（EAPC＝－4.61%，95%CI －5.10%~－4.12%）。见附表 2（印刷版未展示）。
附表 2 1990－2023年全球204个国家和地区20~60岁人群食管癌疾病负担Location name ASIR ASPR ASMR ASDR 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% Chinese Mainland 15.20 (10.39, 18.12) 4.97 (3.99, 6.14) －4.26 (－4.73, －3.79) 30.49 (20.50, 36.49) 12.38 (9.99, 15.34) －3.59 (－4.04, －3.15) 13.18 (9.41, 16.44) 3.89 (2.92, 5.24) －4.59 (－5.08, －4.11) 507.42 (360.35, 632.58) 150.05 (112.87, 201.26) －4.61 (－5.10, －4.12) Democratic People's Republic of Korea 6.25 (4.21, 8.95) 6.19 (3.91, 9.64) －0.34 (－0.44, －0.25) 12.49 (8.38, 17.94) 13.54 (8.57, 21.10) －0.04 (－0.13, 0.06) 5.29 (3.45, 7.61) 5.16 (3.14, 8.06) －0.43 (－0.53, －0.33) 207.49 (134.20, 299.41) 200.70 (122.55, 314.43) －0.45 (－0.54, －0.35) Taiwan, China 6.24 (5.40, 7.15) 9.93 (8.30, 11.61) 1.27 (0.72, 1.82) 13.87 (11.92, 15.99) 27.29 (22.24, 32.62) 1.85 (1.18, 2.52) 5.11 (4.45, 5.88) 7.31 (6.14, 8.49) 0.93 (0.45, 1.41) 201.42 (175.21, 232.06) 286.46 (240.63, 333.16) 0.89 (0.37, 1.41) Cambodia 2.22 (1.43, 3.21) 1.58 (1.07, 2.32) －1.43 (－1.52, －1.34) 4.51 (2.90, 6.57) 3.27 (2.19, 4.81) －1.44 (－1.54, －1.34) 1.81 (1.15, 2.59) 1.35 (0.88, 2.06) －1.27 (－1.36, －1.18) 78.61 (49.97, 113.03) 54.72 (35.75, 83.37) －1.57 (－1.67, －1.47) Indonesia 1.77 (1.20, 2.48) 1.93 (1.24, 2.94) 0.63 (0.47, 0.78) 3.49 (2.38, 4.91) 4.06 (2.60, 6.16) 0.80 (0.65, 0.96) 1.49 (1.03, 2.08) 1.69 (1.09, 2.65) 0.82 (0.66, 0.98) 59.70 (41.03, 83.19) 68.08 (43.87, 106.15) 0.85 (0.69, 1.01) Lao People's Democratic Republic 1.73 (1.07, 2.50) 2.28 (1.52, 3.39) 0.60 (0.35, 0.84) 3.39 (2.10, 4.93) 4.81 (3.18, 7.16) 0.79 (0.51, 1.07) 1.41 (0.88, 1.97) 2.02 (1.32, 3.04) 0.78 (0.55, 1.00) 58.60 (36.72, 81.93) 82.83 (54.21, 124.36) 0.69 (0.44, 0.95) Malaysia 1.19 (0.86, 1.60) 1.14 (0.83, 1.51) －0.23 (－0.33, －0.14) 2.38 (1.72, 3.22) 2.53 (1.84, 3.38) 0.07 (－0.01, 0.16) 1.00 (0.72, 1.35) 0.96 (0.72, 1.29) －0.34 (－0.44, －0.23) 39.30 (28.12, 52.84) 37.74 (27.98, 50.85) －0.32 (－0.42, －0.22) Maldives 1.49 (1.11, 1.90) 0.77 (0.57, 1.02) －2.11 (－2.21, －2.00) 2.96 (2.19, 3.80) 1.84 (1.35, 2.44) －1.49 (－1.63, －1.35) 1.26 (0.92, 1.66) 0.60 (0.44, 0.81) －2.35 (－2.45, －2.25) 49.72 (36.14, 65.83) 23.16 (16.81, 31.44) －2.41 (－2.52, －2.30) Myanmar 2.54 (1.72, 3.52) 2.13 (1.40, 3.22) －1.08 (－1.31, －0.86) 4.96 (3.35, 6.88) 4.49 (2.94, 6.82) －0.89 (－1.13, －0.64) 2.09 (1.42, 2.91) 1.88 (1.23, 2.86) －0.87 (－1.12, －0.62) 87.01 (58.75, 120.95) 76.23 (49.83, 115.99) －0.98 (－1.24, －0.72) Philippines 1.01 (0.75, 1.31) 0.84 (0.66, 1.09) －0.74 (－0.97, －0.52) 2.09 (1.53, 2.71) 1.76 (1.39, 2.31) －0.72 (－0.93, －0.51) 0.86 (0.63, 1.11) 0.71 (0.56, 0.93) －0.75 (－0.98, －0.52) 35.49 (26.09, 45.91) 28.70 (22.49, 37.45) －0.83 (－1.05, －0.61) Sri Lanka 3.74 (2.65, 4.87) 4.27 (3.10, 5.81) －0.58 (－0.89, －0.28) 7.77 (5.45, 10.26) 10.31 (7.40, 14.16) －0.13 (－0.43, 0.18) 3.16 (2.32, 4.15) 3.57 (2.52, 4.96) －0.75 (－1.09, －0.41) 125.65 (91.96, 165.24) 139.32 (98.52, 194.02) －0.85 (－1.19, －0.50) Thailand 4.45 (3.39, 5.53) 5.20 (3.73, 7.15) －0.09 (－0.37, 0.18) 9.13 (6.91, 11.39) 12.40 (8.90, 17.08) 0.36 (0.08, 0.64) 3.77 (2.88, 4.82) 4.21 (2.98, 5.75) －0.34 (－0.64, －0.04) 150.35 (114.07, 192.37) 170.84 (120.18, 234.47) －0.33 (－0.64, －0.01) Timor-Leste 1.81 (1.10, 2.76) 1.88 (1.22, 2.85) －0.11 (－0.39, 0.16) 3.69 (2.21, 5.67) 4.24 (2.72, 6.48) 0.17 (－0.12, 0.46) 1.46 (0.85, 2.29) 1.52 (0.98, 2.28) －0.18 (－0.45, 0.10) 61.24 (35.57, 95.85) 64.07 (41.28, 96.22) －0.13 (－0.44, 0.17) Viet Nam 1.26 (0.89, 1.68) 2.26 (1.34, 3.56) 2.09 (1.88, 2.30) 2.48 (1.75, 3.30) 4.94 (2.94, 7.79) 2.38 (2.19, 2.57) 1.09 (0.76, 1.46) 1.91 (1.05, 2.98) 2.03 (1.83, 2.23) 42.31 (29.45, 56.68) 74.66 (41.17, 116.93) 2.02 (1.83, 2.21) Fiji 1.40 (0.99, 1.90) 1.58 (1.07, 2.35) 0.84 (0.58, 1.11) 2.78 (1.96, 3.79) 3.28 (2.22, 4.89) 0.96 (0.69, 1.23) 1.15 (0.80, 1.58) 1.41 (0.97, 2.08) 0.98 (0.71, 1.24) 46.48 (32.41, 64.07) 57.14 (39.32, 84.17) 0.98 (0.71, 1.24) Kiribati 2.12 (1.44, 2.90) 2.42 (1.48, 3.68) 0.27 (0.15, 0.38) 4.19 (2.84, 5.73) 4.89 (2.99, 7.44) 0.33 (0.21, 0.45) 1.68 (1.16, 2.30) 2.10 (1.28, 3.20) 0.51 (0.39, 0.62) 70.82 (48.47, 96.96) 88.53 (53.87, 134.29) 0.50 (0.38, 0.62) Marshall Islands 1.87 (1.27, 2.67) 1.78 (1.15, 2.63) －0.34 (－0.44, －0.24) 3.60 (2.45, 5.14) 3.51 (2.29, 5.19) －0.26 (－0.38, －0.15) 1.64 (1.11, 2.32) 1.72 (1.15, 2.49) －0.02 (－0.17, 0.13) 65.12 (44.09, 92.32) 67.92 (45.35, 98.83) －0.03 (－0.19, 0.12) Micronesia (Federated States of) 3.30 (2.14, 4.69) 2.26 (1.46, 3.31) －1.14 (－1.22, －1.06) 6.40 (4.16, 9.12) 4.59 (2.98, 6.73) －1.00 (－1.08, －0.93) 2.90 (1.90, 4.07) 1.93 (1.25, 2.83) －1.24 (－1.32, －1.15) 117.21 (76.91, 164.37) 78.91 (51.33, 115.99) －1.20 (－1.28, －1.11) Papua New Guinea 1.43 (0.79, 2.29) 1.39 (0.82, 2.24) －0.49 (－0.61, －0.37) 2.87 (1.58, 4.56) 2.96 (1.74, 4.78) －0.30 (－0.43, －0.18) 1.18 (0.65, 1.80) 1.18 (0.69, 1.92) －0.41 (－0.53, －0.29) 48.17 (26.62, 74.23) 48.85 (28.46, 79.49) －0.33 (－0.45, －0.22) Samoa 0.49 (0.32, 0.69) 0.56 (0.36, 0.83) 1.14 (0.90, 1.38) 0.99 (0.65, 1.40) 1.16 (0.75, 1.73) 0.06 (－0.12, 0.23) 0.41 (0.26, 0.57) 0.51 (0.31, 0.74) 0.23 (0.06, 0.40) 16.23 (10.50, 22.65) 19.88 (12.28, 28.76) 0.18 (0.01, 0.34) Solomon Islands 2.14 (1.18, 3.19) 2.45 (1.53, 3.75) 0.34 (0.15, 0.53) 4.15 (2.29, 6.20) 4.96 (3.12, 7.59) 0.46 (0.28, 0.64) 1.76 (0.96, 2.64) 2.21 (1.36, 3.46) 0.59 (0.37, 0.80) 71.09 (38.99, 106.33) 89.86 (55.33, 140.43) 0.61 (0.40, 0.82) Tonga 1.13 (0.72, 1.57) 1.08 (0.70, 1.62) －0.34 (－0.41, －0.27) 2.32 (1.49, 3.25) 2.33 (1.52, 3.50) －0.21 (－0.28, －0.14) 0.95 (0.61, 1.35) 0.98 (0.63, 1.47) －0.14 (－0.25, －0.04) 38.41 (24.52, 54.47) 39.17 (25.20, 58.98) －0.15 (－0.25, －0.05) Vanuatu 1.61 (0.91, 2.43) 1.54 (1.00, 2.37) －0.49 (－0.67, －0.32) 3.14 (1.78, 4.72) 3.09 (2.00, 4.76) －0.40 (－0.57, －0.23) 1.37 (0.74, 2.14) 1.36 (0.86, 2.08) －0.43 (－0.62, －0.24) 55.56 (30.09, 86.73) 55.24 (35.22, 84.86) －0.41 (－0.59, －0.22) Armenia 1.44 (1.24, 1.69) 0.29 (0.23, 0.35) －4.00 (－4.41, －3.58) 2.88 (2.46, 3.38) 0.59 (0.48, 0.72) －3.92 (－4.33, －3.51) 1.24 (1.05, 1.44) 0.24 (0.19, 0.29) －4.03 (－4.45, －3.62) 48.77 (40.96, 56.71) 9.07 (7.13, 11.20) －4.14 (－4.56, －3.71) Azerbaijan 6.26 (4.86, 7.57) 2.76 (2.03, 3.68) －2.76 (－3.13, －2.40) 12.23 (9.43, 14.86) 5.53 (4.06, 7.41) －2.67 (－3.05, －2.29) 5.47 (4.36, 6.61) 2.42 (1.79, 3.19) －2.73 (－3.09, －2.37) 214.72 (169.87, 260.07) 93.61 (69.20, 124.22) －2.78 (－3.15, －2.42) Georgia 1.33 (1.11, 1.56) 0.60 (0.48, 0.74) －1.44 (－1.91, －0.97) 2.64 (2.20, 3.11) 1.18 (0.95, 1.46) －1.51 (－1.96, －1.06) 1.16 (0.96, 1.38) 0.52 (0.41, 0.66) －1.41 (－1.89, －0.93) 45.41 (37.83, 54.24) 19.88 (15.75, 25.12) －1.55 (－2.01, －1.09) Kazakhstan 10.96 (9.98, 11.96) 2.21 (1.90, 2.55) －4.93 (－5.03, －4.83) 21.23 (19.26, 23.23) 4.56 (3.91, 5.28) －4.68 (－4.78, －4.58) 9.57 (8.71, 10.52) 1.90 (1.63, 2.19) －5.00 (－5.11, －4.90) 370.25 (336.01, 407.10) 74.11 (63.38, 85.70) －5.00 (－5.10, －4.90) Kyrgyzstan 5.35 (4.67, 6.14) 1.10 (0.91, 1.32) －5.21 (－5.41, －5.01) 10.45 (9.06, 11.99) 2.21 (1.84, 2.66) －5.09 (－5.28, －4.89) 4.69 (3.99, 5.42) 0.97 (0.79, 1.17) －5.26 (－5.47, －5.05) 185.27 (157.63, 214.68) 37.45 (30.49, 45.33) －5.31 (－5.52, －5.11) Mongolia 12.39 (8.30, 17.30) 6.71 (5.18, 8.96) －2.44 (－2.62, －2.25) 24.45 (16.19, 34.42) 13.39 (10.26, 17.96) －2.39 (－2.55, －2.22) 10.47 (7.04, 14.92) 6.04 (4.55, 7.96) －2.38 (－2.59, －2.17) 421.81 (280.55, 603.14) 237.83 (179.00, 314.04) －2.45 (－2.65, －2.24) Tajikistan 8.06 (5.96, 9.97) 1.97 (1.32, 3.18) －5.79 (－6.31, －5.26) 15.85 (11.60, 19.71) 4.01 (2.68, 6.45) －5.70 (－6.23, －5.17) 7.00 (5.29, 8.68) 1.74 (1.12, 2.84) －5.87 (－6.42, －5.32) 276.78 (206.58, 344.92) 68.41 (44.27, 111.06) －5.89 (－6.44, －5.34) Turkmenistan 18.03 (15.97, 20.26) 4.71 (3.73, 5.86) －4.14 (－4.67, －3.60) 34.94 (30.79, 39.40) 9.40 (7.44, 11.71) －1.43 (－1.69, －1.17) 15.75 (13.75, 17.78) 4.06 (3.10, 5.12) －4.18 (－4.72, －3.63) 610.97 (531.93, 692.05) 159.56 (122.59, 201.17) －4.14 (－4.65, －3.62) Uzbekistan 9.54 (8.56, 10.61) 2.12 (1.84, 2.43) －4.87 (－5.37, －4.37) 18.76 (16.74, 20.93) 4.43 (3.82, 5.13) －4.70 (－5.20, －4.19) 8.31 (7.47, 9.22) 1.75 (1.52, 2.03) －5.00 (－5.47, －4.53) 325.16 (291.61, 361.16) 69.91 (60.37, 81.03) －4.96 (－5.42, －4.50) Albania 1.11 (0.76, 1.49) 1.02 (0.65, 1.53) 0.12 (－0.11, 0.35) 2.19 (1.50, 2.93) 2.15 (1.39, 3.25) 0.30 (0.09, 0.50) 0.98 (0.68, 1.32) 0.87 (0.53, 1.35) 0.08 (－0.17, 0.34) 38.28 (26.39, 51.99) 34.53 (21.21, 53.22) 0.07 (－0.17, 0.32) Bosnia and Herzegovina 1.78 (1.43, 2.23) 1.29 (0.97, 1.62) －0.68 (－0.81, －0.54) 3.44 (2.75, 4.33) 2.63 (1.98, 3.30) －0.49 (－0.64, －0.35) 1.57 (1.26, 1.99) 1.11 (0.83, 1.38) －0.73 (－0.86, －0.60) 60.61 (48.34, 77.09) 42.73 (31.67, 53.39) －0.75 (－0.88, －0.61) Bulgaria 1.83 (1.63, 2.04) 1.48 (1.25, 1.73) －0.57 (－0.82, －0.32) 3.56 (3.16, 3.98) 2.95 (2.50, 3.47) －0.50 (－0.75, －0.26) 1.60 (1.43, 1.79) 1.27 (1.08, 1.49) －0.60 (－0.85, －0.35) 62.76 (55.97, 70.31) 49.40 (41.82, 57.84) －0.66 (－0.91, －0.41) Croatia 3.11 (2.75, 3.51) 1.79 (1.51, 2.09) －1.88 (－2.10, －1.65) 6.11 (5.39, 6.91) 3.82 (3.22, 4.50) 0.03 (－0.48, 0.54) 2.72 (2.40, 3.07) 1.50 (1.28, 1.75) －1.99 (－2.22, －1.76) 105.95 (93.17, 119.85) 57.92 (49.27, 67.70) －2.03 (－2.26, －1.80) Czechia 2.69 (2.41, 2.98) 2.07 (1.79, 2.39) －1.18 (－1.46, －0.90) 5.59 (4.99, 6.23) 5.13 (4.33, 6.00) 0.66 (0.52, 0.80) 2.28 (2.04, 2.51) 1.61 (1.38, 1.84) －1.44 (－1.70, －1.19) 89.57 (80.41, 98.89) 61.38 (52.61, 70.55) －1.56 (－1.81, －1.30) Hungary 4.74 (4.34, 5.20) 1.80 (1.56, 2.05) －3.35 (－3.93, －2.77) 9.14 (8.36, 10.05) 3.69 (3.17, 4.20) －3.23 (－3.80, －2.65) 4.16 (3.80, 4.56) 1.55 (1.34, 1.76) －3.39 (－3.96, －2.81) 164.41 (149.83, 180.71) 58.93 (50.89, 67.18) －3.59 (－4.15, －3.01) North Macedonia 0.94 (0.75, 1.19) 0.88 (0.65, 1.16) －0.17 (－0.32, －0.02) 1.84 (1.45, 2.31) 1.80 (1.34, 2.37) －0.03 (－0.17, 0.11) 0.83 (0.65, 1.04) 0.75 (0.56, 0.99) －0.23 (－0.38, －0.07) 32.24 (25.39, 40.47) 29.14 (21.47, 38.26) －0.27 (－0.42, －0.11) Montenegro 1.81 (1.36, 2.32) 1.53 (1.11, 2.06) －0.61 (－0.78, －0.44) 3.68 (2.77, 4.71) 3.21 (2.32, 4.34) －0.51 (－0.65, －0.36) 1.56 (1.17, 2.02) 1.30 (0.93, 1.76) －0.68 (－0.86, －0.49) 61.06 (45.62, 78.91) 50.36 (35.99, 68.20) －0.74 (－0.93, －0.56) Poland 2.84 (2.59, 3.11) 1.94 (1.72, 2.16) －1.38 (－1.59, －1.17) 5.42 (4.93, 5.93) 3.85 (3.41, 4.30) －1.27 (－1.49, －1.06) 2.51 (2.28, 2.74) 1.69 (1.51, 1.89) －1.41 (－1.62, －1.20) 98.06 (89.12, 107.11) 64.91 (57.80, 72.70) －1.48 (－1.69, －1.28) Romania 1.43 (1.27, 1.57) 2.09 (1.78, 2.42) 0.82 (0.41, 1.24) 2.78 (2.46, 3.05) 4.16 (3.55, 4.84) 0.89 (0.49, 1.30) 1.25 (1.11, 1.39) 1.81 (1.52, 2.10) 0.79 (0.38, 1.21) 49.54 (43.99, 55.00) 69.58 (58.56, 80.85) 0.65 (0.25, 1.06) Serbia 2.14 (1.52, 2.90) 1.47 (1.06, 1.96) －1.21 (－1.43, －1.00) 4.26 (3.02, 5.80) 3.22 (2.31, 4.33) －0.89 (－1.09, －0.69) 1.85 (1.30, 2.51) 1.23 (0.84, 1.67) －1.37 (－1.59, －1.15) 71.29 (50.17, 97.10) 46.99 (32.23, 64.22) －1.42 (－1.63, －1.20) Slovakia 4.26 (3.37, 5.29) 2.48 (1.85, 3.20) －1.79 (－1.99, －1.58) 8.26 (6.51, 10.29) 5.08 (3.78, 6.58) －1.65 (－1.84, －1.45) 3.71 (2.92, 4.54) 2.14 (1.59, 2.75) －1.82 (－2.03, －1.61) 146.36 (114.57, 179.75) 82.45 (61.04, 106.53) －1.94 (－2.15, －1.74) Slovenia 3.19 (2.80, 3.65) 1.58 (1.30, 1.88) －2.50 (－2.66, －2.33) 6.44 (5.62, 7.39) 3.74 (3.05, 4.50) －1.98 (－2.14, －1.81) 2.75 (2.42, 3.13) 1.25 (1.02, 1.51) －2.75 (－2.92, －2.58) 106.83 (93.88, 121.76) 48.38 (39.83, 58.51) －2.78 (－2.95, －2.61) Belarus 1.98 (1.74, 2.24) 2.78 (2.26, 3.40) 0.33 (0.04, 0.63) 3.93 (3.44, 4.44) 5.98 (4.86, 7.32) 0.67 (0.41, 0.92) 1.72 (1.52, 1.95) 2.32 (1.87, 2.86) 0.17 (－0.14, 0.49) 66.57 (58.54, 75.54) 88.00 (71.05, 108.26) 0.08 (－0.23, 0.39) Estonia 2.64 (2.29, 3.07) 1.57 (1.31, 1.87) －2.07 (－2.31, －1.83) 5.17 (4.47, 6.01) 3.50 (2.89, 4.21) －1.56 (－1.79, －1.32) 2.30 (1.98, 2.68) 1.28 (1.06, 1.54) －2.30 (－2.55, －2.06) 88.17 (75.86, 102.75) 48.33 (39.87, 58.22) －2.38 (－2.63, －2.14) Latvia 2.76 (2.41, 3.15) 2.30 (1.91, 2.75) －1.27 (－1.55, －0.98) 5.41 (4.71, 6.19) 4.79 (3.96, 5.74) －1.00 (－1.29, －0.72) 2.40 (2.11, 2.73) 1.94 (1.60, 2.32) －1.37 (－1.66, －1.08) 92.80 (81.22, 105.60) 73.53 (60.69, 88.35) －1.45 (－1.74, －1.15) Lithuania 2.93 (2.57, 3.32) 2.98 (2.51, 3.48) －0.33 (－0.60, －0.07) 5.79 (5.08, 6.59) 6.28 (5.26, 7.39) －0.13 (－0.36, 0.11) 2.54 (2.23, 2.91) 2.51 (2.10, 2.96) －0.42 (－0.69, －0.14) 98.21 (86.21, 112.96) 95.80 (80.03, 113.48) －0.51 (－0.77, －0.24) Republic of Moldova 1.83 (1.56, 2.14) 1.31 (1.04, 1.62) －1.12 (－1.47, －0.77) 3.53 (3.01, 4.13) 2.61 (2.07, 3.25) －1.01 (－1.37, －0.66) 1.60 (1.38, 1.88) 1.11 (0.86, 1.42) －1.21 (－1.56, －0.85) 61.84 (52.93, 72.63) 41.31 (32.07, 53.04) －1.32 (－1.67, －0.98) Russian Federation 3.81 (3.34, 4.35) 2.31 (2.00, 2.64) －1.65 (－1.90, －1.39) 7.36 (6.46, 8.42) 4.87 (4.17, 5.58) －1.27 (－1.58, －0.96) 3.34 (2.91, 3.78) 1.91 (1.66, 2.19) －1.81 (－2.05, －1.57) 128.02 (111.75, 145.17) 73.54 (63.83, 84.50) －1.80 (－2.05, －1.55) Ukraine 2.19 (1.94, 2.47) 2.29 (1.88, 2.78) －0.37 (－0.54, －0.19) 4.62 (4.04, 5.24) 5.16 (4.21, 6.29) －0.07 (－0.22, 0.09) 1.84 (1.64, 2.07) 1.86 (1.54, 2.26) －0.47 (－0.66, －0.28) 71.94 (63.91, 80.93) 72.06 (59.57, 87.39) －0.50 (－0.68, －0.32) Brunei Darussalam 1.39 (1.07, 1.75) 1.21 (0.88, 1.61) －0.53 (－0.71, －0.36) 2.93 (2.25, 3.71) 2.98 (2.16, 4.00) －0.08 (－0.24, 0.08) 1.13 (0.89, 1.43) 0.96 (0.69, 1.27) －0.71 (－0.87, －0.54) 42.98 (33.83, 54.22) 36.91 (26.79, 49.15) －0.66 (－0.82, －0.49) Japan 3.38 (3.10, 3.68) 2.17 (1.87, 2.47) －1.65 (－2.08, －1.22) 10.30 (9.03, 11.71) 9.26 (7.48, 10.91) －0.57 (－1.12, －0.01) 2.25 (2.10, 2.41) 1.08 (0.97, 1.19) －2.64 (－2.97, －2.30) 85.09 (78.96, 91.41) 41.42 (37.13, 45.70) －2.62 (－2.94, －2.29) Republic of Korea 5.05 (3.75, 6.15) 1.34 (1.02, 1.80) －4.36 (－4.96, －3.76) 10.97 (8.05, 13.40) 5.24 (3.83, 7.27) －2.37 (－2.91, －1.82) 4.13 (3.14, 5.02) 0.74 (0.57, 0.97) －5.74 (－6.34, －5.14) 159.86 (120.72, 194.94) 28.09 (21.89, 37.32) －5.74 (－6.34, －5.13) Singapore 2.63 (2.29, 2.99) 1.17 (0.97, 1.42) －2.62 (－2.81, －2.43) 6.14 (5.24, 7.14) 4.58 (3.58, 5.80) －1.00 (－1.17, －0.83) 2.09 (1.82, 2.37) 0.64 (0.53, 0.75) －3.81 (－4.00, －3.63) 77.82 (67.78, 88.24) 24.39 (20.37, 28.78) －3.76 (－3.95, －3.58) Australia 2.27 (2.05, 2.51) 2.15 (1.87, 2.47) －0.14 (－0.41, 0.14) 6.11 (5.31, 7.05) 7.35 (6.06, 8.87) 0.60 (0.25, 0.95) 1.66 (1.51, 1.82) 1.32 (1.16, 1.50) －0.68 (－0.90, －0.45) 63.66 (57.77, 69.84) 51.09 (45.03, 57.98) －0.66 (－0.90, －0.43) New Zealand 1.93 (1.69, 2.20) 1.80 (1.52, 2.13) －0.50 (－0.70, －0.30) 4.50 (3.85, 5.22) 5.47 (4.45, 6.70) 0.37 (0.20, 0.54) 1.55 (1.36, 1.78) 1.22 (1.03, 1.45) －1.05 (－1.28, －0.82) 59.32 (51.99, 67.99) 47.18 (39.80, 55.78) －1.02 (－1.24, －0.80) Andorra 2.84 (1.90, 4.07) 2.85 (1.86, 4.12) －0.05 (－0.12, 0.01) 6.88 (4.63, 9.91) 8.97 (5.77, 13.06) 0.77 (0.66, 0.88) 2.12 (1.39, 3.01) 2.02 (1.29, 2.87) －0.26 (－0.32, －0.20) 83.47 (54.53, 118.70) 80.31 (51.51, 114.49) －0.24 (－0.31, －0.18) Austria 2.11 (1.89, 2.36) 1.44 (1.22, 1.68) －1.22 (－1.45, －0.99) 4.67 (4.13, 5.29) 4.08 (3.37, 4.89) －0.47 (－0.73, －0.21) 1.74 (1.55, 1.93) 1.02 (0.87, 1.18) －1.66 (－1.88, －1.45) 67.51 (60.01, 75.18) 39.43 (33.53, 45.68) －1.72 (－1.93, －1.52) Belgium 2.94 (2.64, 3.29) 2.32 (1.98, 2.70) －1.00 (－1.42, －0.58) 6.77 (5.99, 7.68) 6.50 (5.36, 7.68) －0.39 (－0.80, 0.01) 2.38 (2.14, 2.63) 1.66 (1.43, 1.91) －1.36 (－1.79, －0.93) 93.56 (84.11, 103.97) 64.49 (55.34, 74.38) －1.44 (－1.85, －1.02) Cyprus 1.06 (0.72, 1.52) 0.92 (0.60, 1.39) －0.38 (－0.49, －0.26) 2.20 (1.49, 3.15) 2.59 (1.68, 3.90) 1.56 (1.23, 1.90) 0.89 (0.60, 1.29) 0.65 (0.42, 0.99) －0.94 (－1.06, －0.81) 34.17 (23.08, 49.63) 25.49 (16.41, 38.43) －0.93 (－1.06, －0.80) Denmark 3.92 (3.47, 4.39) 2.32 (1.98, 2.71) －1.72 (－1.91, －1.52) 8.47 (7.42, 9.54) 6.34 (5.25, 7.55) －0.87 (－1.09, －0.65) 3.26 (2.93, 3.64) 1.69 (1.44, 1.97) －2.21 (－2.39, －2.02) 126.20 (113.09, 140.84) 64.32 (54.51, 74.93) －2.29 (－2.48, －2.09) Finland 2.20 (1.93, 2.49) 2.15 (1.82, 2.53) －0.31 (－0.51, －0.10) 5.87 (4.99, 6.90) 7.18 (5.81, 8.80) 0.44 (0.18, 0.70) 1.62 (1.44, 1.82) 1.35 (1.15, 1.57) －0.85 (－1.04, －0.67) 63.98 (56.57, 71.94) 52.32 (44.51, 61.00) －0.93 (－1.11, －0.75) France 6.88 (6.30, 7.53) 3.14 (2.66, 3.59) －2.56 (－2.76, －2.36) 16.32 (14.62, 18.23) 11.94 (9.61, 14.42) －0.99 (－1.16, －0.82) 5.45 (5.01, 5.93) 1.77 (1.54, 2.01) －3.71 (－3.96, －3.46) 211.99 (194.66, 231.03) 69.25 (60.19, 78.31) －3.77 (－4.02, －3.52) Germany 3.34 (3.07, 3.62) 2.60 (2.28, 2.93) －1.04 (－1.23, －0.85) 7.64 (6.91, 8.46) 7.73 (6.51, 9.14) －0.18 (－0.47, 0.11) 2.70 (2.49, 2.92) 1.77 (1.57, 1.96) －1.60 (－1.75, －1.45) 106.04 (97.90, 114.77) 67.21 (59.61, 74.40) －1.68 (－1.83, －1.54) Greece 1.02 (0.90, 1.15) 1.12 (0.94, 1.31) 0.32 (0.18, 0.45) 2.45 (2.11, 2.84) 3.00 (2.47, 3.59) 0.62 (0.41, 0.83) 0.80 (0.71, 0.89) 0.82 (0.70, 0.96) 0.12 (0.02, 0.22) 31.28 (27.69, 34.90) 31.89 (27.04, 37.32) 0.07 (－0.03, 0.18) Iceland 2.77 (2.38, 3.23) 3.06 (2.51, 3.70) －0.29 (－0.49, －0.08) 6.65 (5.59, 7.85) 9.50 (7.53, 11.82) 0.59 (0.43, 0.75) 2.18 (1.89, 2.54) 2.06 (1.67, 2.53) －0.85 (－1.09, －0.60) 84.42 (73.01, 98.02) 81.34 (65.89, 99.62) －0.80 (－1.04, －0.55) Ireland 3.98 (3.53, 4.46) 3.30 (2.82, 3.88) －0.68 (－0.78, －0.57) 8.91 (7.78, 10.22) 10.07 (8.26, 12.22) 0.42 (0.31, 0.54) 3.26 (2.90, 3.64) 2.23 (1.90, 2.58) －1.37 (－1.49, －1.25) 125.50 (111.47, 140.61) 85.68 (73.14, 99.30) －1.37 (－1.50, －1.24) Israel 0.96 (0.84, 1.10) 0.83 (0.70, 0.98) －0.49 (－0.67, －0.30) 2.12 (1.82, 2.44) 2.32 (1.89, 2.79) 0.28 (0.08, 0.48) 0.80 (0.69, 0.90) 0.59 (0.50, 0.71) －0.92 (－1.11, －0.73) 30.80 (26.81, 34.91) 23.15 (19.61, 27.42) －0.93 (－1.13, －0.73) Italy 2.31 (2.05, 2.57) 0.98 (0.84, 1.14) －2.58 (－2.70, －2.47) 5.27 (4.63, 5.98) 2.82 (2.37, 3.36) －1.92 (－1.99, －1.85) 1.88 (1.67, 2.08) 0.70 (0.61, 0.80) －2.97 (－3.12, －2.82) 73.04 (65.00, 81.10) 27.41 (23.66, 31.29) －2.98 (－3.13, －2.82) Luxembourg 3.32 (2.87, 3.87) 2.15 (1.76, 2.61) －1.85 (－2.07, －1.62) 7.34 (6.24, 8.62) 6.08 (4.83, 7.54) －1.07 (－1.33, －0.80) 2.74 (2.35, 3.18) 1.54 (1.25, 1.87) －2.31 (－2.52, －2.09) 106.99 (91.83, 124.31) 58.86 (47.70, 71.36) －2.39 (－2.59, －2.18) Malta 1.52 (1.29, 1.76) 1.35 (1.09, 1.65) 0.04 (－0.07, 0.16) 3.39 (2.87, 3.95) 3.68 (2.91, 4.58) 0.73 (0.58, 0.89) 1.26 (1.08, 1.46) 0.98 (0.80, 1.19) －0.37 (－0.48, －0.27) 48.51 (41.60, 56.39) 37.67 (30.56, 45.74) －0.39 (－0.50, －0.29) Netherlands 3.17 (2.88, 3.49) 3.36 (2.95, 3.82) －0.10 (－0.48, 0.29) 7.09 (6.32, 7.94) 9.33 (7.91, 10.98) 0.68 (0.27, 1.09) 2.60 (2.37, 2.86) 2.41 (2.12, 2.72) －0.57 (－0.94, －0.19) 101.22 (91.97, 111.33) 93.55 (81.94, 105.60) －0.63 (－0.99, －0.26) Norway 1.40 (1.21, 1.61) 1.56 (1.30, 1.85) 0.42 (0.22, 0.61) 3.22 (2.75, 3.77) 4.65 (3.79, 5.65) 1.18 (0.96, 1.40) 1.13 (0.98, 1.30) 1.08 (0.91, 1.28) －0.03 (－0.22, 0.15) 43.10 (37.54, 49.53) 42.13 (35.45, 49.80) －0.04 (－0.22, 0.14) Portugal 3.29 (2.94, 3.69) 3.27 (2.76, 3.82) －0.07 (－0.51, 0.38) 7.70 (6.73, 8.83) 10.15 (8.22, 12.29) 0.74 (0.18, 1.31) 2.64 (2.38, 2.94) 2.20 (1.86, 2.55) －0.59 (－0.96, －0.22) 104.22 (93.79, 116.33) 84.02 (71.16, 97.50) －0.73 (－1.12, －0.34) Spain 3.69 (3.39, 4.05) 1.69 (1.46, 1.91) －2.62 (－2.74, －2.49) 8.25 (7.47, 9.18) 4.96 (4.13, 5.83) －1.77 (－1.92, －1.63) 3.03 (2.79, 3.31) 1.17 (1.03, 1.32) －3.14 (－3.26, －3.02) 118.91 (109.21, 130.41) 45.11 (39.38, 50.76) －3.24 (－3.36, －3.11) Sweden 1.63 (1.44, 1.83) 1.30 (1.12, 1.50) －0.90 (－1.13, －0.66) 4.06 (3.52, 4.68) 3.67 (3.05, 4.35) －0.55 (－0.78, －0.31) 1.25 (1.12, 1.40) 0.93 (0.81, 1.07) －1.09 (－1.33, －0.85) 49.07 (43.77, 54.67) 36.25 (31.26, 41.83) －1.12 (－1.34, －0.90) Switzerland 3.82 (3.38, 4.27) 1.65 (1.40, 1.92) －2.50 (－2.66, －2.33) 9.05 (7.89, 10.34) 5.13 (4.21, 6.16) －1.69 (－1.84, －1.53) 3.03 (2.70, 3.36) 1.09 (0.94, 1.25) －3.02 (－3.20, －2.85) 117.94 (104.51, 130.97) 42.46 (36.28, 48.67) －3.07 (－3.24, －2.90) United Kingdom 3.48 (3.18, 3.83) 3.47 (3.13, 3.83) －0.46 (－0.72, －0.20) 7.73 (6.90, 8.66) 9.08 (7.88, 10.32) 0.10 (－0.17, 0.38) 2.86 (2.61, 3.12) 2.61 (2.38, 2.87) －0.77 (－1.02, －0.52) 110.41 (100.51, 120.61) 102.10 (92.80, 112.47) －0.72 (－0.97, －0.47) Argentina 4.30 (3.94, 4.70) 2.03 (1.74, 2.33) －2.41 (－2.60, －2.21) 8.67 (7.90, 9.52) 4.59 (3.90, 5.32) －2.12 (－2.32, －1.91) 3.71 (3.41, 4.03) 1.64 (1.41, 1.87) －2.55 (－2.75, －2.35) 142.82 (131.02, 155.14) 63.70 (54.91, 72.68) －2.55 (－2.75, －2.34) Chile 3.07 (2.77, 3.39) 1.05 (0.90, 1.21) －3.42 (－3.55, －3.29) 6.32 (5.66, 7.04) 2.75 (2.30, 3.24) －2.72 (－2.86, －2.59) 2.62 (2.37, 2.89) 0.78 (0.67, 0.89) －3.81 (－3.92, －3.69) 101.82 (91.97, 112.76) 31.00 (26.75, 35.48) －3.72 (－3.84, －3.61) Uruguay 4.74 (4.25, 5.33) 2.81 (2.37, 3.25) －2.04 (－2.29, －1.79) 9.73 (8.67, 10.99) 6.47 (5.40, 7.55) －1.69 (－1.94, －1.45) 4.06 (3.63, 4.55) 2.28 (1.91, 2.68) －2.20 (－2.45, －1.95) 155.06 (138.61, 173.88) 88.45 (74.00, 103.78) －2.18 (－2.43, －1.93) Canada 2.29 (2.07, 2.51) 2.17 (1.89, 2.51) －0.19 (－0.33, －0.05) 5.92 (5.17, 6.77) 6.86 (5.70, 8.23) 0.44 (0.26, 0.62) 1.73 (1.57, 1.88) 1.43 (1.26, 1.63) －0.61 (－0.74, －0.49) 66.29 (60.23, 72.42) 55.78 (48.83, 63.76) －0.58 (－0.70, －0.45) United States of America 2.74 (2.47, 3.03) 2.28 (2.01, 2.56) －0.68 (－0.83, －0.53) 7.03 (6.17, 8.06) 6.64 (5.64, 7.77) －0.35 (－0.54, －0.16) 2.06 (1.89, 2.25) 1.61 (1.44, 1.78) －0.88 (－1.01, －0.75) 79.68 (72.87, 87.12) 62.71 (56.10, 69.82) －0.86 (－0.99, －0.73) Antigua and Barbuda 2.13 (1.78, 2.51) 1.53 (1.21, 1.91) －0.97 (－1.21, －0.74) 4.34 (3.63, 5.13) 3.34 (2.62, 4.21) －0.75 (－0.98, －0.52) 1.81 (1.49, 2.15) 1.26 (0.97, 1.62) －1.10 (－1.33, －0.86) 70.44 (58.18, 83.53) 49.38 (38.35, 63.43) －1.06 (－1.29, －0.82) Bahamas 5.47 (4.60, 6.41) 4.24 (3.43, 5.24) －0.33 (－0.57, －0.09) 10.82 (9.11, 12.69) 8.94 (7.20, 11.04) －0.15 (－0.38, 0.08) 4.76 (4.00, 5.59) 3.59 (2.83, 4.55) －0.35 (－0.67, －0.04) 187.56 (157.09, 219.95) 143.66 (113.55, 181.65) －0.31 (－0.63, 0.00) Barbados 3.86 (3.30, 4.51) 3.83 (3.06, 4.67) －0.21 (－0.41, －0.02) 7.91 (6.70, 9.24) 8.38 (6.69, 10.29) －0.03 (－0.22, 0.16) 3.30 (2.83, 3.83) 3.21 (2.52, 3.93) －0.23 (－0.44, －0.02) 129.17 (110.86, 150.43) 125.47 (98.96, 153.82) －0.24 (－0.45, －0.04) Belize 1.40 (1.19, 1.65) 1.64 (1.33, 2.02) 0.64 (0.36, 0.92) 2.83 (2.41, 3.36) 3.44 (2.78, 4.20) 0.73 (0.48, 0.98) 1.21 (1.03, 1.43) 1.40 (1.12, 1.73) 0.63 (0.35, 0.91) 47.40 (40.23, 55.90) 55.45 (44.42, 68.23) 0.64 (0.37, 0.92) Cuba 2.35 (2.07, 2.64) 3.01 (2.33, 3.84) 1.50 (1.16, 1.85) 4.98 (4.34, 5.64) 6.62 (5.12, 8.48) －1.62 (－1.84, －1.40) 1.98 (1.72, 2.24) 2.50 (1.90, 3.27) 1.48 (1.13, 1.84) 77.95 (67.53, 87.92) 95.13 (72.56, 124.25) 1.36 (1.01, 1.71) Dominica 2.42 (1.86, 3.12) 2.46 (1.70, 3.63) 0.71 (0.32, 1.10) 4.88 (3.74, 6.27) 5.02 (3.45, 7.37) 0.41 (0.30, 0.52) 2.09 (1.60, 2.69) 2.09 (1.46, 3.04) 0.38 (0.24, 0.52) 83.15 (63.33, 106.96) 82.07 (57.25, 119.35) 0.33 (0.19, 0.47) Dominican Republic 1.56 (1.17, 1.97) 1.78 (1.21, 2.57) 0.71 (0.32, 1.10) 3.14 (2.34, 3.96) 3.60 (2.46, 5.21) 0.74 (0.35, 1.13) 1.35 (1.01, 1.71) 1.58 (1.06, 2.30) 0.72 (0.32, 1.12) 53.68 (40.28, 67.89) 61.82 (41.15, 89.71) 0.69 (0.28, 1.09) Grenada 4.32 (3.52, 5.27) 3.68 (2.81, 4.73) －0.36 (－0.53, －0.19) 8.56 (6.99, 10.39) 7.56 (5.78, 9.68) －0.27 (－0.44, －0.11) 3.72 (3.00, 4.55) 3.20 (2.39, 4.31) －0.34 (－0.52, －0.17) 146.54 (118.23, 178.95) 125.08 (93.64, 168.54) －0.37 (－0.54, －0.20) Guyana 1.41 (1.17, 1.66) 1.62 (1.28, 2.05) 0.14 (－0.08, 0.35) 2.68 (2.23, 3.17) 3.19 (2.51, 4.03) 0.19 (－0.03, 0.41) 1.24 (1.03, 1.48) 1.44 (1.09, 1.93) 0.19 (－0.05, 0.42) 48.18 (40.22, 57.38) 56.62 (42.88, 75.26) 0.22 (－0.01, 0.44) Haiti 2.92 (1.90, 4.11) 3.11 (2.04, 4.68) 0.34 (0.06, 0.61) 5.63 (3.66, 7.96) 6.08 (3.98, 9.18) 0.38 (0.08, 0.68) 2.41 (1.57, 3.35) 2.79 (1.86, 4.19) 0.45 (0.21, 0.69) 99.15 (64.21, 137.76) 111.81 (74.31, 167.98) 0.40 (0.13, 0.67) Jamaica 1.75 (1.48, 2.06) 2.26 (1.74, 2.89) 0.87 (0.42, 1.32) 3.54 (2.98, 4.20) 4.79 (3.67, 6.11) 1.02 (0.57, 1.46) 1.50 (1.25, 1.76) 2.03 (1.53, 2.70) 1.05 (0.56, 1.55) 57.79 (48.19, 67.84) 79.99 (60.55, 106.17) 1.17 (0.66, 1.68) Saint Lucia 3.55 (2.94, 4.26) 2.72 (2.07, 3.52) －0.59 (－0.79, －0.40) 7.06 (5.82, 8.47) 5.75 (4.36, 7.45) －0.41 (－0.60, －0.22) 3.10 (2.52, 3.78) 2.31 (1.71, 3.13) －0.63 (－0.85, －0.42) 122.25 (99.60, 149.06) 91.82 (68.32, 123.66) －0.63 (－0.84, －0.41) Saint Vincent and the Grenadines 1.82 (1.49, 2.20) 1.97 (1.49, 2.59) 0.57 (0.34, 0.79) 3.62 (2.96, 4.36) 3.97 (2.99, 5.21) 0.59 (0.38, 0.80) 1.59 (1.28, 1.97) 1.71 (1.26, 2.28) 0.54 (0.31, 0.77) 62.68 (50.57, 77.49) 66.64 (48.94, 88.45) 0.49 (0.27, 0.70) Suriname 1.19 (0.84, 1.58) 1.14 (0.79, 1.59) 0.08 (－0.03, 0.20) 2.33 (1.65, 3.09) 2.30 (1.60, 3.21) 0.17 (0.06, 0.29) 1.05 (0.76, 1.37) 0.94 (0.65, 1.33) －0.00 (－0.16, 0.16) 40.97 (29.58, 53.68) 37.13 (25.59, 52.84) 0.02 (－0.14, 0.19) Trinidad and Tobago 1.78 (1.55, 2.05) 1.57 (1.30, 1.91) －0.45 (－0.71, －0.20) 3.49 (3.03, 4.01) 3.28 (2.69, 3.99) －0.23 (－0.48, 0.01) 1.55 (1.35, 1.79) 1.33 (1.09, 1.66) －0.49 (－0.78, －0.20) 60.03 (52.21, 69.45) 52.08 (42.50, 64.79) －0.45 (－0.73, －0.17) Bolivia (Plurinational State of) 1.19 (0.86, 1.61) 1.21 (0.83, 1.72) 0.20 (0.10, 0.29) 2.34 (1.69, 3.17) 2.47 (1.70, 3.53) 0.31 (0.21, 0.42) 1.00 (0.71, 1.36) 1.07 (0.72, 1.52) 0.61 (0.35, 0.86) 40.84 (28.85, 55.48) 42.24 (28.64, 60.06) 0.51 (0.26, 0.75) Ecuador 1.29 (1.13, 1.44) 0.52 (0.45, 0.61) －3.24 (－3.45, －3.02) 2.59 (2.28, 2.92) 1.19 (1.01, 1.41) －2.95 (－3.18, －2.72) 1.11 (0.98, 1.24) 0.43 (0.37, 0.50) －3.33 (－3.54, －3.11) 44.60 (39.25, 49.98) 17.67 (15.20, 20.60) －3.31 (－3.53, －3.10) Peru 0.78 (0.59, 0.99) 0.40 (0.30, 0.53) －2.07 (－2.44, －1.70) 1.58 (1.19, 2.02) 0.92 (0.67, 1.24) －1.68 (－2.02, －1.33) 0.65 (0.50, 0.83) 0.31 (0.23, 0.42) －2.21 (－2.61, －1.81) 26.44 (20.10, 33.53) 12.72 (9.37, 17.26) －2.20 (－2.60, －1.81) Colombia 2.00 (1.80, 2.20) 0.69 (0.60, 0.79) －2.99 (－3.13, －2.85) 4.09 (3.66, 4.53) 1.67 (1.43, 1.96) －2.50 (－2.63, －2.37) 1.73 (1.56, 1.91) 0.54 (0.47, 0.62) －3.22 (－3.37, －3.08) 68.83 (62.00, 76.20) 21.89 (19.00, 25.00) －3.23 (－3.36, －3.09) Costa Rica 1.31 (1.13, 1.49) 0.78 (0.66, 0.93) －1.97 (－2.18, －1.76) 2.84 (2.43, 3.27) 1.92 (1.60, 2.31) －1.56 (－1.78, －1.35) 1.09 (0.94, 1.24) 0.61 (0.51, 0.72) －2.17 (－2.38, －1.96) 42.69 (37.11, 48.58) 24.34 (20.54, 28.65) －2.13 (－2.34, －1.92) El Salvador 1.33 (1.05, 1.65) 1.15 (0.86, 1.51) －0.58 (－0.78, －0.39) 2.71 (2.13, 3.35) 2.52 (1.87, 3.30) －0.37 (－0.54, －0.20) 1.15 (0.90, 1.43) 0.99 (0.72, 1.33) －0.60 (－0.84, －0.35) 46.54 (36.53, 58.35) 39.45 (28.39, 52.74) －0.65 (－0.88, －0.41) Guatemala 1.63 (1.43, 1.86) 0.85 (0.67, 1.04) －2.28 (－2.43, －2.13) 3.28 (2.86, 3.75) 1.80 (1.43, 2.21) －2.16 (－2.33, －2.00) 1.45 (1.26, 1.65) 0.72 (0.57, 0.92) －2.41 (－2.55, －2.27) 59.58 (51.91, 67.86) 29.21 (23.09, 36.90) －2.50 (－2.64, －2.36) Honduras 0.53 (0.37, 0.71) 0.42 (0.28, 0.62) －0.72 (－0.80, －0.65) 1.07 (0.74, 1.45) 0.88 (0.59, 1.31) －0.60 (－0.68, －0.53) 0.45 (0.32, 0.61) 0.36 (0.24, 0.54) －0.70 (－0.80, －0.61) 18.29 (12.94, 24.83) 15.00 (9.97, 22.36) －0.61 (－0.71, －0.51) Mexico 1.07 (0.95, 1.21) 0.71 (0.61, 0.83) －0.85 (－0.96, －0.75) 2.19 (1.93, 2.49) 1.57 (1.33, 1.86) －0.66 (－0.76, －0.57) 0.92 (0.82, 1.03) 0.60 (0.52, 0.69) －0.94 (－1.05, －0.84) 37.07 (32.91, 41.66) 24.33 (21.03, 27.91) －0.93 (－1.04, －0.82) Nicaragua 0.78 (0.57, 1.02) 0.58 (0.40, 0.82) －0.56 (－0.67, －0.45) 1.61 (1.18, 2.13) 1.29 (0.90, 1.84) －0.37 (－0.47, －0.27) 0.67 (0.49, 0.89) 0.49 (0.33, 0.71) －0.62 (－0.73, －0.51) 26.90 (19.60, 35.77) 19.51 (13.22, 28.41) －0.66 (－0.76, －0.56) Panama 0.76 (0.66, 0.87) 0.55 (0.46, 0.65) －0.77 (－1.08, －0.47) 1.62 (1.39, 1.86) 1.31 (1.08, 1.59) －0.44 (－0.74, －0.15) 0.65 (0.56, 0.74) 0.44 (0.36, 0.52) －0.93 (－1.24, －0.61) 25.68 (22.26, 29.41) 17.36 (14.22, 20.89) －0.93 (－1.24, －0.62) Venezuela (Bolivarian Republic of) 1.55 (1.38, 1.75) 1.03 (0.84, 1.26) －1.11 (－1.38, －0.84) 3.11 (2.75, 3.52) 2.17 (1.76, 2.66) －0.89 (－1.13, －0.65) 1.34 (1.20, 1.52) 0.89 (0.71, 1.09) －1.13 (－1.45, －0.81) 52.46 (46.65, 59.45) 35.18 (28.15, 43.21) －1.10 (－1.39, －0.80) Brazil 4.84 (4.33, 5.32) 3.06 (2.83, 3.31) －1.13 (－1.33, －0.93) 9.56 (8.53, 10.55) 6.45 (5.92, 7.02) －0.96 (－1.15, －0.76) 4.21 (3.78, 4.64) 2.59 (2.40, 2.80) －1.20 (－1.40, －0.99) 165.39 (148.41, 181.96) 101.24 (93.67, 109.63) －1.23 (－1.44, －1.02) Paraguay 2.07 (1.65, 2.53) 2.84 (2.21, 3.70) 0.89 (0.77, 1.02) 4.13 (3.27, 5.04) 5.77 (4.46, 7.54) 0.94 (0.82, 1.06) 1.80 (1.43, 2.18) 2.29 (1.78, 2.95) 0.81 (0.63, 0.98) 69.85 (55.58, 85.24) 88.81 (68.74, 114.91) 0.80 (0.62, 0.98) Algeria 0.50 (0.34, 0.71) 0.49 (0.31, 0.74) －0.00 (－0.12, 0.11) 1.05 (0.71, 1.48) 1.15 (0.74, 1.73) 0.35 (0.22, 0.48) 0.43 (0.28, 0.60) 0.42 (0.26, 0.62) －0.02 (－0.12, 0.09) 17.28 (11.26, 24.02) 16.42 (10.37, 24.47) －0.07 (－0.18, 0.04) Bahrain 1.35 (1.05, 1.72) 0.79 (0.54, 1.13) －2.46 (－2.78, －2.14) 2.73 (2.12, 3.51) 1.98 (1.34, 2.84) －1.75 (－2.06, －1.43) 1.14 (0.87, 1.44) 0.64 (0.43, 0.91) －2.69 (－3.04, －2.34) 44.09 (33.76, 56.01) 25.00 (16.75, 35.54) －2.64 (－2.98, －2.30) Egypt 0.76 (0.46, 0.98) 0.56 (0.40, 0.76) －1.45 (－1.63, －1.27) 1.51 (0.92, 1.96) 1.25 (0.89, 1.73) －1.17 (－1.36, －0.99) 0.65 (0.42, 0.85) 0.48 (0.33, 0.67) －1.53 (－1.74, －1.33) 26.11 (16.65, 33.97) 19.03 (13.11, 26.36) －1.62 (－1.83, －1.40) Iran (Islamic Republic of) 2.63 (1.88, 3.52) 1.76 (1.29, 2.33) －1.49 (－1.63, －1.35) 5.51 (3.92, 7.38) 4.72 (3.38, 6.34) －0.80 (－0.99, －0.61) 2.22 (1.60, 2.98) 1.29 (0.94, 1.72) －1.81 (－1.93, －1.68) 87.68 (63.23, 117.86) 51.88 (37.65, 69.61) －1.74 (－1.87, －1.61) Iraq 0.91 (0.62, 1.27) 1.14 (0.80, 1.56) 0.53 (0.45, 0.61) 1.88 (1.27, 2.65) 2.86 (1.96, 3.99) 1.12 (1.01, 1.23) 0.73 (0.50, 1.02) 0.89 (0.62, 1.23) 0.50 (0.42, 0.59) 29.40 (20.02, 41.18) 36.26 (24.97, 50.10) 0.53 (0.45, 0.62) Jordan 1.10 (0.76, 1.52) 0.70 (0.50, 0.98) －1.68 (－1.82, －1.55) 2.33 (1.60, 3.24) 1.77 (1.26, 2.51) －1.03 (－1.16, －0.91) 0.93 (0.64, 1.31) 0.58 (0.41, 0.80) －1.66 (－1.79, －1.53) 37.22 (25.70, 52.59) 22.71 (16.15, 31.54) －1.69 (－1.82, －1.56) Kuwait 1.24 (1.07, 1.44) 0.45 (0.38, 0.53) －3.59 (－3.83, －3.35) 2.92 (2.48, 3.43) 1.38 (1.12, 1.66) －2.80 (－3.01, －2.58) 0.99 (0.85, 1.14) 0.30 (0.26, 0.36) －4.05 (－4.31, －3.80) 38.63 (33.10, 44.40) 12.21 (10.25, 14.51) －4.01 (－4.26, －3.75) Lebanon 0.38 (0.26, 0.52) 0.70 (0.48, 0.97) 2.24 (1.69, 2.79) 0.77 (0.54, 1.08) 1.78 (1.23, 2.49) 2.89 (2.36, 3.42) 0.29 (0.20, 0.42) 0.51 (0.34, 0.77) 2.12 (1.56, 2.69) 11.70 (7.85, 16.80) 20.22 (13.52, 30.12) 2.02 (1.49, 2.55) Libya 0.83 (0.52, 1.17) 0.71 (0.42, 1.09) －0.41 (－0.54, －0.28) 1.71 (1.06, 2.43) 1.57 (0.93, 2.40) －0.21 (－0.37, －0.05) 0.74 (0.45, 1.04) 0.62 (0.35, 0.95) －0.41 (－0.51, －0.32) 29.13 (17.80, 40.94) 24.73 (14.04, 37.55) －0.40 (－0.50, －0.30) Morocco 0.47 (0.31, 0.69) 0.56 (0.34, 0.86) 0.58 (0.41, 0.75) 0.92 (0.60, 1.36) 1.22 (0.75, 1.93) 0.89 (0.71, 1.08) 0.42 (0.27, 0.62) 0.54 (0.33, 0.79) 0.94 (0.70, 1.17) 16.17 (10.58, 23.87) 21.03 (12.89, 31.32) 0.99 (0.76, 1.23) Palestine 0.59 (0.41, 0.83) 0.40 (0.29, 0.56) －1.50 (－1.60, －1.40) 1.21 (0.85, 1.71) 0.93 (0.67, 1.31) －1.13 (－1.24, －1.03) 0.49 (0.35, 0.71) 0.32 (0.23, 0.45) －1.68 (－1.79, －1.58) 19.71 (13.94, 28.15) 12.32 (8.80, 17.52) －1.77 (－1.89, －1.66) Oman 0.86 (0.59, 1.19) 0.59 (0.39, 0.86) 0.82 (0.41, 1.24) 1.75 (1.18, 2.42) 1.45 (0.96, 2.14) －0.69 (－0.80, －0.58) 0.76 (0.52, 1.02) 0.45 (0.30, 0.65) －1.62 (－1.79, －1.46) 29.68 (20.49, 40.23) 18.05 (12.14, 26.05) －1.58 (－1.73, －1.43) Qatar 1.42 (0.87, 1.99) 0.34 (0.22, 0.57) －5.48 (－6.04, －4.91) 2.98 (1.79, 4.16) 0.97 (0.62, 1.64) －4.64 (－5.22, －4.06) 1.20 (0.74, 1.67) 0.24 (0.15, 0.37) －6.02 (－6.60, －5.43) 46.57 (28.42, 64.92) 9.56 (6.03, 14.82) －5.98 (－6.59, －5.38) Saudi Arabia 1.29 (0.91, 1.70) 0.73 (0.50, 1.14) －1.85 (－2.24, －1.46) 2.61 (1.85, 3.45) 1.91 (1.30, 3.00) －1.08 (－1.45, －0.72) 1.12 (0.80, 1.43) 0.58 (0.40, 0.89) －2.11 (－2.51, －1.70) 44.26 (31.52, 56.84) 23.83 (16.36, 36.73) －2.01 (－2.44, －1.58) Syrian Arab Republic 0.45 (0.33, 0.60) 0.35 (0.25, 0.48) －1.06 (－1.22, －0.89) 0.94 (0.69, 1.24) 0.80 (0.58, 1.11) －0.69 (－0.88, －0.51) 0.38 (0.28, 0.51) 0.27 (0.19, 0.38) －1.29 (－1.46, －1.12) 15.31 (11.13, 20.31) 10.68 (7.60, 14.77) －1.37 (－1.53, －1.20) Tunisia 0.55 (0.38, 0.77) 0.69 (0.50, 0.95) 0.13 (－0.13, 0.38) 1.19 (0.82, 1.68) 1.71 (1.25, 2.40) 0.56 (0.30, 0.81) 0.44 (0.30, 0.63) 0.47 (0.34, 0.63) －0.15 (－0.24, －0.07) 17.71 (11.99, 25.18) 18.25 (13.35, 24.65) －0.20 (－0.29, －0.12) Turkey 1.55 (1.09, 2.11) 0.92 (0.66, 1.27) －2.14 (－2.40, －1.88) 3.19 (2.22, 4.34) 2.40 (1.68, 3.36) 0.68 (0.61, 0.75) 1.32 (0.94, 1.76) 0.70 (0.48, 0.99) －2.50 (－2.78, －2.22) 53.30 (37.79, 71.19) 28.06 (19.40, 39.80) －2.54 (－2.82, －2.25) United Arab Emirates 1.08 (0.61, 1.69) 0.20 (0.13, 0.30) －6.64 (－7.43, －5.85) 2.10 (1.17, 3.31) 0.48 (0.31, 0.70) －6.10 (－6.85, －5.34) 0.94 (0.50, 1.44) 0.16 (0.10, 0.24) －6.98 (－7.80, －6.14) 35.67 (19.07, 55.14) 6.30 (3.95, 9.39) －6.79 (－7.58, －5.99) Yemen 1.67 (0.74, 2.46) 1.40 (0.68, 2.16) －0.62 (－0.70, －0.53) 3.21 (1.41, 4.71) 2.86 (1.38, 4.39) －0.41 (－0.50, －0.32) 1.42 (0.64, 2.07) 1.17 (0.52, 1.79) －0.69 (－0.78, －0.59) 54.84 (24.49, 79.62) 45.72 (20.49, 70.15) －0.65 (－0.75, －0.55) Afghanistan 1.34 (0.65, 2.09) 1.30 (0.62, 2.22) 0.09 (－0.06, 0.24) 2.53 (1.22, 3.92) 2.54 (1.22, 4.35) 0.23 (0.08, 0.38) 1.19 (0.50, 1.91) 1.15 (0.54, 1.96) 0.01 (－0.10, 0.12) 46.81 (19.45, 74.79) 45.69 (21.06, 77.18) 0.05 (－0.07, 0.16) Bangladesh 5.49 (3.52, 7.73) 7.99 (5.17, 12.20) 0.35 (－0.08, 0.78) 10.91 (6.97, 15.47) 17.52 (11.21, 27.11) 0.59 (0.12, 1.05) 4.49 (2.89, 6.32) 6.79 (4.28, 10.28) 0.55 (0.10, 1.01) 186.24 (119.20, 262.67) 279.45 (176.29, 424.38) 0.50 (0.02, 0.98) Bhutan 3.16 (1.93, 4.88) 4.65 (2.78, 7.35) 0.65 (0.49, 0.80) 6.18 (3.75, 9.59) 9.96 (5.98, 15.91) 0.93 (0.77, 1.09) 2.82 (1.62, 4.28) 4.47 (2.57, 7.23) 0.82 (0.67, 0.98) 112.38 (64.25, 171.70) 184.44 (106.52, 297.53) 0.93 (0.78, 1.09) India 2.57 (1.95, 3.38) 4.80 (3.47, 6.35) 1.74 (1.24, 2.25) 4.99 (3.79, 6.59) 10.11 (7.31, 13.46) 1.98 (1.45, 2.51) 2.24 (1.72, 3.00) 4.40 (3.14, 5.90) 1.88 (1.32, 2.44) 89.20 (68.19, 119.46) 179.62 (127.29, 242.13) 1.96 (1.40, 2.52) Nepal 2.64 (1.62, 3.86) 3.25 (2.09, 4.88) 0.10 (－0.09, 0.30) 5.16 (3.15, 7.62) 6.79 (4.37, 10.19) 0.33 (0.13, 0.53) 2.19 (1.30, 3.14) 2.91 (1.79, 4.44) 0.19 (－0.04, 0.41) 89.51 (53.08, 130.06) 120.90 (74.88, 184.71) 0.33 (0.11, 0.55) Pakistan 5.29 (3.67, 7.33) 5.77 (4.02, 8.32) 0.35 (0.26, 0.44) 10.35 (7.17, 14.40) 11.58 (8.03, 16.79) 0.44 (0.34, 0.54) 4.58 (3.12, 6.44) 5.29 (3.55, 7.76) 0.58 (0.44, 0.72) 182.11 (124.62, 256.34) 209.59 (140.72, 308.54) 0.57 (0.43, 0.72) Angola 4.76 (2.64, 6.65) 3.91 (2.51, 5.77) －0.77 (－0.96, －0.58) 9.08 (5.03, 12.76) 7.67 (4.93, 11.32) －0.68 (－0.88, －0.49) 4.07 (2.33, 5.80) 3.46 (2.12, 5.15) －0.68 (－0.87, －0.49) 165.28 (94.39, 236.00) 138.63 (85.25, 206.87) －0.72 (－0.91, －0.52) Central African Republic 4.87 (2.55, 7.14) 4.08 (2.42, 6.58) －0.91 (－1.26, －0.56) 9.21 (4.83, 13.57) 7.78 (4.62, 12.49) －0.86 (－1.24, －0.49) 3.47 (1.98, 5.16) 3.24 (1.98, 5.20) －0.94 (－1.24, －0.65) 142.05 (80.65, 211.59) 131.31 (80.09, 211.50) －0.98 (－1.29, －0.68) Congo 4.80 (2.68, 6.67) 3.80 (2.31, 5.85) 0.44 (0.14, 0.74) 9.35 (5.20, 13.03) 7.37 (4.45, 11.39) －0.83 (－1.01, －0.65) 3.74 (2.21, 5.30) 3.79 (2.32, 5.66) －0.33 (－0.50, －0.15) 156.27 (91.93, 222.11) 149.84 (91.14, 225.28) －0.53 (－0.73, －0.34) Democratic Republic of the Congo 4.63 (2.46, 6.75) 5.48 (3.40, 8.56) 0.44 (0.14, 0.74) 8.99 (4.76, 13.10) 10.94 (6.77, 17.11) 0.53 (0.21, 0.85) 4.04 (2.34, 5.86) 4.83 (2.99, 7.65) 0.45 (0.15, 0.76) 164.82 (95.09, 239.19) 196.33 (121.63, 311.18) 0.45 (0.13, 0.76) Equatorial Guinea 5.34 (2.85, 7.68) 5.34 (3.09, 8.54) －0.28 (－0.47, －0.09) 10.06 (5.36, 14.47) 10.59 (6.11, 17.11) －0.14 (－0.34, 0.07) 4.70 (2.73, 6.70) 6.42 (3.67, 9.92) 0.25 (－0.02, 0.53) 189.81 (110.02, 270.44) 255.17 (145.07, 395.57) 0.17 (－0.11, 0.45) Gabon 4.15 (2.35, 5.89) 4.01 (2.62, 5.96) －0.19 (－0.37, －0.00) 8.09 (4.59, 11.49) 8.04 (5.24, 11.98) －0.10 (－0.31, 0.11) 3.51 (1.96, 5.04) 3.45 (2.11, 5.16) －0.12 (－0.29, 0.04) 142.52 (79.87, 204.54) 138.18 (84.85, 205.60) －0.17 (－0.34, 0.01) Burundi 9.76 (4.97, 14.80) 10.25 (6.52, 15.57) 0.46 (0.02, 0.89) 19.13 (9.62, 29.23) 20.47 (13.01, 31.10) 0.55 (0.08, 1.02) 7.68 (4.02, 11.34) 9.03 (5.66, 14.05) 0.78 (0.38, 1.18) 326.71 (169.27, 487.05) 372.05 (232.61, 580.64) 0.63 (0.20, 1.07) Comoros 6.29 (3.61, 8.82) 4.19 (2.87, 6.04) －1.40 (－1.53, －1.27) 12.06 (6.90, 16.95) 8.16 (5.59, 11.81) －1.36 (－1.49, －1.23) 5.10 (2.94, 7.16) 3.45 (2.40, 4.96) －1.41 (－1.55, －1.26) 201.37 (115.22, 283.21) 133.81 (92.90, 192.15) －1.48 (－1.63, －1.34) Djibouti 14.11 (8.39, 20.13) 9.39 (5.67, 14.44) －1.29 (－1.71, －0.87) 27.98 (16.42, 40.09) 18.72 (11.24, 28.91) －1.28 (－1.74, －0.83) 11.80 (7.09, 16.52) 8.02 (4.94, 12.55) －1.26 (－1.67, －0.84) 487.00 (289.33, 686.00) 325.20 (200.28, 507.52) －1.32 (－1.77, －0.87) Eritrea 9.47 (5.28, 13.68) 10.38 (7.03, 15.17) 0.24 (－0.01, 0.49) 18.37 (10.18, 26.78) 20.87 (14.17, 30.49) 0.36 (0.10, 0.62) 7.68 (4.25, 10.96) 8.81 (5.98, 12.47) 0.26 (0.04, 0.48) 327.29 (179.36, 470.40) 369.65 (251.53, 523.04) 0.25 (0.02, 0.49) Ethiopia 3.37 (2.16, 4.87) 6.31 (4.09, 9.31) 1.84 (1.53, 2.16) 6.50 (4.14, 9.48) 12.93 (8.33, 19.05) 2.02 (1.67, 2.37) 2.71 (1.70, 3.97) 5.82 (3.78, 8.42) 2.20 (1.93, 2.47) 113.75 (70.80, 167.46) 237.86 (153.21, 345.32) 2.07 (1.77, 2.38) Kenya 13.40 (9.28, 18.87) 10.49 (7.23, 15.03) －0.63 (－0.82, －0.45) 26.93 (18.44, 38.14) 21.55 (14.75, 31.14) －0.53 (－0.76, －0.31) 12.11 (8.13, 16.90) 9.54 (6.44, 13.68) －0.69 (－0.86, －0.51) 489.63 (326.80, 686.99) 387.26 (261.58, 555.47) －0.65 (－0.83, －0.47) Madagascar 19.64 (11.35, 26.68) 13.49 (9.26, 19.45) －1.89 (－2.28, －1.50) 38.97 (22.51, 52.99) 26.95 (18.46, 38.99) －1.91 (－2.33, －1.50) 17.74 (10.64, 24.08) 12.15 (8.37, 17.66) －1.95 (－2.36, －1.54) 741.95 (442.48, 1008.06) 496.38 (343.16, 722.73) －2.07 (－2.49, －1.64) Malawi 24.91 (14.25, 35.63) 27.82 (18.19, 40.61) 0.82 (0.58, 1.07) 48.52 (27.40, 69.56) 55.11 (35.86, 80.43) 0.98 (0.69, 1.26) 22.41 (15.44, 30.14) 25.23 (17.40, 36.52) 0.81 (0.46, 1.16) 932.24 (638.16, 1259.75) 1037.54 (712.92, 1505.83) 0.83 (0.47, 1.18) Mauritius 2.53 (2.21, 2.85) 2.03 (1.71, 2.40) －0.67 (－0.95, －0.38) 5.19 (4.50, 5.89) 4.58 (3.82, 5.47) －0.37 (－0.66, －0.07) 2.15 (1.88, 2.45) 1.66 (1.38, 1.98) －0.80 (－1.08, －0.52) 84.48 (73.79, 96.06) 65.09 (54.35, 77.66) －0.78 (－1.07, －0.49) Mozambique 2.41 (1.67, 3.41) 1.88 (1.21, 2.89) －0.60 (－0.72, －0.48) 4.52 (3.13, 6.45) 3.46 (2.22, 5.36) －0.70 (－0.83, －0.57) 2.02 (1.37, 2.86) 1.40 (0.86, 2.11) －1.40 (－1.62, －1.18) 78.59 (53.43, 112.55) 51.99 (31.91, 79.08) －1.52 (－1.74, －1.29) Rwanda 15.81 (8.36, 22.78) 12.68 (8.27, 18.87) －1.31 (－1.73, －0.90) 30.86 (16.11, 44.65) 25.26 (16.42, 37.70) －1.23 (－1.67, －0.80) 13.55 (7.10, 19.33) 11.47 (7.44, 16.81) －1.10 (－1.55, －0.65) 577.51 (300.51, 826.96) 460.81 (296.99, 678.04) －1.44 (－1.95, －0.92) Seychelles 4.19 (3.20, 5.44) 4.34 (3.18, 5.60) －0.40 (－0.57, －0.23) 8.30 (6.35, 10.77) 9.43 (6.91, 12.26) －0.12 (－0.29, 0.04) 3.59 (2.75, 4.67) 3.60 (2.61, 4.71) －0.52 (－0.71, －0.32) 142.49 (108.72, 185.19) 143.06 (103.70, 186.99) －0.49 (－0.67, －0.32) Somalia 5.64 (2.99, 8.48) 5.65 (3.86, 8.47) －0.05 (－0.28, 0.18) 10.79 (5.70, 16.36) 10.92 (7.46, 16.42) －0.04 (－0.27, 0.20) 4.07 (2.16, 6.19) 4.46 (3.01, 6.56) 0.20 (－0.00, 0.40) 168.64 (89.31, 257.28) 183.17 (123.95, 269.79) 0.17 (－0.03, 0.37) United Republic of Tanzania 6.93 (4.69, 9.52) 5.00 (3.43, 7.19) －0.53 (－0.81, －0.26) 13.23 (8.95, 18.27) 9.75 (6.69, 13.98) －0.42 (－0.71, －0.13) 5.86 (3.87, 8.26) 4.31 (2.94, 6.22) －0.52 (－0.79, －0.26) 230.73 (152.66, 325.24) 167.96 (114.42, 242.78) －0.53 (－0.80, －0.25) Uganda 15.06 (7.68, 24.47) 12.16 (8.03, 17.60) －1.16 (－1.35, －0.97) 28.92 (14.51, 47.34) 24.79 (16.41, 35.81) －0.97 (－1.18, －0.76) 8.14 (5.70, 11.14) 9.63 (6.46, 13.63) 0.10 (－0.04, 0.23) 330.24 (229.71, 453.39) 397.48 (266.70, 564.53) 0.10 (－0.05, 0.24) Zambia 6.46 (3.87, 9.24) 6.50 (4.34, 9.48) 0.21 (0.07, 0.35) 12.51 (7.40, 17.96) 12.95 (8.65, 18.93) 0.39 (0.19, 0.59) 4.92 (3.29, 7.00) 6.38 (4.08, 9.27) 1.27 (1.09, 1.46) 201.10 (134.30, 287.58) 260.10 (166.47, 378.11) 1.29 (1.10, 1.48) Botswana 5.02 (3.27, 7.09) 4.52 (2.77, 6.70) －0.68 (－1.28, －0.07) 9.70 (6.27, 13.72) 8.98 (5.48, 13.28) －0.50 (－1.11, 0.12) 3.60 (2.25, 5.16) 3.58 (2.19, 5.33) －0.65 (－1.33, 0.03) 145.91 (90.01, 209.94) 141.92 (86.40, 211.03) －0.69 (－1.40, 0.03) Lesotho 9.70 (5.19, 14.25) 5.99 (3.67, 9.14) －1.27 (－1.72, －0.82) 18.67 (9.98, 27.44) 11.00 (6.72, 16.78) －1.38 (－1.80, －0.95) 8.29 (4.50, 12.56) 6.14 (3.76, 9.43) －1.30 (－2.04, －0.55) 327.98 (178.10, 497.91) 240.75 (147.51, 369.68) －1.22 (－1.97, －0.46) Namibia 2.75 (1.65, 3.88) 1.62 (1.03, 2.47) －1.44 (－1.63, －1.25) 5.37 (3.20, 7.57) 3.26 (2.09, 4.97) －1.33 (－1.57, －1.09) 2.40 (1.41, 3.38) 1.46 (0.95, 2.18) －1.41 (－1.85, －0.97) 98.23 (57.17, 138.49) 59.56 (38.83, 89.14) －1.40 (－1.86, －0.94) South Africa 12.47 (9.06, 16.24) 8.05 (6.57, 10.17) －1.86 (－2.25, －1.47) 24.11 (17.50, 31.37) 15.66 (12.71, 20.05) －1.83 (－2.27, －1.39) 11.06 (7.96, 14.90) 5.17 (4.01, 6.82) －2.82 (－3.12, －2.51) 426.63 (306.54, 575.57) 200.83 (155.06, 267.02) －2.81 (－3.13, －2.50) Eswatini 17.61 (10.61, 24.91) 6.26 (3.53, 10.51) －3.98 (－4.55, －3.41) 34.09 (20.56, 48.22) 11.87 (6.68, 19.90) －4.07 (－4.57, －3.57) 15.52 (9.06, 22.06) 4.24 (2.72, 6.53) －4.49 (－4.89, －4.09) 629.42 (367.83, 895.24) 168.46 (108.37, 259.56) －4.54 (－4.95, －4.13) Zimbabwe 8.51 (4.45, 13.14) 7.03 (4.11, 11.61) －1.40 (－2.02, －0.78) 15.97 (8.22, 24.96) 13.24 (7.76, 21.87) －1.28 (－1.83, －0.71) 5.86 (4.20, 7.93) 5.61 (3.61, 8.38) －0.55 (－1.14, 0.04) 220.29 (157.63, 298.58) 219.70 (141.39, 327.54) －0.34 (－0.97, 0.29) Benin 2.56 (1.77, 3.53) 2.72 (1.77, 3.94) 0.28 (0.09, 0.47) 4.87 (3.38, 6.71) 5.39 (3.50, 7.79) 0.40 (0.20, 0.60) 2.33 (1.57, 3.20) 2.39 (1.55, 3.44) 0.16 (－0.02, 0.35) 91.26 (61.43, 125.21) 95.47 (62.07, 137.17) 0.25 (0.05, 0.44) Burkina Faso 1.38 (0.91, 1.88) 1.37 (0.98, 2.01) －0.06 (－0.27, 0.14) 2.61 (1.72, 3.57) 2.69 (1.92, 3.95) 0.06 (－0.16, 0.28) 1.20 (0.81, 1.69) 1.20 (0.84, 1.68) －0.28 (－0.49, －0.07) 46.99 (31.65, 66.50) 47.70 (33.49, 67.21) －0.23 (－0.45, －0.00) Cameroon 2.11 (1.44, 2.96) 1.84 (1.20, 2.71) －0.22 (－0.74, 0.30) 4.12 (2.81, 5.77) 3.68 (2.40, 5.41) －0.17 (－0.72, 0.39) 1.82 (1.23, 2.49) 1.58 (1.01, 2.35) －0.07 (－0.58, 0.45) 74.49 (50.28, 101.83) 64.76 (41.44, 96.68) －0.07 (－0.59, 0.46) Cabo Verde 5.15 (3.53, 7.23) 7.76 (4.27, 12.18) 1.25 (0.99, 1.51) 10.24 (7.01, 14.39) 16.04 (8.76, 25.47) 1.39 (1.13, 1.64) 4.25 (2.95, 6.01) 8.29 (4.98, 12.62) 2.18 (2.05, 2.30) 168.55 (116.75, 239.25) 335.27 (200.51, 510.19) 2.25 (2.13, 2.37) Chad 2.05 (1.36, 2.91) 2.20 (1.48, 3.25) 0.45 (0.14, 0.76) 3.93 (2.61, 5.57) 4.29 (2.88, 6.32) 0.52 (0.18, 0.85) 1.82 (1.21, 2.57) 1.97 (1.35, 2.80) 0.38 (0.07, 0.70) 72.26 (47.92, 102.21) 78.67 (53.88, 112.16) 0.43 (0.11, 0.76) Cote d'Ivoire 0.61 (0.37, 0.87) 0.61 (0.41, 0.88) －0.10 (－0.57, 0.38) 1.18 (0.70, 1.68) 1.21 (0.82, 1.77) －0.67 (－0.99, －0.35) 0.52 (0.31, 0.74) 0.53 (0.36, 0.76) －0.30 (－0.83, 0.23) 21.02 (12.52, 29.98) 21.53 (14.65, 30.94) －0.30 (－0.84, 0.24) Gambia 0.53 (0.37, 0.72) 0.72 (0.48, 1.07) 0.60 (0.34, 0.86) 1.03 (0.71, 1.40) 1.42 (0.94, 2.11) 0.66 (0.40, 0.93) 0.46 (0.32, 0.63) 0.62 (0.41, 0.90) 0.61 (0.32, 0.90) 17.97 (12.47, 24.89) 24.66 (16.05, 35.78) 0.65 (0.36, 0.94) Ghana 1.94 (1.36, 2.67) 2.26 (1.46, 3.30) 0.42 (0.03, 0.81) 3.77 (2.63, 5.18) 4.49 (2.89, 6.56) 0.49 (0.08, 0.90) 1.78 (1.24, 2.42) 2.07 (1.35, 3.15) 0.40 (－0.01, 0.82) 71.12 (49.56, 97.05) 83.15 (53.83, 126.92) 0.44 (0.02, 0.87) Guinea 0.54 (0.37, 0.73) 0.66 (0.44, 0.98) －0.28 (－0.47, －0.09) 1.02 (0.71, 1.40) 1.30 (0.87, 1.91) 0.60 (0.43, 0.77) 0.48 (0.33, 0.64) 0.57 (0.38, 0.83) 0.30 (0.15, 0.44) 18.72 (12.96, 25.16) 22.65 (15.23, 33.20) 0.37 (0.22, 0.52) Guinea-Bissau 1.34 (0.94, 1.85) 1.98 (1.34, 2.87) 1.41 (1.04, 1.78) 2.52 (1.76, 3.48) 3.83 (2.57, 5.54) 1.48 (1.08, 1.87) 1.10 (0.77, 1.47) 1.65 (1.07, 2.37) 1.40 (1.07, 1.73) 44.21 (31.05, 59.13) 66.35 (43.02, 95.44) 1.41 (1.06, 1.76) Liberia 2.28 (1.57, 3.16) 2.62 (1.68, 3.94) 0.68 (0.27, 1.09) 4.37 (3.03, 6.10) 5.24 (3.36, 7.89) 0.80 (0.37, 1.23) 2.07 (1.42, 2.91) 2.36 (1.52, 3.54) 0.85 (0.39, 1.32) 82.31 (56.82, 115.92) 95.11 (61.39, 142.93) 0.90 (0.42, 1.39) Mali 1.82 (1.29, 2.46) 2.09 (1.46, 2.95) 0.21 (－0.09, 0.51) 3.50 (2.50, 4.76) 4.15 (2.90, 5.85) 0.29 (－0.02, 0.60) 1.64 (1.18, 2.24) 1.89 (1.30, 2.74) 0.19 (－0.10, 0.48) 65.81 (47.33, 89.96) 76.42 (52.62, 110.19) 0.23 (－0.07, 0.53) Mauritania 1.60 (1.12, 2.22) 2.05 (1.25, 3.13) 0.75 (0.52, 0.97) 3.05 (2.13, 4.23) 4.13 (2.50, 6.36) 0.91 (0.68, 1.14) 1.46 (1.02, 2.08) 2.05 (1.29, 3.08) 1.08 (0.86, 1.29) 56.51 (39.61, 80.36) 80.10 (50.36, 120.65) 1.10 (0.89, 1.31) Niger 1.03 (0.68, 1.43) 1.12 (0.76, 1.66) 0.08 (－0.17, 0.33) 1.97 (1.30, 2.74) 2.21 (1.49, 3.29) 0.18 (－0.08, 0.45) 0.90 (0.60, 1.27) 0.99 (0.64, 1.45) 0.05 (－0.19, 0.29) 35.02 (23.44, 49.65) 39.07 (25.54, 57.27) 0.10 (－0.16, 0.36) Nigeria 0.97 (0.64, 1.44) 0.74 (0.46, 1.17) －1.07 (－1.18, －0.97) 1.87 (1.23, 2.76) 1.46 (0.90, 2.29) －0.99 (－1.10, －0.88) 0.86 (0.56, 1.28) 0.70 (0.40, 1.15) －0.82 (－0.92, －0.72) 33.79 (21.72, 49.91) 27.40 (15.53, 45.08) －0.81 (－0.92, －0.70) Sao Tome and Principe 1.46 (0.98, 2.03) 1.80 (1.17, 2.75) 1.26 (0.95, 1.57) 2.85 (1.92, 3.97) 3.64 (2.38, 5.54) 1.39 (1.05, 1.72) 1.31 (0.89, 1.80) 1.67 (1.02, 2.52) 1.45 (1.13, 1.76) 51.59 (35.06, 71.29) 66.30 (40.56, 100.54) 1.50 (1.17, 1.84) Senegal 1.54 (1.07, 2.11) 1.75 (1.14, 2.61) 0.26 (－0.00, 0.53) 2.98 (2.07, 4.09) 3.48 (2.28, 5.20) 0.30 (0.03, 0.58) 1.31 (0.93, 1.81) 1.52 (0.95, 2.28) 0.28 (0.01, 0.56) 52.55 (37.34, 72.67) 60.49 (38.14, 90.90) 0.22 (－0.06, 0.50) Sierra Leone 2.93 (1.97, 4.13) 3.29 (2.24, 4.66) 0.21 (－0.21, 0.63) 5.81 (3.89, 8.19) 6.72 (4.53, 9.55) 0.30 (－0.16, 0.76) 2.47 (1.68, 3.44) 2.88 (2.02, 4.12) 0.32 (－0.13, 0.78) 101.50 (68.57, 142.21) 119.11 (83.25, 170.67) 0.35 (－0.13, 0.83) Togo 1.92 (1.36, 2.63) 2.14 (1.41, 3.13) 0.43 (0.03, 0.84) 3.68 (2.60, 5.05) 4.22 (2.76, 6.21) 0.54 (0.11, 0.97) 1.69 (1.20, 2.26) 1.87 (1.20, 2.75) 0.34 (－0.11, 0.80) 66.44 (47.25, 89.24) 74.76 (48.22, 110.19) 0.43 (－0.03, 0.89) American Samoa 0.73 (0.50, 1.02) 0.99 (0.62, 1.47) 1.14 (0.90, 1.38) 1.47 (1.01, 2.08) 2.09 (1.32, 3.12) 1.28 (1.04, 1.52) 0.61 (0.42, 0.85) 0.87 (0.54, 1.33) 1.27 (1.02, 1.52) 24.57 (17.01, 34.41) 35.55 (22.00, 54.31) 1.34 (1.09, 1.59) Bermuda 4.35 (3.65, 5.15) 3.03 (2.48, 3.68) －1.45 (－1.85, －1.05) 9.18 (7.66, 10.89) 7.96 (6.39, 9.80) －0.81 (－1.15, －0.46) 3.69 (3.10, 4.42) 2.30 (1.86, 2.84) －1.72 (－2.18, －1.27) 143.87 (120.56, 172.14) 89.43 (72.31, 110.24) －1.73 (－2.19, －1.28) Cook Islands 1.57 (1.08, 2.20) 2.04 (1.27, 3.06) 0.64 (0.51, 0.77) 3.28 (2.25, 4.62) 4.83 (3.02, 7.27) 1.04 (0.90, 1.18) 1.24 (0.88, 1.71) 1.67 (1.06, 2.54) 0.70 (0.53, 0.87) 50.54 (35.75, 69.76) 67.06 (42.54, 101.78) 0.64 (0.47, 0.80) Greenland 9.30 (6.96, 12.04) 4.51 (3.19, 6.07) －2.15 (－2.27, －2.02) 18.27 (13.67, 23.63) 9.96 (6.97, 13.64) －1.77 (－1.89, －1.65) 7.97 (5.97, 10.29) 3.54 (2.48, 4.89) －2.34 (－2.49, －2.20) 302.14 (225.33, 390.67) 135.59 (94.46, 188.35) －2.31 (－2.46, －2.17) Guam 1.47 (1.20, 1.76) 1.23 (1.02, 1.47) 1.09 (0.02, 2.17) 3.10 (2.53, 3.74) 2.94 (2.38, 3.54) 1.30 (0.25, 2.36) 1.24 (1.01, 1.50) 0.96 (0.80, 1.15) 0.96 (－0.13, 2.05) 49.96 (40.77, 60.39) 39.36 (32.80, 46.97) 0.97 (－0.11, 2.05) Monaco 3.35 (2.34, 4.59) 3.87 (2.50, 5.76) 0.47 (0.31, 0.63) 8.27 (5.73, 11.52) 11.33 (7.35, 16.88) 1.03 (0.86, 1.21) 2.61 (1.83, 3.56) 3.06 (1.88, 4.61) 0.47 (0.36, 0.58) 101.80 (71.12, 138.80) 118.93 (73.27, 179.40) 0.46 (0.34, 0.57) Nauru 2.90 (1.88, 4.26) 2.79 (1.79, 4.16) －0.21 (－0.44, 0.02) 5.65 (3.68, 8.28) 5.57 (3.59, 8.29) －0.11 (－0.37, 0.14) 2.49 (1.58, 3.67) 2.57 (1.66, 3.91) 0.03 (－0.27, 0.32) 102.90 (65.37, 151.39) 106.22 (68.28, 161.71) 0.03 (－0.26, 0.33) Niue 1.51 (1.02, 2.11) 1.27 (0.77, 2.02) －0.64 (－0.71, －0.57) 3.10 (2.11, 4.34) 2.69 (1.64, 4.28) －0.50 (－0.59, －0.41) 1.27 (0.87, 1.75) 1.15 (0.69, 1.83) －0.44 (－0.51, －0.38) 52.79 (35.82, 72.66) 47.43 (28.49, 75.40) －0.45 (－0.51, －0.39) Northern Mariana Islands 0.65 (0.45, 1.02) 1.18 (0.82, 1.65) 2.70 (2.14, 3.27) 1.37 (0.94, 2.19) 2.87 (1.95, 4.06) 3.02 (2.45, 3.59) 0.52 (0.36, 0.83) 0.93 (0.65, 1.27) 2.68 (2.09, 3.27) 20.68 (14.39, 33.28) 38.33 (26.80, 52.73) 2.75 (2.17, 3.34) Palau 1.59 (1.10, 2.22) 1.62 (1.12, 2.35) －0.06 (－0.14, 0.03) 3.25 (2.24, 4.52) 3.52 (2.44, 5.10) 0.12 (0.02, 0.22) 1.29 (0.89, 1.79) 1.37 (0.92, 1.98) 0.06 (－0.06, 0.17) 53.38 (36.79, 74.07) 56.93 (38.47, 82.46) 0.05 (－0.06, 0.17) Puerto Rico 4.06 (3.56, 4.62) 1.55 (1.29, 1.85) －2.42 (－2.62, －2.23) 8.57 (7.47, 9.88) 3.96 (3.23, 4.79) －1.81 (－2.01, －1.61) 3.43 (3.00, 3.88) 1.18 (0.97, 1.43) －2.74 (－2.94, －2.54) 136.41 (119.04, 154.92) 47.92 (39.42, 57.67) －2.69 (－2.89, －2.49) Saint Kitts and Nevis 3.15 (2.72, 3.63) 2.28 (1.85, 2.76) －0.62 (－0.91, －0.33) 6.12 (5.26, 7.06) 4.68 (3.81, 5.67) －0.45 (－0.72, －0.18) 2.78 (2.37, 3.27) 1.69 (1.35, 2.06) －1.24 (－1.53, －0.96) 108.81 (92.83, 128.29) 66.20 (52.86, 80.38) －1.24 (－1.52, －0.96) San Marino 1.03 (0.69, 1.45) 0.62 (0.39, 0.95) －2.46 (－2.75, －2.16) 2.56 (1.71, 3.66) 1.98 (1.23, 3.06) －1.63 (－1.94, －1.31) 0.79 (0.51, 1.15) 0.42 (0.25, 0.65) －2.99 (－3.32, －2.67) 30.42 (19.45, 44.01) 16.37 (9.70, 25.31) －2.91 (－3.24, －2.59) Tokelau 0.80 (0.52, 1.15) 0.76 (0.48, 1.17) －0.39 (－0.52, －0.26) 1.60 (1.05, 2.32) 1.58 (1.00, 2.44) －0.23 (－0.38, －0.09) 0.66 (0.42, 0.95) 0.70 (0.42, 1.10) －0.11 (－0.23, 0.01) 26.85 (17.30, 38.55) 28.34 (17.30, 44.60) －0.12 (－0.24, 0.00) Tuvalu 1.77 (1.18, 2.52) 2.23 (1.38, 3.39) 0.55 (0.48, 0.63) 3.48 (2.32, 4.95) 4.57 (2.85, 6.95) －4.03 (－4.56, －3.50) 1.52 (1.00, 2.15) 1.95 (1.22, 3.03) 0.57 (0.46, 0.67) 62.91 (41.08, 89.07) 81.54 (50.58, 126.77) 0.57 (0.46, 0.68) United States Virgin Islands 2.18 (1.78, 2.61) 1.63 (1.24, 2.12) －0.46 (－0.68, －0.25) 4.46 (3.63, 5.34) 3.72 (2.81, 4.84) －0.13 (－0.35, 0.09) 1.86 (1.50, 2.24) 1.33 (0.99, 1.77) －0.61 (－0.82, －0.40) 73.77 (59.65, 88.80) 53.51 (39.78, 70.91) －0.56 (－0.77, －0.34) South Sudan 18.86 (10.98, 25.90) 15.31 (10.31, 22.67) －0.85 (－1.02, －0.68) 36.82 (21.31, 50.82) 30.16 (20.23, 44.81) －0.83 (－1.01, －0.64) 16.56 (9.66, 22.59) 13.52 (9.09, 19.73) －0.84 (－1.06, －0.63) 681.97 (395.75, 933.27) 555.48 (373.83, 811.04) －0.85 (－1.08, －0.62) Sudan 2.06 (0.94, 3.14) 2.00 (1.02, 3.32) －0.53 (－0.64, －0.41) 4.11 (1.86, 6.31) 4.44 (2.25, 7.43) －0.24 (－0.39, －0.10) 1.75 (0.81, 2.69) 1.67 (0.83, 2.71) －0.57 (－0.68, －0.47) 70.38 (32.21, 108.53) 67.20 (33.26, 109.46) －0.56 (－0.67, －0.45) ASIR: Age-standardized incidence rate; 95%UI: 95% uncertainty interval; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized DALY rate; DALY: Disability-adjusted life year. 2.4 全球20~60岁人群食管癌流行趋势的Joinpoint回归分析
Joinpoint回归分析结果显示，1990－2023年，全球20~60岁人群食管癌ASIR、ASPR、ASMR和ASDR均呈不同幅度的下降趋势。ASIR和ASPR的变化趋势一致，均在2004年、2013年和2019年出现转折点，2019年后两者均呈上升趋势，但变化无统计学意义（均P＞0.05）。ASMR和ASDR的变化趋势相近，转折点同样为2004年、2013年和2019年，2013－2019年虽出现上升趋势，但这一变化无统计学意义（均P＞0.05），而2019－2023年上升趋势有统计学意义（均P＜0.05）。见图 1。
图 1 1990－2023年全球20~60岁人群食管癌负担变化趋势分析A: Joinpoint analysis of ASIR; B: Joinpoint analysis of ASPR; C: Joinpoint analysis of ASMR; D: Joinpoint analysis of ASDR. ASIR: Age-standardized incidence rate; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized disability-adjusted life year rate.Fig. 1 Trends in burden of esophageal cancer among global population aged 20-60 years from 1990 to 2023
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2.5 20~60岁人群食管癌负担与SDI的关联分析
全球及21个GBD地区中，20~60岁人群食管癌ASIR、ASPR、ASMR、ASDR均与SDI呈非线性相关（均P＜0.05，图 2A），具体规律表现为：1990－2023年，随SDI升高，食管癌负担先缓慢下降，在SDI约为0.40时达到最低值，之后呈“缓慢上升-小幅回落”的波动趋势。在204个国家和地区，20~60岁人群食管癌4项ASR中仅ASIR与SDI无显著关联（P＞0.05），ASPR、ASMR、ASDR仍与SDI呈非线性关联（均P＜0.01，图 2B）；ASIR、ASPR、ASMR、ASDR的EAPC均与SDI呈负向关联（均P＜0.05），即SDI越高，疾病负担的下降速率越平缓（图 2C）。
图 2 1990－2023年20~60岁人群食管癌负担与SDI的相关性分析结果A: The correlations of ASIR, ASPR, ASMR, and ASDR with SDI in 21 GBD regions; B: The correlations of ASIR, ASPR, ASMR, and ASDR with SDI in 204 countries and territories; C: The correlations of EAPC of ASIR, ASPR, ASMR, and ASDR with SDI. SDI: Socio-demographic index; ASIR: Age-standardized incidence rate; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized disability-adjusted life year rate; EAPC: Estimated annual percentage change; GBD: Global Burden of Disease Study.Fig. 2 Correlation analysis results of esophageal cancer burden and SDI in population aged 20-60 years from 1990 to 2023下载:
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健康不平等分析显示，20~60岁人群食管癌ASDR存在显著的绝对和相对不平等。SII分析显示，1990－2023年，SDI最高与最低国家和地区之间的ASDR差距从－20.35/10万人年（95%UI －46.84/10万人年~6.13/10万人年）增大至－53.29/10万人年（95%UI －74.73/10万人年~－31.84/10万人年）（图 3A），表明SDI最高与最低国家和地区之间的绝对健康不平等有所增加，且食管癌负担主要集中在低SDI国家和地区。同时，集中指数从1990年的－0.12（95%CI －0.21~－0.04）下降至2023年的－0.24（95%CI －0.33~－0.15）（图 3B），表明高SDI与低SDI国家和地区之间的相对不平等更加严重。
图 3 全球20~60岁人群食管癌负担的不平等斜率指数及集中指数分析A: Slope index of inequality analysis; B: Concentration index analysis. ASDR: Age-standardized DALY rate; SDI: Socio-demographic index; 95%CI: 95% confidence interval; DALY: Disability-adjusted life year.Fig. 3 Slope index of inequality and concentration index analyses of esophageal cancer burden in population aged 20-60 years下载:
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2.6 20~60岁人群食管癌负担的APC分析
20~60岁人群食管癌的发病率、患病率、死亡率和DALY的APC分析趋势一致。净漂移率与局部漂移率趋势分析显示，20~60岁各年龄组人群的食管癌负担均随着时间推移逐渐下降，而且年龄越大下降速度越快。年龄效应分析显示，1990－2023年任一时间点上，年龄越大食管癌负担越高。时期效应分析显示，1990－2018年食管癌负担随着时间推移逐渐下降，而2019年－2023年略有升高。队列效应分析显示，晚出生队列的食管癌负担显著低于早出生队列。见图 4。
图 4 1990－2023年20~60岁人群食管癌负担的年龄-时期-队列分析结果A: Net drifts & local drifts of incidence rates; B: Age effect of incidence rates; C: Period effect of incidence rates; D: Cohort effect of incidence rates; E: Net drifts & local drifts of prevalence rates; F: Age effect of prevalence rates; G: Period effect of prevalence rates; H: Cohort effect of prevalence rates; I: Net drifts & local drifts of mortality rates; J: Age effect of mortality rates; K: Period effect of mortality rates; L: Cohort effect of mortality rates; M: Net drifts & local drifts of DALY rates; N: Age effect of DALY rates; O: Period effect of DALY rates; P: Cohort effect of DALY rates. APC: Annual percentage change; DALY: Disability-adjusted life year.Fig. 4 Results of age-period-cohort analysis of esophageal cancer burden among population aged 20-60 years from 1990 to 2023下载:
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2.7 20~60岁人群食管癌负担的因素分解分析结果
在1990－2023年全研究周期内，全球层面分析显示，人口增长与年龄结构变化均导致20~60岁人群食管癌负担加重，流行病学变化降低了疾病负担水平，其中人口增长是主要驱动因素。在不同SDI地区及GBD地区中，人口增长均是导致20~60岁人群食管癌负担加重的驱动因素，而年龄结构变化和流行病学变化在不同地区疾病负担中的作用存在差异。具体而言，年龄结构变化一定程度降低了亚太高收入地区、西欧、东欧和中欧地区20~60岁人群的食管癌负担，但却是其他各地区疾病负担增加的主要因素；流行病学变化是降低高、中高SDI地区20~60岁人群食管癌发病、死亡风险及DALY的主要因素，也是降低东亚与中亚地区疾病负担的主要因素，但却一定程度增加了中低、低SDI地区及南亚地区的疾病负担。见图 5及附表 3（印刷版未展示）。
图 5 2023年20~60岁人群食管癌负担的因素分解分析结果SDI: Socio-demographic index; DALY: Disability-adjusted life year.Fig. 5 Results of breakdown analysis of burden of esophageal cancer among population aged 20-60 years in 2023下载:
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附表 3 2023年20~60岁人群食管癌疾病负担的影响因素分解分析数据Region Change in number of incident cases Change in number of prevalent cases Change in number of deaths Change in DALYs Aging Population growth Epidemiological change Aging Population growth Epidemiological change Aging Population growth Epidemiological change Aging Population growth Epidemiological change Global 37 193.94 76 595.54 －77 579.79 75 045.63 165 941.19 －124 571.22 32 312.50 64 418.54 －69 501.41 1 179 992.46 2 530 392.64 －2 608 187.33 High SDI 3 506.98 29 545.86 －35 399.30 4 711.36 67 879.69 －53 088.85 3 419.71 23 998.44 －33 247.80 97 844.06 920 960.76 －1 286 683.7 High-middle SDI 22 017.18 26 407.29 －53 097.41 42 835.57 55 383.77 －95 946.80 19 436.39 22 559.70 －48 145.12 701 232.31 871 961.94 －1 820 060.14 Middle SDI 3 669.37 4 070.83 －3 034.78 7 225.72 8 351.70 －4 552.35 3 224.97 3 509.88 －2 671.29 122 288.05 138 669.97 －103 311.93 Low-middle SDI 4 601.02 7 734.15 7 481.37 9 266.59 15 972.08 17 553.06 4 146.44 6 862.55 7 273.83 165 679.16 283 119.56 313 185.58 Low SDI 7 311.97 8 405.20 2 551.52 15 025.83 17 228.63 7 164.20 6 223.33 7 151.70 3 202.24 261 132.65 299 091.95 126 457.46 Andean Latin America 83.21 80.90 －93.22 167.76 171.99 －162 71.35 67.69 －81.78 2 776.43 2 778.41 －3 348.11 Australasia 62.65 154.06 －19.64 160.11 460.12 178.21 46.73 105.48 －51.47 1 622.56 4 049.40 －1 889.87 Caribbean 113.98 246.54 9.61 －67.19 563.76 281.69 101.58 210.43 15.52 3 545.48 8 301.07 395.4 Central Asia 307.46 970.63 －2 304.67 593.3 1 924.68 －4 433.94 271.71 840.37 －2 015.53 10 401.95 33 002.27 －78 855.27 Central Europe －677.32 865.45 －540.08 －1 359.62 1 715.04 －861.27 －586.19 752.6 －507.11 －22 534.37 29 001.26 －20 637.35 Central Latin America 473.67 456.73 －563.27 940.7 978.68 －1 010.17 416.07 387.12 －501.43 15 757.32 15 716.77 －20 134.77 Central Sub-Saharan Africa 764.30 669.66 63.29 1 542.32 1 341.99 204.27 661.55 580.38 96.45 27 933.33 24 283.05 3 185.74 East Asia 26 805.64 38 925.31 －83 565.68 49 821.60 82 467.45 －145 740.44 24 010.53 33 003.04 －76 226.82 824 736.80 1 259 708.89 －2 891 189.30 Eastern Europe －1793.25 2 020.99 －1 393.83 －3 621.05 4 064.42 －2 132.91 －1 532.48 1 730.55 －1 360.20 －57 788.30 66 003.44 －51 809.52 Eastern Sub-Saharan Africa 3985.79 3 968.62 －447.24 8 186.51 8 059.80 －418.04 3 355.73 3 352.29 183.18 144 098.88 141 805.32 2 360.68 High-income Asia Pacific －755.69 1 721.73 －2 305.76 －2 621.80 5 541.03 －3 253.71 －464.59 1 116.56 －2 100.86 －18 570.11 42 263.98 －79 264.90 High-income North America 144.08 2 236.83 －807.54 －238.18 6 081.27 －540.19 201.62 1 637.44 －839.24 4 074.86 63 231.67 －30 917.75 North Africa and Middle East 1 283.14 1 095.63 －701.64 2 809.99 2 495.12 －555.27 1 067.32 893.82 －720.53 42 561.36 36 248.30 －28 420.57 Oceania 31.01 27.52 1.12 63.77 57.91 10.56 26.17 22.98 2.68 1 074.05 964.22 141.64 South Asia 9 302.28 12 539.89 13 751.8 18 916.21 26 111.21 32 704.03 8 357.14 11 114.19 13 162.52 334 541.65 457 748.08 558 441.17 Southeast Asia 2 584.41 2 979.93 426.12 5 175.35 6 320.54 2 083.13 2 248.73 2 524.32 406.79 85 614.04 101 463.05 14 935.38 Southern Latin America 71.98 444.18 －730.35 136.93 940.03 －1 306.16 63.19 373.43 －665.16 2 286.29 14 435.47 －25 335.92 Southern Sub-Saharan Africa 1 002.78 1 202.48 －1 024.29 1 946.93 2 352.38 －1 962.99 777.85 929.03 －1 266.41 30 309.18 36 545.60 －48 924.08 Tropical Latin America 1 432.44 1 709.40 －1 613.97 2 757.14 3 484.44 －2 817.79 1 261.27 1 467.15 －1 479.18 46 954.17 57 794.29 －58 618.61 Western Europe －1 393.31 3 979.81 －3 304.96 －4 056.39 10 051.21 －2 866.82 －984.02 3 054.94 －3 488.37 －41 230.70 116 959.43 －135 162.16 Western Sub-Saharan Africa 658.86 613.27 －23.74 1 321.31 1 221.48 35.17 583.73 544.78 2.98 24 092.97 22 249.28 434.88 DALY: Disability-adjusted life year; SDI: Socio-demographic index. 2.8 2024－2050年全球20~60岁人群食管癌负担的预测结果
BAPC模型预测结果显示，从2024年到2050年，全球20~60岁人群食管癌的ASPR总体呈现持续上升趋势，而ASIR、ASMR和ASDR则总体呈先下降后上升的趋势。具体而言，至2050年，ASPR可能会持续上升至10.36/10万（95%UI 6.81/10万~13.92/10万）；ASIR到2032年持续下降至3.59/10万（95%UI 3.00/10万~4.18/10万），之后出现上升趋势，预计到2050年可达4.13/10万（95%UI 2.70/10万~5.56/10万）；ASMR和ASDR到2034年分别下降至2.91/10万（95%UI 2.32/10万~3.50/10万）和115.70/10万（95%UI 91.64/10万~139.76/10万），之后出现上升趋势，预计到2050年分别为3.12/10万（95%UI 1.95/10万~4.29/10万）、124.09/10万（95%UI 76.41/10万~171.78/10万）。见附表 4（印刷版未展示）。
附表 4 2024－2050年全球20~60岁人群食管癌疾病负担预测Time ASIR (95%UI)/(×10－5) ASPR (95%UI)/(×10－5) ASMR (95%UI)/(×10－5) ASDR (95%UI)/(×10－5) 2024 3.72 (3.49, 3.95) 8.66 (8.14, 9.18) 3.09 (2.87, 3.31) 123.13 (113.68, 132.59) 2025 3.69 (3.40, 3.99) 8.64 (7.98, 9.30) 3.06 (2.78, 3.33) 122.01 (110.51, 133.52) 2026 3.67 (3.32, 4.01) 8.62 (7.84, 9.39) 3.03 (2.71, 3.35) 120.92 (107.65, 134.19) 2027 3.64 (3.25, 4.03) 8.60 (7.72, 9.48) 3.00 (2.64, 3.36) 119.85 (105.00, 134.70) 2028 3.62 (3.19, 4.06) 8.59 (7.61, 9.57) 2.98 (2.58, 3.37) 118.86 (102.55, 135.17) 2029 3.61 (3.13, 4.08) 8.59 (7.51, 9.67) 2.96 (2.53, 3.39) 117.98 (100.29, 135.68) 2030 3.60 (3.08, 4.11) 8.60 (7.43, 9.78) 2.94 (2.47, 3.40) 117.24 (98.22, 136.25) 2031 3.59 (3.04, 4.14) 8.63 (7.36, 9.89) 2.93 (2.43, 3.42) 116.63 (96.33, 136.93) 2032 3.59 (3.00, 4.18) 8.66 (7.30, 10.01) 2.92 (2.39, 3.45) 116.17 (94.61, 137.72) 2033 3.60 (2.97, 4.22) 8.70 (7.25, 10.15) 2.91 (2.35, 3.47) 115.86 (93.05, 138.66) 2034 3.61 (2.94, 4.27) 8.76 (7.22, 10.30) 2.91 (2.32, 3.50) 115.70 (91.64, 139.76) 2035 3.62 (2.92, 4.33) 8.83 (7.19, 10.47) 2.91 (2.29, 3.54) 115.71 (90.37, 141.04) 2036 3.64 (2.90, 4.39) 8.91 (7.17, 10.65) 2.92 (2.26, 3.58) 115.86 (89.24, 142.48) 2037 3.67 (2.88, 4.45) 9.00 (7.16, 10.84) 2.93 (2.23, 3.62) 116.11 (88.19, 144.03) 2038 3.69 (2.87, 4.52) 9.09 (7.15, 11.04) 2.93 (2.21, 3.66) 116.44 (87.21, 145.68) 2039 3.72 (2.85, 4.59) 9.19 (7.14, 11.24) 2.94 (2.19, 3.70) 116.82 (86.26, 147.39) 2040 3.75 (2.84, 4.66) 9.29 (7.13, 11.45) 2.96 (2.17, 3.75) 117.28 (85.36, 149.20) 2041 3.78 (2.83, 4.74) 9.40 (7.12, 11.68) 2.97 (2.14, 3.79) 117.81 (84.51, 151.12) 2042 3.82 (2.82, 4.82) 9.51 (7.12, 11.91) 2.98 (2.12, 3.84) 118.41 (83.68, 153.13) 2043 3.85 (2.81, 4.90) 9.62 (7.10, 12.14) 3.00 (2.10, 3.89) 119.03 (82.86, 155.20) 2044 3.89 (2.80, 4.98) 9.73 (7.08, 12.37) 3.01 (2.08, 3.94) 119.66 (82.02, 157.30) 2045 3.92 (2.78, 5.07) 9.83 (7.05, 12.60) 3.03 (2.06, 3.99) 120.32 (81.16, 159.47) 2046 3.96 (2.77, 5.16) 9.93 (7.02, 12.84) 3.04 (2.04, 4.05) 121.02 (80.30, 161.75) 2047 4.00 (2.75, 5.25) 10.04 (6.98, 13.09) 3.06 (2.02, 4.11) 121.78 (79.42, 164.13) 2048 4.04 (2.74, 5.35) 10.14 (6.93, 13.35) 3.08 (2.00, 4.16) 122.56 (78.50, 166.62) 2049 4.09 (2.72, 5.45) 10.25 (6.88, 13.63) 3.10 (1.98, 4.23) 123.34 (77.50, 169.17) 2050 4.13 (2.70, 5.56) 10.36 (6.81, 13.92) 3.12 (1.95, 4.29) 124.09 (76.41, 171.78) ASIR: Age-standardized incidence rate; 95%UI: 95% uncertainty interval; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized DALY rate; DALY: Disability-adjusted life year. 2.9 20~60岁人群食管癌的归因危险因素
在可归因于全球20~60岁人群食管癌负担（DALY）的危险因素中，吸烟占44.1%，过量饮酒占27.91%，低蔬菜饮食占23.34%，嚼烟占7.84%。进一步分析显示，高、中高SDI地区20~60岁人群食管癌的危险因素归因顺位与全球总体趋势一致；而在中低、低SDI地区，低蔬菜饮食则成为该疾病的首要可归因危险因素（图 6A）。纵向趋势分析表明，各危险因素导致的20~60岁人群食管癌DALY均随时间呈下降态势，其中吸烟和过量饮酒相关DALY的降幅最为显著（图 6B）。
图 6 1990－2023年20~60岁人群食管癌的归因危险因素A: Attributable risk factors in 2023; B: Temporal trends of attributable risk factors. SDI: Socio-demographic index.Fig. 6 Attributable risk factors for esophageal cancer among population aged 20-60 years from 1990 to 2023下载:
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3 讨论
本研究基于GBD数据分析发现，1990－2023年，全球20~60岁人群食管癌的ASIR、ASPR、ASMR和ASDR均呈显著下降趋势。然而，疾病负担各项指标的绝对数值仍持续上升，这表明人口增长与年龄结构变化对疾病负担存在复合影响，该结果与全年龄段食管癌的研究结论[9]一致。性别差异分析显示，男性的各项疾病负担指标均显著高于女性，这与男性更频繁暴露于烟草、酒精等危险因素的普遍观察结果[9]一致。吸烟和饮酒是食管癌的重要危险因素[10-11]，并且无烟烟草也已被证实为食管癌的危险因素[12]。一项大型队列研究表明，饮酒频率比单次饮酒量对食管癌的影响更为显著，这意味着即便单次饮酒量较少，反复饮酒也可能对消化道器官产生较强的致癌作用，且其风险高于偶尔的大量饮酒[13]。
研究表明，SDI与20~60岁人群食管癌的发病率呈非线性相关：当SDI值约为0.40时，发病率最低；而当SDI值低于或高于该值时，发病率均会上升。SDI和食管癌发病风险呈非线性关联的原因可能涉及不同SDI地区之间医疗资源可及性的梯度差异、人群危险因素暴露模式的异质性，以及食管癌筛查与早诊早治干预力度的不均衡分布。具体表现为，低SDI地区医疗资源匮乏、筛查覆盖面有限，同时亚硝酸盐摄入、蔬菜摄入不足等传统危险因素管控不足；而高SDI地区则由于控烟和内镜筛查等措施的实施，食管癌发病率下降，但肥胖、胃食管反流病等新兴危险因素的暴露水平逐渐升高。需要说明的是，目前关于SDI与食管癌发病风险的关联仍处于假设层面，需结合个体水平数据及专项研究进一步验证。另外，高SDI地区前期已通过控烟限酒、普及内镜筛查、优化临床诊疗等措施实现疾病负担大幅下降，后期可挖掘的防控空间有限，故下降速率趋缓；中低SDI地区虽防控基础较弱，但随着社会经济发展，基础公共卫生服务体系逐步完善，传统危险因素得到一定管控，使得疾病负担下降速率相对更快。这意味着不同SDI水平的地区需实施针对性的防控策略：低SDI地区应重点加强基础公共卫生工作，包括通过营养教育推广新鲜蔬菜食用、减少加工食品摄入，同时扩大早期筛查的覆盖面；高SDI地区则需对肥胖、胃食管反流病等新兴危因素开展重点监测，并提供健康生活方式指导，尤其是针对青少年的体重管理。此外，对于SDI接近0.40的地区，需警惕其在社会转型期面临“双重风险叠加”的潜在威胁，在强化传统危险因素防控措施的同时，还应主动建立针对新兴危险因素的监测与干预机制。
危险因素分析表明，吸烟、过量饮酒、蔬菜摄入不足和嚼烟是全球20~60岁人群食管癌的主要诱因，并且与地域聚集性及经济发展水平存在显著关联[14-15]：低、低中SDI地区的首要危险因素为蔬菜摄入不足，反映该类地区营养健康干预的不足；而高、中高SDI地区仍以烟草和酒精暴露为主，提示传统危险因素的防控仍需持续强化。食管癌是地域分布差异最大的癌症类型，高发区域主要集中在“亚洲食管癌带”（土耳其东部、里海沿岸国家、阿富汗北部、东亚及中亚地区），此外日本、南非和南美洲也为高发区域[16-17]。不同地域的危险因素谱存在明显差异：非洲尤其是撒哈拉以南非洲西部地区的食管癌高发，主要归因于饮食中铁、镁、锌、硒等微量元素的摄入不足[15-16]。中国食管癌发病率和死亡率也较高，吸烟和饮酒是我国全年龄段食管癌高发的主要危险因素，表明我国亟须积极防控吸烟、饮酒这两大食管癌核心危险因素[18]。此外，中国女性群体中，高BMI和水果摄入不足是食管癌的重要危险因素，反映出性别特异性危险因素的干预价值[19]。这种地域差异、性别差异与不同的危险因素暴露程度密切相关，意味着干预策略必须兼顾针对性与差异化，通过精准施策有效缩小地域与性别间的食管癌疾病负担差距，提升整体防控效率[20-21]。
年龄效应分析显示，1990－2023年任一时间点内，年龄越大食管癌负担越高，其中45岁以上人群应作为筛查重点。队列效应显示，早期出生队列的疾病负担更重，这可能与该人群暴露于传统危险因素的剂量更高、持续时间更长相关。时期效应显示，2019年后疾病负担略有升高，这一现象与全球公共卫生事件的时间节点存在重合，提示上述因素与疾病负担变化之间可能存在潜在关联。本研究基于生态趋势数据开展分析，无法直接推导社会因素与疾病负担变化的因果关联，未来研究可结合个体暴露数据、专项监测数据等开展深入分析，以明确该趋势变化的关键因素。
未来预测显示，2024年至2050年ASPR将持续上升，而ASIR、ASMR和ASDR将呈现先下降后上升的趋势，这可能与人口年龄结构变化及危险因素管控效果趋于稳定相关。经预测至2050年ASIR将升高至4.13/10万，这凸显了提前制定长期防控规划的必要性。在预防层面，需加强对吸烟、饮酒等传统危险因素的干预，同时通过营养教育和运动推广应对肥胖、饮食结构不合理等新兴危险因素。此外，需扩大如具有家族遗传倾向或长期胃食管反流病史等高风险人群的内镜筛查范围，并推广应用循环肿瘤DNA、食管细胞学检测、呼气和唾液标志物检测及人工智能辅助诊断等技术以提高早期检出率[22-25]。同时，需完善食管癌患者的长期治疗体系，建立统一的随访机制和康复服务，降低疾病复发率和残疾影响。
本研究为全球及中国20~60岁人群食管癌的防控提供了流行病学证据，但仍存在一定局限性：首先，未对食管鳞状细胞癌与腺癌这2种主要病理亚型进行分层分析，缺乏对不同亚型流行特征及疾病负担趋势差异的深入探究。另外，预测模型存在固有不确定性，本研究采用BAPC模型，通过严格等距分组、贝叶斯平滑先验及敏感性分析优化分组设计，虽能整合先验信息、灵活处理复杂效应并量化不确定性，但受模型假设条件、参数设定及先验信息选择的潜在影响，仍可能存在未完全消除的效应混杂风险。未来研究可采用更精细的分层策略，结合病理亚型、基因型等特征开展亚组分析，揭示不同亚型食管癌的疾病负担差异及驱动因素；同时通过拓展多源数据、调整模型参数及验证多种先验分布进一步降低模型不确定性，提升预测结果的精准度。
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图 1 1990－2023年全球20~60岁人群食管癌负担变化趋势分析
A: Joinpoint analysis of ASIR; B: Joinpoint analysis of ASPR; C: Joinpoint analysis of ASMR; D: Joinpoint analysis of ASDR. ASIR: Age-standardized incidence rate; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized disability-adjusted life year rate.
Fig. 1 Trends in burden of esophageal cancer among global population aged 20-60 years from 1990 to 2023
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图 2 1990－2023年20~60岁人群食管癌负担与SDI的相关性分析结果
A: The correlations of ASIR, ASPR, ASMR, and ASDR with SDI in 21 GBD regions; B: The correlations of ASIR, ASPR, ASMR, and ASDR with SDI in 204 countries and territories; C: The correlations of EAPC of ASIR, ASPR, ASMR, and ASDR with SDI. SDI: Socio-demographic index; ASIR: Age-standardized incidence rate; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized disability-adjusted life year rate; EAPC: Estimated annual percentage change; GBD: Global Burden of Disease Study.
Fig. 2 Correlation analysis results of esophageal cancer burden and SDI in population aged 20-60 years from 1990 to 2023
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图 3 全球20~60岁人群食管癌负担的不平等斜率指数及集中指数分析
A: Slope index of inequality analysis; B: Concentration index analysis. ASDR: Age-standardized DALY rate; SDI: Socio-demographic index; 95%CI: 95% confidence interval; DALY: Disability-adjusted life year.
Fig. 3 Slope index of inequality and concentration index analyses of esophageal cancer burden in population aged 20-60 years
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图 4 1990－2023年20~60岁人群食管癌负担的年龄-时期-队列分析结果
A: Net drifts & local drifts of incidence rates; B: Age effect of incidence rates; C: Period effect of incidence rates; D: Cohort effect of incidence rates; E: Net drifts & local drifts of prevalence rates; F: Age effect of prevalence rates; G: Period effect of prevalence rates; H: Cohort effect of prevalence rates; I: Net drifts & local drifts of mortality rates; J: Age effect of mortality rates; K: Period effect of mortality rates; L: Cohort effect of mortality rates; M: Net drifts & local drifts of DALY rates; N: Age effect of DALY rates; O: Period effect of DALY rates; P: Cohort effect of DALY rates. APC: Annual percentage change; DALY: Disability-adjusted life year.
Fig. 4 Results of age-period-cohort analysis of esophageal cancer burden among population aged 20-60 years from 1990 to 2023
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图 5 2023年20~60岁人群食管癌负担的因素分解分析结果
SDI: Socio-demographic index; DALY: Disability-adjusted life year.
Fig. 5 Results of breakdown analysis of burden of esophageal cancer among population aged 20-60 years in 2023
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图 6 1990－2023年20~60岁人群食管癌的归因危险因素
A: Attributable risk factors in 2023; B: Temporal trends of attributable risk factors. SDI: Socio-demographic index.
Fig. 6 Attributable risk factors for esophageal cancer among population aged 20-60 years from 1990 to 2023
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表 1 1990－2023年全球20~60岁人群的食管癌负担变化
Table 1 Esophageal cancer burden among population aged 20-60 years globally from 1990 to 2023
Indicator 1990 2023 EAPC (95%CI)/% Number (95%UI) ASR (95%UI)/(×10－5) Number (95%UI) ASR (95%UI)/(×10－5) Total Incidence 133 437.46 (107 953.94, 149 427.58) 6.03 (4.88, 6.75) 169 647.15 (147 682.44, 196 508.69) 3.71 (3.22, 4.31) －2.06 (－2.31, －1.80) Prevalence 276 283.85 (222 118.73, 311 013.91) 12.38 (9.96, 13.92) 392 699.45 (340 815.17, 457 863.69) 8.65 (7.50, 10.11) －1.66 (－1.92, －1.41) Mortality 113 272.57 (94 430.18, 130 388.63) 5.14 (4.29, 5.91) 140 502.20 (118 295.41, 168 744.09) 3.06 (2.57, 3.68) －2.18 (－2.45, －1.91) DALY 4 445 634.84 (3 699 746.35, 5 113 567.81) 199.94 (166.58, 229.90) 5 547 832.61 (4 656 241.59, 6 674 213.05) 121.93 (102.18, 146.85) －2.13 (－2.41, －1.86) Female Incidence 33 818.68 (22 121.71, 41 607.83) 3.07 (2.00, 3.77) 46 798.56 (34 836.21, 62 884.53) 2.07 (1.54, 2.79) －1.21 (－1.02, －1.35) Prevalence 73 725.66 (48 430.57, 91 119.34) 6.61 (4.32, 8.15) 113 343.65 (84 586.35, 150 412.88) 5.08 (3.77, 6.76) －0.88 (－0.75, －0.92) Mortality 27 814.70 (18 317.42, 34 970.04) 2.54 (1.67, 3.19) 38 287.26 (27 762.46, 53 125.19) 1.69 (1.22, 2.35) －1.28 (－1.15, －1.39) DALY 1 103 089.21 (735 381.19, 1 390 792.16) 99.53 (66.15, 125.33) 1 563 765.48 (1 123 972.77, 2 186 431.96) 69.74 (49.92, 97.83) －1.05 (－0.98, －1.16) Male Incidence 99 618.78 (81 946.60, 115 187.78) 8.93 (7.35, 10.31) 122 848.59 (103 962.18, 146 566.92) 5.36 (4.53, 6.40) －1.38 (－1.25, －1.64) Prevalence 202 558.19 (166 172.49, 233 887.32) 18.03 (14.82, 20.79) 279 355.80 (236 849.93, 333 876.15) 12.25 (10.37, 14.66) －1.15 (－1.08, －1.29) Mortality 85 457.87 (69 052.21, 101 792.97) 7.68 (6.21, 9.15) 102 214.94 (82 809.69, 127 207.86) 4.45 (3.60, 5.54) －1.45 (－1.32, －1.72) DALY 3 342 545.63 (2 703 498.24, 3 983 350.30) 298.10 (241.31, 354.88) 3 984 067.13 (3 217 896.98, 4 968 383.54) 174.38 (140.65, 217.69) －1.42 (－1.30, －1.68) 95%UI: 95% uncertainty interval; ASR: Age-standardized rate; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval; DALY: Disability-adjusted life year. 表 2 1990－2023年全球不同SDI水平地区20~60岁人群食管癌负担
Table 2 Burden of esophageal cancer among population aged 20-60 years in different SDI level regions globally from 1990 to 2023
Indicator 1990 2023 EAPC (95%CI)/% Number (95%UI) ASR (95%UI)/(×10－5) Number (95%UI) ASR (95%UI)/(×10－5) Incidence High SDI 58 584.03 (49 392.74, 65 646.45) 5.70 (4.80, 6.38) 56 237.57 (49 248.89, 64 258.32) 3.16 (2.77, 3.61) －2.23 (－2.56, －1.90) High-middle SDI 50 122.79 (32 901.93, 59 685.42) 11.34 (7.44, 13.49) 45 449.86 (39 253.64, 53 340.65) 4.22 (3.64, 4.95) －3.89 (－4.29, －3.49) Middle SDI 5 993.45 (5 118.00, 7 026.39) 2.81 (2.40, 3.29) 10 698.87 (8 743.91, 13 831.75) 1.97 (1.61, 2.55) －1.32 (－1.44, －1.20) Low-middle SDI 7 968.32 (6 060.63, 10 089.39) 3.12 (2.37, 3.94) 27 784.87 (19 970.15, 37 076.73) 4.94 (3.56, 6.58) 1.36 (0.94, 1.78) Low SDI 9 727.49 (6 966.69, 13 115.13) 3.91 (2.80, 5.25) 27 996.17 (20 553.67, 39 798.70) 4.53 (3.33, 6.45) 0.14 (－0.11, 0.38) Prevalence High SDI 125 335.63 (105 488.60, 140 673.14) 12.17 (10.24, 13.65) 144 837.84 (125 551.29, 166 233.19) 8.36 (7.23, 9.61) －1.57 (－1.90, －1.23) High-middle SDI 101 668.21 (65 913.46, 120 943.60) 22.71 (14.72, 26.97) 103 940.74 (88 788.87, 122 543.17) 9.81 (8.36, 11.58) －3.45 (－3.84, －3.06) Middle SDI 11 874.07 (10 104.36, 13 938.70) 5.49 (4.68, 6.44) 22 899.15 (18 553.52, 29 828.80) 4.23 (3.43, 5.51) －1.06 (－1.18, －0.93) Low-middle SDI 15 803.96 (12 032.74, 20 091.40) 6.11 (4.66, 7.75) 58 595.69 (41 749.58, 78 645.67) 10.32 (7.38, 13.82) 1.54 (1.11, 1.98) Low SDI 19 312.00 (13 832.24, 26 119.57) 7.64 (5.48, 10.30) 58 730.66 (42 735.26, 83 792.03) 9.31 (6.78, 13.26) 0.27 (－0.00, 0.55) Mortality High SDI 49 032.48 (41 476.10, 56 957.97) 4.77 (4.04, 5.54) 43 202.83 (36 608.05, 52 416.60) 2.39 (2.03, 2.90) －2.57 (－2.91, －2.24) High-middle SDI 43 420.78 (29 943.74, 52 997.02) 9.88 (6.82, 12.05) 37 271.75 (30 718.35, 45 987.13) 3.43 (2.83, 4.23) －4.12 (－4.53, －3.70) Middle SDI 5 163.19 (4 351.34, 6 146.00) 2.43 (2.05, 2.89) 9 226.75 (7 314.67, 11 927.87) 1.70 (1.35, 2.20) －1.34 (－1.48, －1.20) Low-middle SDI 6 843.26 (5 215.11, 8 658.47) 2.69 (2.06, 3.41) 25 126.09 (18 055.96, 33 892.64) 4.49 (3.23, 6.05) 1.51 (1.06, 1.95) Low SDI 7 951.72 (5 708.72, 10 503.77) 3.21 (2.31, 4.24) 24 529.00 (17 879.33, 33 869.07) 4.01 (2.93, 5.54) 0.39 (0.13, 0.65) DALY High SDI 1 902 361.42 (1 610 117.14, 2 212 738.28) 185.17 (156.78, 215.28) 1 634 482.54 (1 388 942.21, 1 978 600.27) 91.99 (78.27, 111.23) －2.63 (－2.97, －2.28) High-middle SDI 1 690 551.59 (1 162 096.48, 2 064 399.01) 379.75 (261.14, 463.34) 1 443 685.71 (1 190 173.00, 1 773 330.90) 134.92 (111.16, 165.48) －4.05 (－4.46, －3.64) Middle SDI 205 490.94 (173 023.38, 244 403.73) 95.21 (80.21, 113.26) 363 137.03 (287 658.97, 469 783.18) 66.97 (53.05, 86.65) －1.31 (－1.44, －1.17) Low-middle SDI 279 430.04 (212 603.86, 353 789.58) 107.95 (82.24, 136.57) 1 041 414.34 (741 889.77, 1 408 470.54) 183.91 (131.42, 248.43) 1.57 (1.12, 2.03) Low SDI 334 655.68 (239 262.18, 442 694.25) 131.92 (94.61, 174.19) 1 021 337.74 (743 724.85, 1 413 572.98) 163.01 (118.80, 225.44) 0.34 (0.07, 0.61) SDI: Socio-demographic index; 95%UI: 95% uncertainty interval; ASR: Age-standardized rate; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval. 附表 1 1990－2023年21个GBD地区的20~60岁人群食管癌疾病负担
Region ASIR ASPR ASMR ASDR 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% East Asia 14.87 (10.24, 17.67) 5.07 (4.13, 6.21) －4.10 (－4.56, －3.65) 29.84 (20.23, 35.60) 12.64 (10.30, 15.55) －3.43 (－3.87, －3.00) 12.88 (9.26, 16.00) 3.97 (3.02, 5.27) －4.44 (－4.91, －3.97) 496.01 (354.80, 615.96) 153.13 (116.88, 202.73) －4.45 (－4.93, －3.97) Southeast Asia 2.14 (1.62, 2.77) 2.29 (1.85, 2.92) 0.07 (－0.02, 0.16) 4.30 (3.26, 5.57) 5.01 (4.03, 6.38) 1.60 (1.16, 2.04) 1.81 (1.39, 2.31) 1.95 (1.55, 2.50) 0.09 (－0.01, 0.18) 72.41 (55.40, 92.73) 77.73 (61.39, 100.05) 0.05 (－0.04, 0.15) Oceania 1.47 (0.91, 2.17) 1.47 (0.95, 2.26) －0.18 (－0.26, －0.11) 2.92 (1.80, 4.33) 3.12 (2.00, 4.82) －0.02 (－0.09, 0.06) 1.21 (0.75, 1.73) 1.27 (0.82, 1.98) －0.09 (－0.17, －0.01) 49.31 (30.52, 71.05) 52.21 (33.71, 81.68) －0.03 (－0.11, 0.05) Central Asia 8.15 (7.57, 8.68) 2.31 (2.11, 2.55) －4.13 (－4.40, －3.86) 15.96 (14.75, 17.08) 4.73 (4.28, 5.25) －3.98 (－4.26, －3.70) 7.09 (6.59, 7.53) 1.98 (1.79, 2.20) －4.19 (－4.45, －3.94) 277.97 (257.80, 295.62) 77.97 (70.38, 86.64) －4.19 (－4.44, －3.94) Central Europe 2.55 (2.42, 2.68) 1.85 (1.72, 1.99) －1.24 (－1.50, －0.99) 4.96 (4.70, 5.23) 3.85 (3.55, 4.16) －1.07 (－1.32, －0.81) 2.23 (2.12, 2.35) 1.58 (1.46, 1.70) －1.31 (－1.56, －1.05) 87.43 (83.08, 92.00) 60.74 (56.13, 65.53) －1.41 (－1.66, －1.16) Eastern Europe 3.26 (2.93, 3.61) 2.31 (2.09, 2.56) －1.26 (－1.44, －1.07) 6.40 (5.76, 7.11) 4.95 (4.43, 5.53) －0.90 (－1.12, －0.67) 2.84 (2.55, 3.12) 1.91 (1.72, 2.10) －1.41 (－1.59, －1.23) 109.11 (98.15, 119.99) 73.49 (66.10, 80.96) －1.42 (－1.60, －1.23) High-income Asia Pacific 3.70 (3.33, 4.03) 1.88 (1.63, 2.14) －2.46 (－2.72, －2.19) 10.40 (9.11, 11.70) 7.82 (6.46, 9.18) －1.20 (－1.60, －0.79) 2.61 (2.36, 2.82) 0.96 (0.86, 1.06) －3.53 (－3.71, －3.35) 99.67 (89.49, 107.84) 36.65 (32.88, 40.80) －3.52 (－3.69, －3.36) Australasia 2.22 (2.01, 2.44) 2.09 (1.83, 2.39) －0.19 (－0.42, 0.04) 5.84 (5.09, 6.72) 7.05 (5.85, 8.42) 0.57 (0.26, 0.88) 1.64 (1.50, 1.79) 1.30 (1.16, 1.46) －0.73 (－0.92, －0.55) 62.93 (57.20, 68.90) 50.46 (44.68, 56.75) －0.72 (－0.91, －0.53) Western Europe 3.54 (3.36, 3.74) 2.35 (2.10, 2.58) －1.46 (－1.64, －1.28) 8.15 (7.54, 8.91) 7.13 (6.15, 8.26) －0.56 (－0.78, －0.34) 2.86 (2.72, 2.99) 1.60 (1.46, 1.71) －2.02 (－2.18, －1.85) 111.36 (106.12, 116.73) 61.81 (56.38, 66.39) －2.07 (－2.23, －1.90) Southern Latin America 4.04 (3.78, 4.32) 1.77 (1.56, 2.00) －2.68 (－2.86, －2.51) 8.19 (7.61, 8.84) 4.13 (3.57, 4.72) －2.31 (－2.49, －2.13) 3.48 (3.27, 3.70) 1.41 (1.24, 1.58) －2.87 (－3.04, －2.70) 134.04 (125.62, 142.78) 55.16 (48.53, 61.72) －2.85 (－3.02, －2.67) High-income North America 2.69 (2.45, 2.96) 2.27 (2.02, 2.54) －0.64 (－0.78, －0.49) 6.92 (6.09, 7.91) 6.66 (5.69, 7.76) －0.27 (－0.46, －0.09) 2.03 (1.87, 2.20) 1.59 (1.44, 1.75) －0.86 (－0.98, －0.73) 78.34 (72.06, 85.10) 61.99 (55.96, 68.56) －0.84 (－0.96, －0.71) Caribbean 2.49 (2.27, 2.71) 2.53 (2.13, 2.98) 0.47 (0.28, 0.66) 5.10 (4.62, 5.59) 5.34 (4.49, 6.31) 0.55 (0.37, 0.73) 2.11 (1.92, 2.30) 2.18 (1.81, 2.60) 0.49 (0.30, 0.68) 83.61 (75.86, 91.59) 85.43 (70.85, 102.45) 0.44 (0.25, 0.64) Andean Latin America 0.97 (0.82, 1.13) 0.56 (0.46, 0.69) －1.79 (－1.98, －1.61) 1.96 (1.64, 2.28) 1.25 (1.01, 1.54) －1.53 (－1.71, －1.34) 0.83 (0.69, 0.96) 0.47 (0.38, 0.57) －1.74 (－2.00, －1.47) 33.45 (28.05, 38.89) 18.92 (15.35, 23.10) －1.76－1.76 (－2.02, －1.50) Central Latin America 1.34 (1.22, 1.47) 0.75 (0.67, 0.84) －1.53 (－1.63, －1.42) 2.73 (2.48, 3.01) 1.67 (1.48, 1.89) －1.27 (－1.37, －1.18) 1.16 (1.06, 1.26) 0.63 (0.56, 0.69) －1.63 (－1.75, －1.51) 46.21 (42.21, 50.54) 25.16 (22.67, 27.87) －1.63 (－1.75, －1.51) Tropical Latin America 4.77 (4.28, 5.25) 3.06 (2.83, 3.30) －1.10 (－1.30, －0.90) 9.43 (8.43, 10.40) 6.44 (5.91, 6.99) －0.93 (－1.12, －0.74) 4.16 (3.74, 4.57) 2.58 (2.39, 2.79) －1.17 (－1.37, －0.97) 163.20 (146.70, 179.46) 100.93 (93.44, 109.29) －1.20 (－1.40, －0.99) North Africa and Middle East 1.31 (0.93, 1.69) 0.96 (0.74, 1.26) －1.25 (－1.35, －1.14) 2.67 (1.88, 3.47) 2.36 (1.80, 3.12) －0.72 (－0.84, －0.59) 1.11 (0.80, 1.43) 0.76 (0.58, 0.99) －1.43 (－1.54, －1.32) 44.24 (31.53, 56.84) 30.57 (23.24, 39.72) －1.42 (－1.53, －1.31) South Asia 3.04 (2.29, 3.93) 5.14 (3.82, 6.78) 1.39 (0.97, 1.80) 5.93 (4.47, 7.70) 10.84 (8.03, 14.47) 1.60 (1.16, 2.04) 2.62 (1.98, 3.43) 4.66 (3.41, 6.14) 1.55 (1.09, 2.01) 104.97 (79.13, 137.68) 190.05 (138.16, 250.57) 1.59 (1.13, 2.06) Central Sub-Saharan Africa 4.67 (2.53, 6.63) 4.93 (3.19, 7.33) 0.06 (－0.20, 0.31) 9.02 (4.88, 12.83) 9.79 (6.34, 14.52) 0.14 (－0.13, 0.42) 3.99 (2.33, 5.59) 4.38 (2.84, 6.49) 0.11 (－0.14, 0.36) 163.04 (94.94, 228.47) 176.94 (115.14, 263.08) 0.09 (－0.17, 0.35) Eastern Sub-Saharan Africa 9.31 (6.52, 12.78) 8.97 (6.75, 12.30) －0.16 (－0.36, 0.04) 18.19 (12.71, 25.15) 18.02 (13.56, 24.75) －0.07 (－0.30, 0.17) 7.62 (5.34, 10.10) 7.94 (5.88, 10.86) 0.07 (－0.12, 0.25) 314.26 (219.43, 417.95) 323.34 (239.47, 442.14) 0.01 (－0.19, 0.21) Southern Sub-Saharan Africa 11.43 (8.68, 14.79) 7.60 (6.15, 9.53) －1.80 (－2.10, －1.51) 22.03 (16.69, 28.52) 14.73 (11.86, 18.60) －1.76 (－2.09, －1.42) 9.85 (7.27, 12.98) 5.10 (4.01, 6.49) －2.48 (－2.74, －2.22) 379.82 (279.81, 501.56) 198.45 (155.55, 253.70) －2.45 (－2.71, －2.20) Western Sub-Saharan Africa 1.31 (0.92, 1.76) 1.28 (0.89, 1.81) －0.16 (－0.38, 0.05) 2.52 (1.78, 3.40) 2.53 (1.77, 3.60) －0.07 (－0.31, 0.16) 1.16 (0.82, 1.56) 1.15 (0.79, 1.65) －0.08 (－0.29, 0.13) 45.91 (32.52, 61.87) 46.12 (31.52, 65.96) －0.05 (－0.27, 0.17) GBD: Global Burden of Disease Study; ASIR: Age-standardized incidence rate; 95%UI: 95% uncertainty interval; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized DALY rate; DALY: Disability-adjusted life year. 附表 2 1990－2023年全球204个国家和地区20~60岁人群食管癌疾病负担
Location name ASIR ASPR ASMR ASDR 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% 1990 (95%UI)/(×10－5) 2023 (95%UI)/(×10－5) EAPC (95%CI)/% Chinese Mainland 15.20 (10.39, 18.12) 4.97 (3.99, 6.14) －4.26 (－4.73, －3.79) 30.49 (20.50, 36.49) 12.38 (9.99, 15.34) －3.59 (－4.04, －3.15) 13.18 (9.41, 16.44) 3.89 (2.92, 5.24) －4.59 (－5.08, －4.11) 507.42 (360.35, 632.58) 150.05 (112.87, 201.26) －4.61 (－5.10, －4.12) Democratic People's Republic of Korea 6.25 (4.21, 8.95) 6.19 (3.91, 9.64) －0.34 (－0.44, －0.25) 12.49 (8.38, 17.94) 13.54 (8.57, 21.10) －0.04 (－0.13, 0.06) 5.29 (3.45, 7.61) 5.16 (3.14, 8.06) －0.43 (－0.53, －0.33) 207.49 (134.20, 299.41) 200.70 (122.55, 314.43) －0.45 (－0.54, －0.35) Taiwan, China 6.24 (5.40, 7.15) 9.93 (8.30, 11.61) 1.27 (0.72, 1.82) 13.87 (11.92, 15.99) 27.29 (22.24, 32.62) 1.85 (1.18, 2.52) 5.11 (4.45, 5.88) 7.31 (6.14, 8.49) 0.93 (0.45, 1.41) 201.42 (175.21, 232.06) 286.46 (240.63, 333.16) 0.89 (0.37, 1.41) Cambodia 2.22 (1.43, 3.21) 1.58 (1.07, 2.32) －1.43 (－1.52, －1.34) 4.51 (2.90, 6.57) 3.27 (2.19, 4.81) －1.44 (－1.54, －1.34) 1.81 (1.15, 2.59) 1.35 (0.88, 2.06) －1.27 (－1.36, －1.18) 78.61 (49.97, 113.03) 54.72 (35.75, 83.37) －1.57 (－1.67, －1.47) Indonesia 1.77 (1.20, 2.48) 1.93 (1.24, 2.94) 0.63 (0.47, 0.78) 3.49 (2.38, 4.91) 4.06 (2.60, 6.16) 0.80 (0.65, 0.96) 1.49 (1.03, 2.08) 1.69 (1.09, 2.65) 0.82 (0.66, 0.98) 59.70 (41.03, 83.19) 68.08 (43.87, 106.15) 0.85 (0.69, 1.01) Lao People's Democratic Republic 1.73 (1.07, 2.50) 2.28 (1.52, 3.39) 0.60 (0.35, 0.84) 3.39 (2.10, 4.93) 4.81 (3.18, 7.16) 0.79 (0.51, 1.07) 1.41 (0.88, 1.97) 2.02 (1.32, 3.04) 0.78 (0.55, 1.00) 58.60 (36.72, 81.93) 82.83 (54.21, 124.36) 0.69 (0.44, 0.95) Malaysia 1.19 (0.86, 1.60) 1.14 (0.83, 1.51) －0.23 (－0.33, －0.14) 2.38 (1.72, 3.22) 2.53 (1.84, 3.38) 0.07 (－0.01, 0.16) 1.00 (0.72, 1.35) 0.96 (0.72, 1.29) －0.34 (－0.44, －0.23) 39.30 (28.12, 52.84) 37.74 (27.98, 50.85) －0.32 (－0.42, －0.22) Maldives 1.49 (1.11, 1.90) 0.77 (0.57, 1.02) －2.11 (－2.21, －2.00) 2.96 (2.19, 3.80) 1.84 (1.35, 2.44) －1.49 (－1.63, －1.35) 1.26 (0.92, 1.66) 0.60 (0.44, 0.81) －2.35 (－2.45, －2.25) 49.72 (36.14, 65.83) 23.16 (16.81, 31.44) －2.41 (－2.52, －2.30) Myanmar 2.54 (1.72, 3.52) 2.13 (1.40, 3.22) －1.08 (－1.31, －0.86) 4.96 (3.35, 6.88) 4.49 (2.94, 6.82) －0.89 (－1.13, －0.64) 2.09 (1.42, 2.91) 1.88 (1.23, 2.86) －0.87 (－1.12, －0.62) 87.01 (58.75, 120.95) 76.23 (49.83, 115.99) －0.98 (－1.24, －0.72) Philippines 1.01 (0.75, 1.31) 0.84 (0.66, 1.09) －0.74 (－0.97, －0.52) 2.09 (1.53, 2.71) 1.76 (1.39, 2.31) －0.72 (－0.93, －0.51) 0.86 (0.63, 1.11) 0.71 (0.56, 0.93) －0.75 (－0.98, －0.52) 35.49 (26.09, 45.91) 28.70 (22.49, 37.45) －0.83 (－1.05, －0.61) Sri Lanka 3.74 (2.65, 4.87) 4.27 (3.10, 5.81) －0.58 (－0.89, －0.28) 7.77 (5.45, 10.26) 10.31 (7.40, 14.16) －0.13 (－0.43, 0.18) 3.16 (2.32, 4.15) 3.57 (2.52, 4.96) －0.75 (－1.09, －0.41) 125.65 (91.96, 165.24) 139.32 (98.52, 194.02) －0.85 (－1.19, －0.50) Thailand 4.45 (3.39, 5.53) 5.20 (3.73, 7.15) －0.09 (－0.37, 0.18) 9.13 (6.91, 11.39) 12.40 (8.90, 17.08) 0.36 (0.08, 0.64) 3.77 (2.88, 4.82) 4.21 (2.98, 5.75) －0.34 (－0.64, －0.04) 150.35 (114.07, 192.37) 170.84 (120.18, 234.47) －0.33 (－0.64, －0.01) Timor-Leste 1.81 (1.10, 2.76) 1.88 (1.22, 2.85) －0.11 (－0.39, 0.16) 3.69 (2.21, 5.67) 4.24 (2.72, 6.48) 0.17 (－0.12, 0.46) 1.46 (0.85, 2.29) 1.52 (0.98, 2.28) －0.18 (－0.45, 0.10) 61.24 (35.57, 95.85) 64.07 (41.28, 96.22) －0.13 (－0.44, 0.17) Viet Nam 1.26 (0.89, 1.68) 2.26 (1.34, 3.56) 2.09 (1.88, 2.30) 2.48 (1.75, 3.30) 4.94 (2.94, 7.79) 2.38 (2.19, 2.57) 1.09 (0.76, 1.46) 1.91 (1.05, 2.98) 2.03 (1.83, 2.23) 42.31 (29.45, 56.68) 74.66 (41.17, 116.93) 2.02 (1.83, 2.21) Fiji 1.40 (0.99, 1.90) 1.58 (1.07, 2.35) 0.84 (0.58, 1.11) 2.78 (1.96, 3.79) 3.28 (2.22, 4.89) 0.96 (0.69, 1.23) 1.15 (0.80, 1.58) 1.41 (0.97, 2.08) 0.98 (0.71, 1.24) 46.48 (32.41, 64.07) 57.14 (39.32, 84.17) 0.98 (0.71, 1.24) Kiribati 2.12 (1.44, 2.90) 2.42 (1.48, 3.68) 0.27 (0.15, 0.38) 4.19 (2.84, 5.73) 4.89 (2.99, 7.44) 0.33 (0.21, 0.45) 1.68 (1.16, 2.30) 2.10 (1.28, 3.20) 0.51 (0.39, 0.62) 70.82 (48.47, 96.96) 88.53 (53.87, 134.29) 0.50 (0.38, 0.62) Marshall Islands 1.87 (1.27, 2.67) 1.78 (1.15, 2.63) －0.34 (－0.44, －0.24) 3.60 (2.45, 5.14) 3.51 (2.29, 5.19) －0.26 (－0.38, －0.15) 1.64 (1.11, 2.32) 1.72 (1.15, 2.49) －0.02 (－0.17, 0.13) 65.12 (44.09, 92.32) 67.92 (45.35, 98.83) －0.03 (－0.19, 0.12) Micronesia (Federated States of) 3.30 (2.14, 4.69) 2.26 (1.46, 3.31) －1.14 (－1.22, －1.06) 6.40 (4.16, 9.12) 4.59 (2.98, 6.73) －1.00 (－1.08, －0.93) 2.90 (1.90, 4.07) 1.93 (1.25, 2.83) －1.24 (－1.32, －1.15) 117.21 (76.91, 164.37) 78.91 (51.33, 115.99) －1.20 (－1.28, －1.11) Papua New Guinea 1.43 (0.79, 2.29) 1.39 (0.82, 2.24) －0.49 (－0.61, －0.37) 2.87 (1.58, 4.56) 2.96 (1.74, 4.78) －0.30 (－0.43, －0.18) 1.18 (0.65, 1.80) 1.18 (0.69, 1.92) －0.41 (－0.53, －0.29) 48.17 (26.62, 74.23) 48.85 (28.46, 79.49) －0.33 (－0.45, －0.22) Samoa 0.49 (0.32, 0.69) 0.56 (0.36, 0.83) 1.14 (0.90, 1.38) 0.99 (0.65, 1.40) 1.16 (0.75, 1.73) 0.06 (－0.12, 0.23) 0.41 (0.26, 0.57) 0.51 (0.31, 0.74) 0.23 (0.06, 0.40) 16.23 (10.50, 22.65) 19.88 (12.28, 28.76) 0.18 (0.01, 0.34) Solomon Islands 2.14 (1.18, 3.19) 2.45 (1.53, 3.75) 0.34 (0.15, 0.53) 4.15 (2.29, 6.20) 4.96 (3.12, 7.59) 0.46 (0.28, 0.64) 1.76 (0.96, 2.64) 2.21 (1.36, 3.46) 0.59 (0.37, 0.80) 71.09 (38.99, 106.33) 89.86 (55.33, 140.43) 0.61 (0.40, 0.82) Tonga 1.13 (0.72, 1.57) 1.08 (0.70, 1.62) －0.34 (－0.41, －0.27) 2.32 (1.49, 3.25) 2.33 (1.52, 3.50) －0.21 (－0.28, －0.14) 0.95 (0.61, 1.35) 0.98 (0.63, 1.47) －0.14 (－0.25, －0.04) 38.41 (24.52, 54.47) 39.17 (25.20, 58.98) －0.15 (－0.25, －0.05) Vanuatu 1.61 (0.91, 2.43) 1.54 (1.00, 2.37) －0.49 (－0.67, －0.32) 3.14 (1.78, 4.72) 3.09 (2.00, 4.76) －0.40 (－0.57, －0.23) 1.37 (0.74, 2.14) 1.36 (0.86, 2.08) －0.43 (－0.62, －0.24) 55.56 (30.09, 86.73) 55.24 (35.22, 84.86) －0.41 (－0.59, －0.22) Armenia 1.44 (1.24, 1.69) 0.29 (0.23, 0.35) －4.00 (－4.41, －3.58) 2.88 (2.46, 3.38) 0.59 (0.48, 0.72) －3.92 (－4.33, －3.51) 1.24 (1.05, 1.44) 0.24 (0.19, 0.29) －4.03 (－4.45, －3.62) 48.77 (40.96, 56.71) 9.07 (7.13, 11.20) －4.14 (－4.56, －3.71) Azerbaijan 6.26 (4.86, 7.57) 2.76 (2.03, 3.68) －2.76 (－3.13, －2.40) 12.23 (9.43, 14.86) 5.53 (4.06, 7.41) －2.67 (－3.05, －2.29) 5.47 (4.36, 6.61) 2.42 (1.79, 3.19) －2.73 (－3.09, －2.37) 214.72 (169.87, 260.07) 93.61 (69.20, 124.22) －2.78 (－3.15, －2.42) Georgia 1.33 (1.11, 1.56) 0.60 (0.48, 0.74) －1.44 (－1.91, －0.97) 2.64 (2.20, 3.11) 1.18 (0.95, 1.46) －1.51 (－1.96, －1.06) 1.16 (0.96, 1.38) 0.52 (0.41, 0.66) －1.41 (－1.89, －0.93) 45.41 (37.83, 54.24) 19.88 (15.75, 25.12) －1.55 (－2.01, －1.09) Kazakhstan 10.96 (9.98, 11.96) 2.21 (1.90, 2.55) －4.93 (－5.03, －4.83) 21.23 (19.26, 23.23) 4.56 (3.91, 5.28) －4.68 (－4.78, －4.58) 9.57 (8.71, 10.52) 1.90 (1.63, 2.19) －5.00 (－5.11, －4.90) 370.25 (336.01, 407.10) 74.11 (63.38, 85.70) －5.00 (－5.10, －4.90) Kyrgyzstan 5.35 (4.67, 6.14) 1.10 (0.91, 1.32) －5.21 (－5.41, －5.01) 10.45 (9.06, 11.99) 2.21 (1.84, 2.66) －5.09 (－5.28, －4.89) 4.69 (3.99, 5.42) 0.97 (0.79, 1.17) －5.26 (－5.47, －5.05) 185.27 (157.63, 214.68) 37.45 (30.49, 45.33) －5.31 (－5.52, －5.11) Mongolia 12.39 (8.30, 17.30) 6.71 (5.18, 8.96) －2.44 (－2.62, －2.25) 24.45 (16.19, 34.42) 13.39 (10.26, 17.96) －2.39 (－2.55, －2.22) 10.47 (7.04, 14.92) 6.04 (4.55, 7.96) －2.38 (－2.59, －2.17) 421.81 (280.55, 603.14) 237.83 (179.00, 314.04) －2.45 (－2.65, －2.24) Tajikistan 8.06 (5.96, 9.97) 1.97 (1.32, 3.18) －5.79 (－6.31, －5.26) 15.85 (11.60, 19.71) 4.01 (2.68, 6.45) －5.70 (－6.23, －5.17) 7.00 (5.29, 8.68) 1.74 (1.12, 2.84) －5.87 (－6.42, －5.32) 276.78 (206.58, 344.92) 68.41 (44.27, 111.06) －5.89 (－6.44, －5.34) Turkmenistan 18.03 (15.97, 20.26) 4.71 (3.73, 5.86) －4.14 (－4.67, －3.60) 34.94 (30.79, 39.40) 9.40 (7.44, 11.71) －1.43 (－1.69, －1.17) 15.75 (13.75, 17.78) 4.06 (3.10, 5.12) －4.18 (－4.72, －3.63) 610.97 (531.93, 692.05) 159.56 (122.59, 201.17) －4.14 (－4.65, －3.62) Uzbekistan 9.54 (8.56, 10.61) 2.12 (1.84, 2.43) －4.87 (－5.37, －4.37) 18.76 (16.74, 20.93) 4.43 (3.82, 5.13) －4.70 (－5.20, －4.19) 8.31 (7.47, 9.22) 1.75 (1.52, 2.03) －5.00 (－5.47, －4.53) 325.16 (291.61, 361.16) 69.91 (60.37, 81.03) －4.96 (－5.42, －4.50) Albania 1.11 (0.76, 1.49) 1.02 (0.65, 1.53) 0.12 (－0.11, 0.35) 2.19 (1.50, 2.93) 2.15 (1.39, 3.25) 0.30 (0.09, 0.50) 0.98 (0.68, 1.32) 0.87 (0.53, 1.35) 0.08 (－0.17, 0.34) 38.28 (26.39, 51.99) 34.53 (21.21, 53.22) 0.07 (－0.17, 0.32) Bosnia and Herzegovina 1.78 (1.43, 2.23) 1.29 (0.97, 1.62) －0.68 (－0.81, －0.54) 3.44 (2.75, 4.33) 2.63 (1.98, 3.30) －0.49 (－0.64, －0.35) 1.57 (1.26, 1.99) 1.11 (0.83, 1.38) －0.73 (－0.86, －0.60) 60.61 (48.34, 77.09) 42.73 (31.67, 53.39) －0.75 (－0.88, －0.61) Bulgaria 1.83 (1.63, 2.04) 1.48 (1.25, 1.73) －0.57 (－0.82, －0.32) 3.56 (3.16, 3.98) 2.95 (2.50, 3.47) －0.50 (－0.75, －0.26) 1.60 (1.43, 1.79) 1.27 (1.08, 1.49) －0.60 (－0.85, －0.35) 62.76 (55.97, 70.31) 49.40 (41.82, 57.84) －0.66 (－0.91, －0.41) Croatia 3.11 (2.75, 3.51) 1.79 (1.51, 2.09) －1.88 (－2.10, －1.65) 6.11 (5.39, 6.91) 3.82 (3.22, 4.50) 0.03 (－0.48, 0.54) 2.72 (2.40, 3.07) 1.50 (1.28, 1.75) －1.99 (－2.22, －1.76) 105.95 (93.17, 119.85) 57.92 (49.27, 67.70) －2.03 (－2.26, －1.80) Czechia 2.69 (2.41, 2.98) 2.07 (1.79, 2.39) －1.18 (－1.46, －0.90) 5.59 (4.99, 6.23) 5.13 (4.33, 6.00) 0.66 (0.52, 0.80) 2.28 (2.04, 2.51) 1.61 (1.38, 1.84) －1.44 (－1.70, －1.19) 89.57 (80.41, 98.89) 61.38 (52.61, 70.55) －1.56 (－1.81, －1.30) Hungary 4.74 (4.34, 5.20) 1.80 (1.56, 2.05) －3.35 (－3.93, －2.77) 9.14 (8.36, 10.05) 3.69 (3.17, 4.20) －3.23 (－3.80, －2.65) 4.16 (3.80, 4.56) 1.55 (1.34, 1.76) －3.39 (－3.96, －2.81) 164.41 (149.83, 180.71) 58.93 (50.89, 67.18) －3.59 (－4.15, －3.01) North Macedonia 0.94 (0.75, 1.19) 0.88 (0.65, 1.16) －0.17 (－0.32, －0.02) 1.84 (1.45, 2.31) 1.80 (1.34, 2.37) －0.03 (－0.17, 0.11) 0.83 (0.65, 1.04) 0.75 (0.56, 0.99) －0.23 (－0.38, －0.07) 32.24 (25.39, 40.47) 29.14 (21.47, 38.26) －0.27 (－0.42, －0.11) Montenegro 1.81 (1.36, 2.32) 1.53 (1.11, 2.06) －0.61 (－0.78, －0.44) 3.68 (2.77, 4.71) 3.21 (2.32, 4.34) －0.51 (－0.65, －0.36) 1.56 (1.17, 2.02) 1.30 (0.93, 1.76) －0.68 (－0.86, －0.49) 61.06 (45.62, 78.91) 50.36 (35.99, 68.20) －0.74 (－0.93, －0.56) Poland 2.84 (2.59, 3.11) 1.94 (1.72, 2.16) －1.38 (－1.59, －1.17) 5.42 (4.93, 5.93) 3.85 (3.41, 4.30) －1.27 (－1.49, －1.06) 2.51 (2.28, 2.74) 1.69 (1.51, 1.89) －1.41 (－1.62, －1.20) 98.06 (89.12, 107.11) 64.91 (57.80, 72.70) －1.48 (－1.69, －1.28) Romania 1.43 (1.27, 1.57) 2.09 (1.78, 2.42) 0.82 (0.41, 1.24) 2.78 (2.46, 3.05) 4.16 (3.55, 4.84) 0.89 (0.49, 1.30) 1.25 (1.11, 1.39) 1.81 (1.52, 2.10) 0.79 (0.38, 1.21) 49.54 (43.99, 55.00) 69.58 (58.56, 80.85) 0.65 (0.25, 1.06) Serbia 2.14 (1.52, 2.90) 1.47 (1.06, 1.96) －1.21 (－1.43, －1.00) 4.26 (3.02, 5.80) 3.22 (2.31, 4.33) －0.89 (－1.09, －0.69) 1.85 (1.30, 2.51) 1.23 (0.84, 1.67) －1.37 (－1.59, －1.15) 71.29 (50.17, 97.10) 46.99 (32.23, 64.22) －1.42 (－1.63, －1.20) Slovakia 4.26 (3.37, 5.29) 2.48 (1.85, 3.20) －1.79 (－1.99, －1.58) 8.26 (6.51, 10.29) 5.08 (3.78, 6.58) －1.65 (－1.84, －1.45) 3.71 (2.92, 4.54) 2.14 (1.59, 2.75) －1.82 (－2.03, －1.61) 146.36 (114.57, 179.75) 82.45 (61.04, 106.53) －1.94 (－2.15, －1.74) Slovenia 3.19 (2.80, 3.65) 1.58 (1.30, 1.88) －2.50 (－2.66, －2.33) 6.44 (5.62, 7.39) 3.74 (3.05, 4.50) －1.98 (－2.14, －1.81) 2.75 (2.42, 3.13) 1.25 (1.02, 1.51) －2.75 (－2.92, －2.58) 106.83 (93.88, 121.76) 48.38 (39.83, 58.51) －2.78 (－2.95, －2.61) Belarus 1.98 (1.74, 2.24) 2.78 (2.26, 3.40) 0.33 (0.04, 0.63) 3.93 (3.44, 4.44) 5.98 (4.86, 7.32) 0.67 (0.41, 0.92) 1.72 (1.52, 1.95) 2.32 (1.87, 2.86) 0.17 (－0.14, 0.49) 66.57 (58.54, 75.54) 88.00 (71.05, 108.26) 0.08 (－0.23, 0.39) Estonia 2.64 (2.29, 3.07) 1.57 (1.31, 1.87) －2.07 (－2.31, －1.83) 5.17 (4.47, 6.01) 3.50 (2.89, 4.21) －1.56 (－1.79, －1.32) 2.30 (1.98, 2.68) 1.28 (1.06, 1.54) －2.30 (－2.55, －2.06) 88.17 (75.86, 102.75) 48.33 (39.87, 58.22) －2.38 (－2.63, －2.14) Latvia 2.76 (2.41, 3.15) 2.30 (1.91, 2.75) －1.27 (－1.55, －0.98) 5.41 (4.71, 6.19) 4.79 (3.96, 5.74) －1.00 (－1.29, －0.72) 2.40 (2.11, 2.73) 1.94 (1.60, 2.32) －1.37 (－1.66, －1.08) 92.80 (81.22, 105.60) 73.53 (60.69, 88.35) －1.45 (－1.74, －1.15) Lithuania 2.93 (2.57, 3.32) 2.98 (2.51, 3.48) －0.33 (－0.60, －0.07) 5.79 (5.08, 6.59) 6.28 (5.26, 7.39) －0.13 (－0.36, 0.11) 2.54 (2.23, 2.91) 2.51 (2.10, 2.96) －0.42 (－0.69, －0.14) 98.21 (86.21, 112.96) 95.80 (80.03, 113.48) －0.51 (－0.77, －0.24) Republic of Moldova 1.83 (1.56, 2.14) 1.31 (1.04, 1.62) －1.12 (－1.47, －0.77) 3.53 (3.01, 4.13) 2.61 (2.07, 3.25) －1.01 (－1.37, －0.66) 1.60 (1.38, 1.88) 1.11 (0.86, 1.42) －1.21 (－1.56, －0.85) 61.84 (52.93, 72.63) 41.31 (32.07, 53.04) －1.32 (－1.67, －0.98) Russian Federation 3.81 (3.34, 4.35) 2.31 (2.00, 2.64) －1.65 (－1.90, －1.39) 7.36 (6.46, 8.42) 4.87 (4.17, 5.58) －1.27 (－1.58, －0.96) 3.34 (2.91, 3.78) 1.91 (1.66, 2.19) －1.81 (－2.05, －1.57) 128.02 (111.75, 145.17) 73.54 (63.83, 84.50) －1.80 (－2.05, －1.55) Ukraine 2.19 (1.94, 2.47) 2.29 (1.88, 2.78) －0.37 (－0.54, －0.19) 4.62 (4.04, 5.24) 5.16 (4.21, 6.29) －0.07 (－0.22, 0.09) 1.84 (1.64, 2.07) 1.86 (1.54, 2.26) －0.47 (－0.66, －0.28) 71.94 (63.91, 80.93) 72.06 (59.57, 87.39) －0.50 (－0.68, －0.32) Brunei Darussalam 1.39 (1.07, 1.75) 1.21 (0.88, 1.61) －0.53 (－0.71, －0.36) 2.93 (2.25, 3.71) 2.98 (2.16, 4.00) －0.08 (－0.24, 0.08) 1.13 (0.89, 1.43) 0.96 (0.69, 1.27) －0.71 (－0.87, －0.54) 42.98 (33.83, 54.22) 36.91 (26.79, 49.15) －0.66 (－0.82, －0.49) Japan 3.38 (3.10, 3.68) 2.17 (1.87, 2.47) －1.65 (－2.08, －1.22) 10.30 (9.03, 11.71) 9.26 (7.48, 10.91) －0.57 (－1.12, －0.01) 2.25 (2.10, 2.41) 1.08 (0.97, 1.19) －2.64 (－2.97, －2.30) 85.09 (78.96, 91.41) 41.42 (37.13, 45.70) －2.62 (－2.94, －2.29) Republic of Korea 5.05 (3.75, 6.15) 1.34 (1.02, 1.80) －4.36 (－4.96, －3.76) 10.97 (8.05, 13.40) 5.24 (3.83, 7.27) －2.37 (－2.91, －1.82) 4.13 (3.14, 5.02) 0.74 (0.57, 0.97) －5.74 (－6.34, －5.14) 159.86 (120.72, 194.94) 28.09 (21.89, 37.32) －5.74 (－6.34, －5.13) Singapore 2.63 (2.29, 2.99) 1.17 (0.97, 1.42) －2.62 (－2.81, －2.43) 6.14 (5.24, 7.14) 4.58 (3.58, 5.80) －1.00 (－1.17, －0.83) 2.09 (1.82, 2.37) 0.64 (0.53, 0.75) －3.81 (－4.00, －3.63) 77.82 (67.78, 88.24) 24.39 (20.37, 28.78) －3.76 (－3.95, －3.58) Australia 2.27 (2.05, 2.51) 2.15 (1.87, 2.47) －0.14 (－0.41, 0.14) 6.11 (5.31, 7.05) 7.35 (6.06, 8.87) 0.60 (0.25, 0.95) 1.66 (1.51, 1.82) 1.32 (1.16, 1.50) －0.68 (－0.90, －0.45) 63.66 (57.77, 69.84) 51.09 (45.03, 57.98) －0.66 (－0.90, －0.43) New Zealand 1.93 (1.69, 2.20) 1.80 (1.52, 2.13) －0.50 (－0.70, －0.30) 4.50 (3.85, 5.22) 5.47 (4.45, 6.70) 0.37 (0.20, 0.54) 1.55 (1.36, 1.78) 1.22 (1.03, 1.45) －1.05 (－1.28, －0.82) 59.32 (51.99, 67.99) 47.18 (39.80, 55.78) －1.02 (－1.24, －0.80) Andorra 2.84 (1.90, 4.07) 2.85 (1.86, 4.12) －0.05 (－0.12, 0.01) 6.88 (4.63, 9.91) 8.97 (5.77, 13.06) 0.77 (0.66, 0.88) 2.12 (1.39, 3.01) 2.02 (1.29, 2.87) －0.26 (－0.32, －0.20) 83.47 (54.53, 118.70) 80.31 (51.51, 114.49) －0.24 (－0.31, －0.18) Austria 2.11 (1.89, 2.36) 1.44 (1.22, 1.68) －1.22 (－1.45, －0.99) 4.67 (4.13, 5.29) 4.08 (3.37, 4.89) －0.47 (－0.73, －0.21) 1.74 (1.55, 1.93) 1.02 (0.87, 1.18) －1.66 (－1.88, －1.45) 67.51 (60.01, 75.18) 39.43 (33.53, 45.68) －1.72 (－1.93, －1.52) Belgium 2.94 (2.64, 3.29) 2.32 (1.98, 2.70) －1.00 (－1.42, －0.58) 6.77 (5.99, 7.68) 6.50 (5.36, 7.68) －0.39 (－0.80, 0.01) 2.38 (2.14, 2.63) 1.66 (1.43, 1.91) －1.36 (－1.79, －0.93) 93.56 (84.11, 103.97) 64.49 (55.34, 74.38) －1.44 (－1.85, －1.02) Cyprus 1.06 (0.72, 1.52) 0.92 (0.60, 1.39) －0.38 (－0.49, －0.26) 2.20 (1.49, 3.15) 2.59 (1.68, 3.90) 1.56 (1.23, 1.90) 0.89 (0.60, 1.29) 0.65 (0.42, 0.99) －0.94 (－1.06, －0.81) 34.17 (23.08, 49.63) 25.49 (16.41, 38.43) －0.93 (－1.06, －0.80) Denmark 3.92 (3.47, 4.39) 2.32 (1.98, 2.71) －1.72 (－1.91, －1.52) 8.47 (7.42, 9.54) 6.34 (5.25, 7.55) －0.87 (－1.09, －0.65) 3.26 (2.93, 3.64) 1.69 (1.44, 1.97) －2.21 (－2.39, －2.02) 126.20 (113.09, 140.84) 64.32 (54.51, 74.93) －2.29 (－2.48, －2.09) Finland 2.20 (1.93, 2.49) 2.15 (1.82, 2.53) －0.31 (－0.51, －0.10) 5.87 (4.99, 6.90) 7.18 (5.81, 8.80) 0.44 (0.18, 0.70) 1.62 (1.44, 1.82) 1.35 (1.15, 1.57) －0.85 (－1.04, －0.67) 63.98 (56.57, 71.94) 52.32 (44.51, 61.00) －0.93 (－1.11, －0.75) France 6.88 (6.30, 7.53) 3.14 (2.66, 3.59) －2.56 (－2.76, －2.36) 16.32 (14.62, 18.23) 11.94 (9.61, 14.42) －0.99 (－1.16, －0.82) 5.45 (5.01, 5.93) 1.77 (1.54, 2.01) －3.71 (－3.96, －3.46) 211.99 (194.66, 231.03) 69.25 (60.19, 78.31) －3.77 (－4.02, －3.52) Germany 3.34 (3.07, 3.62) 2.60 (2.28, 2.93) －1.04 (－1.23, －0.85) 7.64 (6.91, 8.46) 7.73 (6.51, 9.14) －0.18 (－0.47, 0.11) 2.70 (2.49, 2.92) 1.77 (1.57, 1.96) －1.60 (－1.75, －1.45) 106.04 (97.90, 114.77) 67.21 (59.61, 74.40) －1.68 (－1.83, －1.54) Greece 1.02 (0.90, 1.15) 1.12 (0.94, 1.31) 0.32 (0.18, 0.45) 2.45 (2.11, 2.84) 3.00 (2.47, 3.59) 0.62 (0.41, 0.83) 0.80 (0.71, 0.89) 0.82 (0.70, 0.96) 0.12 (0.02, 0.22) 31.28 (27.69, 34.90) 31.89 (27.04, 37.32) 0.07 (－0.03, 0.18) Iceland 2.77 (2.38, 3.23) 3.06 (2.51, 3.70) －0.29 (－0.49, －0.08) 6.65 (5.59, 7.85) 9.50 (7.53, 11.82) 0.59 (0.43, 0.75) 2.18 (1.89, 2.54) 2.06 (1.67, 2.53) －0.85 (－1.09, －0.60) 84.42 (73.01, 98.02) 81.34 (65.89, 99.62) －0.80 (－1.04, －0.55) Ireland 3.98 (3.53, 4.46) 3.30 (2.82, 3.88) －0.68 (－0.78, －0.57) 8.91 (7.78, 10.22) 10.07 (8.26, 12.22) 0.42 (0.31, 0.54) 3.26 (2.90, 3.64) 2.23 (1.90, 2.58) －1.37 (－1.49, －1.25) 125.50 (111.47, 140.61) 85.68 (73.14, 99.30) －1.37 (－1.50, －1.24) Israel 0.96 (0.84, 1.10) 0.83 (0.70, 0.98) －0.49 (－0.67, －0.30) 2.12 (1.82, 2.44) 2.32 (1.89, 2.79) 0.28 (0.08, 0.48) 0.80 (0.69, 0.90) 0.59 (0.50, 0.71) －0.92 (－1.11, －0.73) 30.80 (26.81, 34.91) 23.15 (19.61, 27.42) －0.93 (－1.13, －0.73) Italy 2.31 (2.05, 2.57) 0.98 (0.84, 1.14) －2.58 (－2.70, －2.47) 5.27 (4.63, 5.98) 2.82 (2.37, 3.36) －1.92 (－1.99, －1.85) 1.88 (1.67, 2.08) 0.70 (0.61, 0.80) －2.97 (－3.12, －2.82) 73.04 (65.00, 81.10) 27.41 (23.66, 31.29) －2.98 (－3.13, －2.82) Luxembourg 3.32 (2.87, 3.87) 2.15 (1.76, 2.61) －1.85 (－2.07, －1.62) 7.34 (6.24, 8.62) 6.08 (4.83, 7.54) －1.07 (－1.33, －0.80) 2.74 (2.35, 3.18) 1.54 (1.25, 1.87) －2.31 (－2.52, －2.09) 106.99 (91.83, 124.31) 58.86 (47.70, 71.36) －2.39 (－2.59, －2.18) Malta 1.52 (1.29, 1.76) 1.35 (1.09, 1.65) 0.04 (－0.07, 0.16) 3.39 (2.87, 3.95) 3.68 (2.91, 4.58) 0.73 (0.58, 0.89) 1.26 (1.08, 1.46) 0.98 (0.80, 1.19) －0.37 (－0.48, －0.27) 48.51 (41.60, 56.39) 37.67 (30.56, 45.74) －0.39 (－0.50, －0.29) Netherlands 3.17 (2.88, 3.49) 3.36 (2.95, 3.82) －0.10 (－0.48, 0.29) 7.09 (6.32, 7.94) 9.33 (7.91, 10.98) 0.68 (0.27, 1.09) 2.60 (2.37, 2.86) 2.41 (2.12, 2.72) －0.57 (－0.94, －0.19) 101.22 (91.97, 111.33) 93.55 (81.94, 105.60) －0.63 (－0.99, －0.26) Norway 1.40 (1.21, 1.61) 1.56 (1.30, 1.85) 0.42 (0.22, 0.61) 3.22 (2.75, 3.77) 4.65 (3.79, 5.65) 1.18 (0.96, 1.40) 1.13 (0.98, 1.30) 1.08 (0.91, 1.28) －0.03 (－0.22, 0.15) 43.10 (37.54, 49.53) 42.13 (35.45, 49.80) －0.04 (－0.22, 0.14) Portugal 3.29 (2.94, 3.69) 3.27 (2.76, 3.82) －0.07 (－0.51, 0.38) 7.70 (6.73, 8.83) 10.15 (8.22, 12.29) 0.74 (0.18, 1.31) 2.64 (2.38, 2.94) 2.20 (1.86, 2.55) －0.59 (－0.96, －0.22) 104.22 (93.79, 116.33) 84.02 (71.16, 97.50) －0.73 (－1.12, －0.34) Spain 3.69 (3.39, 4.05) 1.69 (1.46, 1.91) －2.62 (－2.74, －2.49) 8.25 (7.47, 9.18) 4.96 (4.13, 5.83) －1.77 (－1.92, －1.63) 3.03 (2.79, 3.31) 1.17 (1.03, 1.32) －3.14 (－3.26, －3.02) 118.91 (109.21, 130.41) 45.11 (39.38, 50.76) －3.24 (－3.36, －3.11) Sweden 1.63 (1.44, 1.83) 1.30 (1.12, 1.50) －0.90 (－1.13, －0.66) 4.06 (3.52, 4.68) 3.67 (3.05, 4.35) －0.55 (－0.78, －0.31) 1.25 (1.12, 1.40) 0.93 (0.81, 1.07) －1.09 (－1.33, －0.85) 49.07 (43.77, 54.67) 36.25 (31.26, 41.83) －1.12 (－1.34, －0.90) Switzerland 3.82 (3.38, 4.27) 1.65 (1.40, 1.92) －2.50 (－2.66, －2.33) 9.05 (7.89, 10.34) 5.13 (4.21, 6.16) －1.69 (－1.84, －1.53) 3.03 (2.70, 3.36) 1.09 (0.94, 1.25) －3.02 (－3.20, －2.85) 117.94 (104.51, 130.97) 42.46 (36.28, 48.67) －3.07 (－3.24, －2.90) United Kingdom 3.48 (3.18, 3.83) 3.47 (3.13, 3.83) －0.46 (－0.72, －0.20) 7.73 (6.90, 8.66) 9.08 (7.88, 10.32) 0.10 (－0.17, 0.38) 2.86 (2.61, 3.12) 2.61 (2.38, 2.87) －0.77 (－1.02, －0.52) 110.41 (100.51, 120.61) 102.10 (92.80, 112.47) －0.72 (－0.97, －0.47) Argentina 4.30 (3.94, 4.70) 2.03 (1.74, 2.33) －2.41 (－2.60, －2.21) 8.67 (7.90, 9.52) 4.59 (3.90, 5.32) －2.12 (－2.32, －1.91) 3.71 (3.41, 4.03) 1.64 (1.41, 1.87) －2.55 (－2.75, －2.35) 142.82 (131.02, 155.14) 63.70 (54.91, 72.68) －2.55 (－2.75, －2.34) Chile 3.07 (2.77, 3.39) 1.05 (0.90, 1.21) －3.42 (－3.55, －3.29) 6.32 (5.66, 7.04) 2.75 (2.30, 3.24) －2.72 (－2.86, －2.59) 2.62 (2.37, 2.89) 0.78 (0.67, 0.89) －3.81 (－3.92, －3.69) 101.82 (91.97, 112.76) 31.00 (26.75, 35.48) －3.72 (－3.84, －3.61) Uruguay 4.74 (4.25, 5.33) 2.81 (2.37, 3.25) －2.04 (－2.29, －1.79) 9.73 (8.67, 10.99) 6.47 (5.40, 7.55) －1.69 (－1.94, －1.45) 4.06 (3.63, 4.55) 2.28 (1.91, 2.68) －2.20 (－2.45, －1.95) 155.06 (138.61, 173.88) 88.45 (74.00, 103.78) －2.18 (－2.43, －1.93) Canada 2.29 (2.07, 2.51) 2.17 (1.89, 2.51) －0.19 (－0.33, －0.05) 5.92 (5.17, 6.77) 6.86 (5.70, 8.23) 0.44 (0.26, 0.62) 1.73 (1.57, 1.88) 1.43 (1.26, 1.63) －0.61 (－0.74, －0.49) 66.29 (60.23, 72.42) 55.78 (48.83, 63.76) －0.58 (－0.70, －0.45) United States of America 2.74 (2.47, 3.03) 2.28 (2.01, 2.56) －0.68 (－0.83, －0.53) 7.03 (6.17, 8.06) 6.64 (5.64, 7.77) －0.35 (－0.54, －0.16) 2.06 (1.89, 2.25) 1.61 (1.44, 1.78) －0.88 (－1.01, －0.75) 79.68 (72.87, 87.12) 62.71 (56.10, 69.82) －0.86 (－0.99, －0.73) Antigua and Barbuda 2.13 (1.78, 2.51) 1.53 (1.21, 1.91) －0.97 (－1.21, －0.74) 4.34 (3.63, 5.13) 3.34 (2.62, 4.21) －0.75 (－0.98, －0.52) 1.81 (1.49, 2.15) 1.26 (0.97, 1.62) －1.10 (－1.33, －0.86) 70.44 (58.18, 83.53) 49.38 (38.35, 63.43) －1.06 (－1.29, －0.82) Bahamas 5.47 (4.60, 6.41) 4.24 (3.43, 5.24) －0.33 (－0.57, －0.09) 10.82 (9.11, 12.69) 8.94 (7.20, 11.04) －0.15 (－0.38, 0.08) 4.76 (4.00, 5.59) 3.59 (2.83, 4.55) －0.35 (－0.67, －0.04) 187.56 (157.09, 219.95) 143.66 (113.55, 181.65) －0.31 (－0.63, 0.00) Barbados 3.86 (3.30, 4.51) 3.83 (3.06, 4.67) －0.21 (－0.41, －0.02) 7.91 (6.70, 9.24) 8.38 (6.69, 10.29) －0.03 (－0.22, 0.16) 3.30 (2.83, 3.83) 3.21 (2.52, 3.93) －0.23 (－0.44, －0.02) 129.17 (110.86, 150.43) 125.47 (98.96, 153.82) －0.24 (－0.45, －0.04) Belize 1.40 (1.19, 1.65) 1.64 (1.33, 2.02) 0.64 (0.36, 0.92) 2.83 (2.41, 3.36) 3.44 (2.78, 4.20) 0.73 (0.48, 0.98) 1.21 (1.03, 1.43) 1.40 (1.12, 1.73) 0.63 (0.35, 0.91) 47.40 (40.23, 55.90) 55.45 (44.42, 68.23) 0.64 (0.37, 0.92) Cuba 2.35 (2.07, 2.64) 3.01 (2.33, 3.84) 1.50 (1.16, 1.85) 4.98 (4.34, 5.64) 6.62 (5.12, 8.48) －1.62 (－1.84, －1.40) 1.98 (1.72, 2.24) 2.50 (1.90, 3.27) 1.48 (1.13, 1.84) 77.95 (67.53, 87.92) 95.13 (72.56, 124.25) 1.36 (1.01, 1.71) Dominica 2.42 (1.86, 3.12) 2.46 (1.70, 3.63) 0.71 (0.32, 1.10) 4.88 (3.74, 6.27) 5.02 (3.45, 7.37) 0.41 (0.30, 0.52) 2.09 (1.60, 2.69) 2.09 (1.46, 3.04) 0.38 (0.24, 0.52) 83.15 (63.33, 106.96) 82.07 (57.25, 119.35) 0.33 (0.19, 0.47) Dominican Republic 1.56 (1.17, 1.97) 1.78 (1.21, 2.57) 0.71 (0.32, 1.10) 3.14 (2.34, 3.96) 3.60 (2.46, 5.21) 0.74 (0.35, 1.13) 1.35 (1.01, 1.71) 1.58 (1.06, 2.30) 0.72 (0.32, 1.12) 53.68 (40.28, 67.89) 61.82 (41.15, 89.71) 0.69 (0.28, 1.09) Grenada 4.32 (3.52, 5.27) 3.68 (2.81, 4.73) －0.36 (－0.53, －0.19) 8.56 (6.99, 10.39) 7.56 (5.78, 9.68) －0.27 (－0.44, －0.11) 3.72 (3.00, 4.55) 3.20 (2.39, 4.31) －0.34 (－0.52, －0.17) 146.54 (118.23, 178.95) 125.08 (93.64, 168.54) －0.37 (－0.54, －0.20) Guyana 1.41 (1.17, 1.66) 1.62 (1.28, 2.05) 0.14 (－0.08, 0.35) 2.68 (2.23, 3.17) 3.19 (2.51, 4.03) 0.19 (－0.03, 0.41) 1.24 (1.03, 1.48) 1.44 (1.09, 1.93) 0.19 (－0.05, 0.42) 48.18 (40.22, 57.38) 56.62 (42.88, 75.26) 0.22 (－0.01, 0.44) Haiti 2.92 (1.90, 4.11) 3.11 (2.04, 4.68) 0.34 (0.06, 0.61) 5.63 (3.66, 7.96) 6.08 (3.98, 9.18) 0.38 (0.08, 0.68) 2.41 (1.57, 3.35) 2.79 (1.86, 4.19) 0.45 (0.21, 0.69) 99.15 (64.21, 137.76) 111.81 (74.31, 167.98) 0.40 (0.13, 0.67) Jamaica 1.75 (1.48, 2.06) 2.26 (1.74, 2.89) 0.87 (0.42, 1.32) 3.54 (2.98, 4.20) 4.79 (3.67, 6.11) 1.02 (0.57, 1.46) 1.50 (1.25, 1.76) 2.03 (1.53, 2.70) 1.05 (0.56, 1.55) 57.79 (48.19, 67.84) 79.99 (60.55, 106.17) 1.17 (0.66, 1.68) Saint Lucia 3.55 (2.94, 4.26) 2.72 (2.07, 3.52) －0.59 (－0.79, －0.40) 7.06 (5.82, 8.47) 5.75 (4.36, 7.45) －0.41 (－0.60, －0.22) 3.10 (2.52, 3.78) 2.31 (1.71, 3.13) －0.63 (－0.85, －0.42) 122.25 (99.60, 149.06) 91.82 (68.32, 123.66) －0.63 (－0.84, －0.41) Saint Vincent and the Grenadines 1.82 (1.49, 2.20) 1.97 (1.49, 2.59) 0.57 (0.34, 0.79) 3.62 (2.96, 4.36) 3.97 (2.99, 5.21) 0.59 (0.38, 0.80) 1.59 (1.28, 1.97) 1.71 (1.26, 2.28) 0.54 (0.31, 0.77) 62.68 (50.57, 77.49) 66.64 (48.94, 88.45) 0.49 (0.27, 0.70) Suriname 1.19 (0.84, 1.58) 1.14 (0.79, 1.59) 0.08 (－0.03, 0.20) 2.33 (1.65, 3.09) 2.30 (1.60, 3.21) 0.17 (0.06, 0.29) 1.05 (0.76, 1.37) 0.94 (0.65, 1.33) －0.00 (－0.16, 0.16) 40.97 (29.58, 53.68) 37.13 (25.59, 52.84) 0.02 (－0.14, 0.19) Trinidad and Tobago 1.78 (1.55, 2.05) 1.57 (1.30, 1.91) －0.45 (－0.71, －0.20) 3.49 (3.03, 4.01) 3.28 (2.69, 3.99) －0.23 (－0.48, 0.01) 1.55 (1.35, 1.79) 1.33 (1.09, 1.66) －0.49 (－0.78, －0.20) 60.03 (52.21, 69.45) 52.08 (42.50, 64.79) －0.45 (－0.73, －0.17) Bolivia (Plurinational State of) 1.19 (0.86, 1.61) 1.21 (0.83, 1.72) 0.20 (0.10, 0.29) 2.34 (1.69, 3.17) 2.47 (1.70, 3.53) 0.31 (0.21, 0.42) 1.00 (0.71, 1.36) 1.07 (0.72, 1.52) 0.61 (0.35, 0.86) 40.84 (28.85, 55.48) 42.24 (28.64, 60.06) 0.51 (0.26, 0.75) Ecuador 1.29 (1.13, 1.44) 0.52 (0.45, 0.61) －3.24 (－3.45, －3.02) 2.59 (2.28, 2.92) 1.19 (1.01, 1.41) －2.95 (－3.18, －2.72) 1.11 (0.98, 1.24) 0.43 (0.37, 0.50) －3.33 (－3.54, －3.11) 44.60 (39.25, 49.98) 17.67 (15.20, 20.60) －3.31 (－3.53, －3.10) Peru 0.78 (0.59, 0.99) 0.40 (0.30, 0.53) －2.07 (－2.44, －1.70) 1.58 (1.19, 2.02) 0.92 (0.67, 1.24) －1.68 (－2.02, －1.33) 0.65 (0.50, 0.83) 0.31 (0.23, 0.42) －2.21 (－2.61, －1.81) 26.44 (20.10, 33.53) 12.72 (9.37, 17.26) －2.20 (－2.60, －1.81) Colombia 2.00 (1.80, 2.20) 0.69 (0.60, 0.79) －2.99 (－3.13, －2.85) 4.09 (3.66, 4.53) 1.67 (1.43, 1.96) －2.50 (－2.63, －2.37) 1.73 (1.56, 1.91) 0.54 (0.47, 0.62) －3.22 (－3.37, －3.08) 68.83 (62.00, 76.20) 21.89 (19.00, 25.00) －3.23 (－3.36, －3.09) Costa Rica 1.31 (1.13, 1.49) 0.78 (0.66, 0.93) －1.97 (－2.18, －1.76) 2.84 (2.43, 3.27) 1.92 (1.60, 2.31) －1.56 (－1.78, －1.35) 1.09 (0.94, 1.24) 0.61 (0.51, 0.72) －2.17 (－2.38, －1.96) 42.69 (37.11, 48.58) 24.34 (20.54, 28.65) －2.13 (－2.34, －1.92) El Salvador 1.33 (1.05, 1.65) 1.15 (0.86, 1.51) －0.58 (－0.78, －0.39) 2.71 (2.13, 3.35) 2.52 (1.87, 3.30) －0.37 (－0.54, －0.20) 1.15 (0.90, 1.43) 0.99 (0.72, 1.33) －0.60 (－0.84, －0.35) 46.54 (36.53, 58.35) 39.45 (28.39, 52.74) －0.65 (－0.88, －0.41) Guatemala 1.63 (1.43, 1.86) 0.85 (0.67, 1.04) －2.28 (－2.43, －2.13) 3.28 (2.86, 3.75) 1.80 (1.43, 2.21) －2.16 (－2.33, －2.00) 1.45 (1.26, 1.65) 0.72 (0.57, 0.92) －2.41 (－2.55, －2.27) 59.58 (51.91, 67.86) 29.21 (23.09, 36.90) －2.50 (－2.64, －2.36) Honduras 0.53 (0.37, 0.71) 0.42 (0.28, 0.62) －0.72 (－0.80, －0.65) 1.07 (0.74, 1.45) 0.88 (0.59, 1.31) －0.60 (－0.68, －0.53) 0.45 (0.32, 0.61) 0.36 (0.24, 0.54) －0.70 (－0.80, －0.61) 18.29 (12.94, 24.83) 15.00 (9.97, 22.36) －0.61 (－0.71, －0.51) Mexico 1.07 (0.95, 1.21) 0.71 (0.61, 0.83) －0.85 (－0.96, －0.75) 2.19 (1.93, 2.49) 1.57 (1.33, 1.86) －0.66 (－0.76, －0.57) 0.92 (0.82, 1.03) 0.60 (0.52, 0.69) －0.94 (－1.05, －0.84) 37.07 (32.91, 41.66) 24.33 (21.03, 27.91) －0.93 (－1.04, －0.82) Nicaragua 0.78 (0.57, 1.02) 0.58 (0.40, 0.82) －0.56 (－0.67, －0.45) 1.61 (1.18, 2.13) 1.29 (0.90, 1.84) －0.37 (－0.47, －0.27) 0.67 (0.49, 0.89) 0.49 (0.33, 0.71) －0.62 (－0.73, －0.51) 26.90 (19.60, 35.77) 19.51 (13.22, 28.41) －0.66 (－0.76, －0.56) Panama 0.76 (0.66, 0.87) 0.55 (0.46, 0.65) －0.77 (－1.08, －0.47) 1.62 (1.39, 1.86) 1.31 (1.08, 1.59) －0.44 (－0.74, －0.15) 0.65 (0.56, 0.74) 0.44 (0.36, 0.52) －0.93 (－1.24, －0.61) 25.68 (22.26, 29.41) 17.36 (14.22, 20.89) －0.93 (－1.24, －0.62) Venezuela (Bolivarian Republic of) 1.55 (1.38, 1.75) 1.03 (0.84, 1.26) －1.11 (－1.38, －0.84) 3.11 (2.75, 3.52) 2.17 (1.76, 2.66) －0.89 (－1.13, －0.65) 1.34 (1.20, 1.52) 0.89 (0.71, 1.09) －1.13 (－1.45, －0.81) 52.46 (46.65, 59.45) 35.18 (28.15, 43.21) －1.10 (－1.39, －0.80) Brazil 4.84 (4.33, 5.32) 3.06 (2.83, 3.31) －1.13 (－1.33, －0.93) 9.56 (8.53, 10.55) 6.45 (5.92, 7.02) －0.96 (－1.15, －0.76) 4.21 (3.78, 4.64) 2.59 (2.40, 2.80) －1.20 (－1.40, －0.99) 165.39 (148.41, 181.96) 101.24 (93.67, 109.63) －1.23 (－1.44, －1.02) Paraguay 2.07 (1.65, 2.53) 2.84 (2.21, 3.70) 0.89 (0.77, 1.02) 4.13 (3.27, 5.04) 5.77 (4.46, 7.54) 0.94 (0.82, 1.06) 1.80 (1.43, 2.18) 2.29 (1.78, 2.95) 0.81 (0.63, 0.98) 69.85 (55.58, 85.24) 88.81 (68.74, 114.91) 0.80 (0.62, 0.98) Algeria 0.50 (0.34, 0.71) 0.49 (0.31, 0.74) －0.00 (－0.12, 0.11) 1.05 (0.71, 1.48) 1.15 (0.74, 1.73) 0.35 (0.22, 0.48) 0.43 (0.28, 0.60) 0.42 (0.26, 0.62) －0.02 (－0.12, 0.09) 17.28 (11.26, 24.02) 16.42 (10.37, 24.47) －0.07 (－0.18, 0.04) Bahrain 1.35 (1.05, 1.72) 0.79 (0.54, 1.13) －2.46 (－2.78, －2.14) 2.73 (2.12, 3.51) 1.98 (1.34, 2.84) －1.75 (－2.06, －1.43) 1.14 (0.87, 1.44) 0.64 (0.43, 0.91) －2.69 (－3.04, －2.34) 44.09 (33.76, 56.01) 25.00 (16.75, 35.54) －2.64 (－2.98, －2.30) Egypt 0.76 (0.46, 0.98) 0.56 (0.40, 0.76) －1.45 (－1.63, －1.27) 1.51 (0.92, 1.96) 1.25 (0.89, 1.73) －1.17 (－1.36, －0.99) 0.65 (0.42, 0.85) 0.48 (0.33, 0.67) －1.53 (－1.74, －1.33) 26.11 (16.65, 33.97) 19.03 (13.11, 26.36) －1.62 (－1.83, －1.40) Iran (Islamic Republic of) 2.63 (1.88, 3.52) 1.76 (1.29, 2.33) －1.49 (－1.63, －1.35) 5.51 (3.92, 7.38) 4.72 (3.38, 6.34) －0.80 (－0.99, －0.61) 2.22 (1.60, 2.98) 1.29 (0.94, 1.72) －1.81 (－1.93, －1.68) 87.68 (63.23, 117.86) 51.88 (37.65, 69.61) －1.74 (－1.87, －1.61) Iraq 0.91 (0.62, 1.27) 1.14 (0.80, 1.56) 0.53 (0.45, 0.61) 1.88 (1.27, 2.65) 2.86 (1.96, 3.99) 1.12 (1.01, 1.23) 0.73 (0.50, 1.02) 0.89 (0.62, 1.23) 0.50 (0.42, 0.59) 29.40 (20.02, 41.18) 36.26 (24.97, 50.10) 0.53 (0.45, 0.62) Jordan 1.10 (0.76, 1.52) 0.70 (0.50, 0.98) －1.68 (－1.82, －1.55) 2.33 (1.60, 3.24) 1.77 (1.26, 2.51) －1.03 (－1.16, －0.91) 0.93 (0.64, 1.31) 0.58 (0.41, 0.80) －1.66 (－1.79, －1.53) 37.22 (25.70, 52.59) 22.71 (16.15, 31.54) －1.69 (－1.82, －1.56) Kuwait 1.24 (1.07, 1.44) 0.45 (0.38, 0.53) －3.59 (－3.83, －3.35) 2.92 (2.48, 3.43) 1.38 (1.12, 1.66) －2.80 (－3.01, －2.58) 0.99 (0.85, 1.14) 0.30 (0.26, 0.36) －4.05 (－4.31, －3.80) 38.63 (33.10, 44.40) 12.21 (10.25, 14.51) －4.01 (－4.26, －3.75) Lebanon 0.38 (0.26, 0.52) 0.70 (0.48, 0.97) 2.24 (1.69, 2.79) 0.77 (0.54, 1.08) 1.78 (1.23, 2.49) 2.89 (2.36, 3.42) 0.29 (0.20, 0.42) 0.51 (0.34, 0.77) 2.12 (1.56, 2.69) 11.70 (7.85, 16.80) 20.22 (13.52, 30.12) 2.02 (1.49, 2.55) Libya 0.83 (0.52, 1.17) 0.71 (0.42, 1.09) －0.41 (－0.54, －0.28) 1.71 (1.06, 2.43) 1.57 (0.93, 2.40) －0.21 (－0.37, －0.05) 0.74 (0.45, 1.04) 0.62 (0.35, 0.95) －0.41 (－0.51, －0.32) 29.13 (17.80, 40.94) 24.73 (14.04, 37.55) －0.40 (－0.50, －0.30) Morocco 0.47 (0.31, 0.69) 0.56 (0.34, 0.86) 0.58 (0.41, 0.75) 0.92 (0.60, 1.36) 1.22 (0.75, 1.93) 0.89 (0.71, 1.08) 0.42 (0.27, 0.62) 0.54 (0.33, 0.79) 0.94 (0.70, 1.17) 16.17 (10.58, 23.87) 21.03 (12.89, 31.32) 0.99 (0.76, 1.23) Palestine 0.59 (0.41, 0.83) 0.40 (0.29, 0.56) －1.50 (－1.60, －1.40) 1.21 (0.85, 1.71) 0.93 (0.67, 1.31) －1.13 (－1.24, －1.03) 0.49 (0.35, 0.71) 0.32 (0.23, 0.45) －1.68 (－1.79, －1.58) 19.71 (13.94, 28.15) 12.32 (8.80, 17.52) －1.77 (－1.89, －1.66) Oman 0.86 (0.59, 1.19) 0.59 (0.39, 0.86) 0.82 (0.41, 1.24) 1.75 (1.18, 2.42) 1.45 (0.96, 2.14) －0.69 (－0.80, －0.58) 0.76 (0.52, 1.02) 0.45 (0.30, 0.65) －1.62 (－1.79, －1.46) 29.68 (20.49, 40.23) 18.05 (12.14, 26.05) －1.58 (－1.73, －1.43) Qatar 1.42 (0.87, 1.99) 0.34 (0.22, 0.57) －5.48 (－6.04, －4.91) 2.98 (1.79, 4.16) 0.97 (0.62, 1.64) －4.64 (－5.22, －4.06) 1.20 (0.74, 1.67) 0.24 (0.15, 0.37) －6.02 (－6.60, －5.43) 46.57 (28.42, 64.92) 9.56 (6.03, 14.82) －5.98 (－6.59, －5.38) Saudi Arabia 1.29 (0.91, 1.70) 0.73 (0.50, 1.14) －1.85 (－2.24, －1.46) 2.61 (1.85, 3.45) 1.91 (1.30, 3.00) －1.08 (－1.45, －0.72) 1.12 (0.80, 1.43) 0.58 (0.40, 0.89) －2.11 (－2.51, －1.70) 44.26 (31.52, 56.84) 23.83 (16.36, 36.73) －2.01 (－2.44, －1.58) Syrian Arab Republic 0.45 (0.33, 0.60) 0.35 (0.25, 0.48) －1.06 (－1.22, －0.89) 0.94 (0.69, 1.24) 0.80 (0.58, 1.11) －0.69 (－0.88, －0.51) 0.38 (0.28, 0.51) 0.27 (0.19, 0.38) －1.29 (－1.46, －1.12) 15.31 (11.13, 20.31) 10.68 (7.60, 14.77) －1.37 (－1.53, －1.20) Tunisia 0.55 (0.38, 0.77) 0.69 (0.50, 0.95) 0.13 (－0.13, 0.38) 1.19 (0.82, 1.68) 1.71 (1.25, 2.40) 0.56 (0.30, 0.81) 0.44 (0.30, 0.63) 0.47 (0.34, 0.63) －0.15 (－0.24, －0.07) 17.71 (11.99, 25.18) 18.25 (13.35, 24.65) －0.20 (－0.29, －0.12) Turkey 1.55 (1.09, 2.11) 0.92 (0.66, 1.27) －2.14 (－2.40, －1.88) 3.19 (2.22, 4.34) 2.40 (1.68, 3.36) 0.68 (0.61, 0.75) 1.32 (0.94, 1.76) 0.70 (0.48, 0.99) －2.50 (－2.78, －2.22) 53.30 (37.79, 71.19) 28.06 (19.40, 39.80) －2.54 (－2.82, －2.25) United Arab Emirates 1.08 (0.61, 1.69) 0.20 (0.13, 0.30) －6.64 (－7.43, －5.85) 2.10 (1.17, 3.31) 0.48 (0.31, 0.70) －6.10 (－6.85, －5.34) 0.94 (0.50, 1.44) 0.16 (0.10, 0.24) －6.98 (－7.80, －6.14) 35.67 (19.07, 55.14) 6.30 (3.95, 9.39) －6.79 (－7.58, －5.99) Yemen 1.67 (0.74, 2.46) 1.40 (0.68, 2.16) －0.62 (－0.70, －0.53) 3.21 (1.41, 4.71) 2.86 (1.38, 4.39) －0.41 (－0.50, －0.32) 1.42 (0.64, 2.07) 1.17 (0.52, 1.79) －0.69 (－0.78, －0.59) 54.84 (24.49, 79.62) 45.72 (20.49, 70.15) －0.65 (－0.75, －0.55) Afghanistan 1.34 (0.65, 2.09) 1.30 (0.62, 2.22) 0.09 (－0.06, 0.24) 2.53 (1.22, 3.92) 2.54 (1.22, 4.35) 0.23 (0.08, 0.38) 1.19 (0.50, 1.91) 1.15 (0.54, 1.96) 0.01 (－0.10, 0.12) 46.81 (19.45, 74.79) 45.69 (21.06, 77.18) 0.05 (－0.07, 0.16) Bangladesh 5.49 (3.52, 7.73) 7.99 (5.17, 12.20) 0.35 (－0.08, 0.78) 10.91 (6.97, 15.47) 17.52 (11.21, 27.11) 0.59 (0.12, 1.05) 4.49 (2.89, 6.32) 6.79 (4.28, 10.28) 0.55 (0.10, 1.01) 186.24 (119.20, 262.67) 279.45 (176.29, 424.38) 0.50 (0.02, 0.98) Bhutan 3.16 (1.93, 4.88) 4.65 (2.78, 7.35) 0.65 (0.49, 0.80) 6.18 (3.75, 9.59) 9.96 (5.98, 15.91) 0.93 (0.77, 1.09) 2.82 (1.62, 4.28) 4.47 (2.57, 7.23) 0.82 (0.67, 0.98) 112.38 (64.25, 171.70) 184.44 (106.52, 297.53) 0.93 (0.78, 1.09) India 2.57 (1.95, 3.38) 4.80 (3.47, 6.35) 1.74 (1.24, 2.25) 4.99 (3.79, 6.59) 10.11 (7.31, 13.46) 1.98 (1.45, 2.51) 2.24 (1.72, 3.00) 4.40 (3.14, 5.90) 1.88 (1.32, 2.44) 89.20 (68.19, 119.46) 179.62 (127.29, 242.13) 1.96 (1.40, 2.52) Nepal 2.64 (1.62, 3.86) 3.25 (2.09, 4.88) 0.10 (－0.09, 0.30) 5.16 (3.15, 7.62) 6.79 (4.37, 10.19) 0.33 (0.13, 0.53) 2.19 (1.30, 3.14) 2.91 (1.79, 4.44) 0.19 (－0.04, 0.41) 89.51 (53.08, 130.06) 120.90 (74.88, 184.71) 0.33 (0.11, 0.55) Pakistan 5.29 (3.67, 7.33) 5.77 (4.02, 8.32) 0.35 (0.26, 0.44) 10.35 (7.17, 14.40) 11.58 (8.03, 16.79) 0.44 (0.34, 0.54) 4.58 (3.12, 6.44) 5.29 (3.55, 7.76) 0.58 (0.44, 0.72) 182.11 (124.62, 256.34) 209.59 (140.72, 308.54) 0.57 (0.43, 0.72) Angola 4.76 (2.64, 6.65) 3.91 (2.51, 5.77) －0.77 (－0.96, －0.58) 9.08 (5.03, 12.76) 7.67 (4.93, 11.32) －0.68 (－0.88, －0.49) 4.07 (2.33, 5.80) 3.46 (2.12, 5.15) －0.68 (－0.87, －0.49) 165.28 (94.39, 236.00) 138.63 (85.25, 206.87) －0.72 (－0.91, －0.52) Central African Republic 4.87 (2.55, 7.14) 4.08 (2.42, 6.58) －0.91 (－1.26, －0.56) 9.21 (4.83, 13.57) 7.78 (4.62, 12.49) －0.86 (－1.24, －0.49) 3.47 (1.98, 5.16) 3.24 (1.98, 5.20) －0.94 (－1.24, －0.65) 142.05 (80.65, 211.59) 131.31 (80.09, 211.50) －0.98 (－1.29, －0.68) Congo 4.80 (2.68, 6.67) 3.80 (2.31, 5.85) 0.44 (0.14, 0.74) 9.35 (5.20, 13.03) 7.37 (4.45, 11.39) －0.83 (－1.01, －0.65) 3.74 (2.21, 5.30) 3.79 (2.32, 5.66) －0.33 (－0.50, －0.15) 156.27 (91.93, 222.11) 149.84 (91.14, 225.28) －0.53 (－0.73, －0.34) Democratic Republic of the Congo 4.63 (2.46, 6.75) 5.48 (3.40, 8.56) 0.44 (0.14, 0.74) 8.99 (4.76, 13.10) 10.94 (6.77, 17.11) 0.53 (0.21, 0.85) 4.04 (2.34, 5.86) 4.83 (2.99, 7.65) 0.45 (0.15, 0.76) 164.82 (95.09, 239.19) 196.33 (121.63, 311.18) 0.45 (0.13, 0.76) Equatorial Guinea 5.34 (2.85, 7.68) 5.34 (3.09, 8.54) －0.28 (－0.47, －0.09) 10.06 (5.36, 14.47) 10.59 (6.11, 17.11) －0.14 (－0.34, 0.07) 4.70 (2.73, 6.70) 6.42 (3.67, 9.92) 0.25 (－0.02, 0.53) 189.81 (110.02, 270.44) 255.17 (145.07, 395.57) 0.17 (－0.11, 0.45) Gabon 4.15 (2.35, 5.89) 4.01 (2.62, 5.96) －0.19 (－0.37, －0.00) 8.09 (4.59, 11.49) 8.04 (5.24, 11.98) －0.10 (－0.31, 0.11) 3.51 (1.96, 5.04) 3.45 (2.11, 5.16) －0.12 (－0.29, 0.04) 142.52 (79.87, 204.54) 138.18 (84.85, 205.60) －0.17 (－0.34, 0.01) Burundi 9.76 (4.97, 14.80) 10.25 (6.52, 15.57) 0.46 (0.02, 0.89) 19.13 (9.62, 29.23) 20.47 (13.01, 31.10) 0.55 (0.08, 1.02) 7.68 (4.02, 11.34) 9.03 (5.66, 14.05) 0.78 (0.38, 1.18) 326.71 (169.27, 487.05) 372.05 (232.61, 580.64) 0.63 (0.20, 1.07) Comoros 6.29 (3.61, 8.82) 4.19 (2.87, 6.04) －1.40 (－1.53, －1.27) 12.06 (6.90, 16.95) 8.16 (5.59, 11.81) －1.36 (－1.49, －1.23) 5.10 (2.94, 7.16) 3.45 (2.40, 4.96) －1.41 (－1.55, －1.26) 201.37 (115.22, 283.21) 133.81 (92.90, 192.15) －1.48 (－1.63, －1.34) Djibouti 14.11 (8.39, 20.13) 9.39 (5.67, 14.44) －1.29 (－1.71, －0.87) 27.98 (16.42, 40.09) 18.72 (11.24, 28.91) －1.28 (－1.74, －0.83) 11.80 (7.09, 16.52) 8.02 (4.94, 12.55) －1.26 (－1.67, －0.84) 487.00 (289.33, 686.00) 325.20 (200.28, 507.52) －1.32 (－1.77, －0.87) Eritrea 9.47 (5.28, 13.68) 10.38 (7.03, 15.17) 0.24 (－0.01, 0.49) 18.37 (10.18, 26.78) 20.87 (14.17, 30.49) 0.36 (0.10, 0.62) 7.68 (4.25, 10.96) 8.81 (5.98, 12.47) 0.26 (0.04, 0.48) 327.29 (179.36, 470.40) 369.65 (251.53, 523.04) 0.25 (0.02, 0.49) Ethiopia 3.37 (2.16, 4.87) 6.31 (4.09, 9.31) 1.84 (1.53, 2.16) 6.50 (4.14, 9.48) 12.93 (8.33, 19.05) 2.02 (1.67, 2.37) 2.71 (1.70, 3.97) 5.82 (3.78, 8.42) 2.20 (1.93, 2.47) 113.75 (70.80, 167.46) 237.86 (153.21, 345.32) 2.07 (1.77, 2.38) Kenya 13.40 (9.28, 18.87) 10.49 (7.23, 15.03) －0.63 (－0.82, －0.45) 26.93 (18.44, 38.14) 21.55 (14.75, 31.14) －0.53 (－0.76, －0.31) 12.11 (8.13, 16.90) 9.54 (6.44, 13.68) －0.69 (－0.86, －0.51) 489.63 (326.80, 686.99) 387.26 (261.58, 555.47) －0.65 (－0.83, －0.47) Madagascar 19.64 (11.35, 26.68) 13.49 (9.26, 19.45) －1.89 (－2.28, －1.50) 38.97 (22.51, 52.99) 26.95 (18.46, 38.99) －1.91 (－2.33, －1.50) 17.74 (10.64, 24.08) 12.15 (8.37, 17.66) －1.95 (－2.36, －1.54) 741.95 (442.48, 1008.06) 496.38 (343.16, 722.73) －2.07 (－2.49, －1.64) Malawi 24.91 (14.25, 35.63) 27.82 (18.19, 40.61) 0.82 (0.58, 1.07) 48.52 (27.40, 69.56) 55.11 (35.86, 80.43) 0.98 (0.69, 1.26) 22.41 (15.44, 30.14) 25.23 (17.40, 36.52) 0.81 (0.46, 1.16) 932.24 (638.16, 1259.75) 1037.54 (712.92, 1505.83) 0.83 (0.47, 1.18) Mauritius 2.53 (2.21, 2.85) 2.03 (1.71, 2.40) －0.67 (－0.95, －0.38) 5.19 (4.50, 5.89) 4.58 (3.82, 5.47) －0.37 (－0.66, －0.07) 2.15 (1.88, 2.45) 1.66 (1.38, 1.98) －0.80 (－1.08, －0.52) 84.48 (73.79, 96.06) 65.09 (54.35, 77.66) －0.78 (－1.07, －0.49) Mozambique 2.41 (1.67, 3.41) 1.88 (1.21, 2.89) －0.60 (－0.72, －0.48) 4.52 (3.13, 6.45) 3.46 (2.22, 5.36) －0.70 (－0.83, －0.57) 2.02 (1.37, 2.86) 1.40 (0.86, 2.11) －1.40 (－1.62, －1.18) 78.59 (53.43, 112.55) 51.99 (31.91, 79.08) －1.52 (－1.74, －1.29) Rwanda 15.81 (8.36, 22.78) 12.68 (8.27, 18.87) －1.31 (－1.73, －0.90) 30.86 (16.11, 44.65) 25.26 (16.42, 37.70) －1.23 (－1.67, －0.80) 13.55 (7.10, 19.33) 11.47 (7.44, 16.81) －1.10 (－1.55, －0.65) 577.51 (300.51, 826.96) 460.81 (296.99, 678.04) －1.44 (－1.95, －0.92) Seychelles 4.19 (3.20, 5.44) 4.34 (3.18, 5.60) －0.40 (－0.57, －0.23) 8.30 (6.35, 10.77) 9.43 (6.91, 12.26) －0.12 (－0.29, 0.04) 3.59 (2.75, 4.67) 3.60 (2.61, 4.71) －0.52 (－0.71, －0.32) 142.49 (108.72, 185.19) 143.06 (103.70, 186.99) －0.49 (－0.67, －0.32) Somalia 5.64 (2.99, 8.48) 5.65 (3.86, 8.47) －0.05 (－0.28, 0.18) 10.79 (5.70, 16.36) 10.92 (7.46, 16.42) －0.04 (－0.27, 0.20) 4.07 (2.16, 6.19) 4.46 (3.01, 6.56) 0.20 (－0.00, 0.40) 168.64 (89.31, 257.28) 183.17 (123.95, 269.79) 0.17 (－0.03, 0.37) United Republic of Tanzania 6.93 (4.69, 9.52) 5.00 (3.43, 7.19) －0.53 (－0.81, －0.26) 13.23 (8.95, 18.27) 9.75 (6.69, 13.98) －0.42 (－0.71, －0.13) 5.86 (3.87, 8.26) 4.31 (2.94, 6.22) －0.52 (－0.79, －0.26) 230.73 (152.66, 325.24) 167.96 (114.42, 242.78) －0.53 (－0.80, －0.25) Uganda 15.06 (7.68, 24.47) 12.16 (8.03, 17.60) －1.16 (－1.35, －0.97) 28.92 (14.51, 47.34) 24.79 (16.41, 35.81) －0.97 (－1.18, －0.76) 8.14 (5.70, 11.14) 9.63 (6.46, 13.63) 0.10 (－0.04, 0.23) 330.24 (229.71, 453.39) 397.48 (266.70, 564.53) 0.10 (－0.05, 0.24) Zambia 6.46 (3.87, 9.24) 6.50 (4.34, 9.48) 0.21 (0.07, 0.35) 12.51 (7.40, 17.96) 12.95 (8.65, 18.93) 0.39 (0.19, 0.59) 4.92 (3.29, 7.00) 6.38 (4.08, 9.27) 1.27 (1.09, 1.46) 201.10 (134.30, 287.58) 260.10 (166.47, 378.11) 1.29 (1.10, 1.48) Botswana 5.02 (3.27, 7.09) 4.52 (2.77, 6.70) －0.68 (－1.28, －0.07) 9.70 (6.27, 13.72) 8.98 (5.48, 13.28) －0.50 (－1.11, 0.12) 3.60 (2.25, 5.16) 3.58 (2.19, 5.33) －0.65 (－1.33, 0.03) 145.91 (90.01, 209.94) 141.92 (86.40, 211.03) －0.69 (－1.40, 0.03) Lesotho 9.70 (5.19, 14.25) 5.99 (3.67, 9.14) －1.27 (－1.72, －0.82) 18.67 (9.98, 27.44) 11.00 (6.72, 16.78) －1.38 (－1.80, －0.95) 8.29 (4.50, 12.56) 6.14 (3.76, 9.43) －1.30 (－2.04, －0.55) 327.98 (178.10, 497.91) 240.75 (147.51, 369.68) －1.22 (－1.97, －0.46) Namibia 2.75 (1.65, 3.88) 1.62 (1.03, 2.47) －1.44 (－1.63, －1.25) 5.37 (3.20, 7.57) 3.26 (2.09, 4.97) －1.33 (－1.57, －1.09) 2.40 (1.41, 3.38) 1.46 (0.95, 2.18) －1.41 (－1.85, －0.97) 98.23 (57.17, 138.49) 59.56 (38.83, 89.14) －1.40 (－1.86, －0.94) South Africa 12.47 (9.06, 16.24) 8.05 (6.57, 10.17) －1.86 (－2.25, －1.47) 24.11 (17.50, 31.37) 15.66 (12.71, 20.05) －1.83 (－2.27, －1.39) 11.06 (7.96, 14.90) 5.17 (4.01, 6.82) －2.82 (－3.12, －2.51) 426.63 (306.54, 575.57) 200.83 (155.06, 267.02) －2.81 (－3.13, －2.50) Eswatini 17.61 (10.61, 24.91) 6.26 (3.53, 10.51) －3.98 (－4.55, －3.41) 34.09 (20.56, 48.22) 11.87 (6.68, 19.90) －4.07 (－4.57, －3.57) 15.52 (9.06, 22.06) 4.24 (2.72, 6.53) －4.49 (－4.89, －4.09) 629.42 (367.83, 895.24) 168.46 (108.37, 259.56) －4.54 (－4.95, －4.13) Zimbabwe 8.51 (4.45, 13.14) 7.03 (4.11, 11.61) －1.40 (－2.02, －0.78) 15.97 (8.22, 24.96) 13.24 (7.76, 21.87) －1.28 (－1.83, －0.71) 5.86 (4.20, 7.93) 5.61 (3.61, 8.38) －0.55 (－1.14, 0.04) 220.29 (157.63, 298.58) 219.70 (141.39, 327.54) －0.34 (－0.97, 0.29) Benin 2.56 (1.77, 3.53) 2.72 (1.77, 3.94) 0.28 (0.09, 0.47) 4.87 (3.38, 6.71) 5.39 (3.50, 7.79) 0.40 (0.20, 0.60) 2.33 (1.57, 3.20) 2.39 (1.55, 3.44) 0.16 (－0.02, 0.35) 91.26 (61.43, 125.21) 95.47 (62.07, 137.17) 0.25 (0.05, 0.44) Burkina Faso 1.38 (0.91, 1.88) 1.37 (0.98, 2.01) －0.06 (－0.27, 0.14) 2.61 (1.72, 3.57) 2.69 (1.92, 3.95) 0.06 (－0.16, 0.28) 1.20 (0.81, 1.69) 1.20 (0.84, 1.68) －0.28 (－0.49, －0.07) 46.99 (31.65, 66.50) 47.70 (33.49, 67.21) －0.23 (－0.45, －0.00) Cameroon 2.11 (1.44, 2.96) 1.84 (1.20, 2.71) －0.22 (－0.74, 0.30) 4.12 (2.81, 5.77) 3.68 (2.40, 5.41) －0.17 (－0.72, 0.39) 1.82 (1.23, 2.49) 1.58 (1.01, 2.35) －0.07 (－0.58, 0.45) 74.49 (50.28, 101.83) 64.76 (41.44, 96.68) －0.07 (－0.59, 0.46) Cabo Verde 5.15 (3.53, 7.23) 7.76 (4.27, 12.18) 1.25 (0.99, 1.51) 10.24 (7.01, 14.39) 16.04 (8.76, 25.47) 1.39 (1.13, 1.64) 4.25 (2.95, 6.01) 8.29 (4.98, 12.62) 2.18 (2.05, 2.30) 168.55 (116.75, 239.25) 335.27 (200.51, 510.19) 2.25 (2.13, 2.37) Chad 2.05 (1.36, 2.91) 2.20 (1.48, 3.25) 0.45 (0.14, 0.76) 3.93 (2.61, 5.57) 4.29 (2.88, 6.32) 0.52 (0.18, 0.85) 1.82 (1.21, 2.57) 1.97 (1.35, 2.80) 0.38 (0.07, 0.70) 72.26 (47.92, 102.21) 78.67 (53.88, 112.16) 0.43 (0.11, 0.76) Cote d'Ivoire 0.61 (0.37, 0.87) 0.61 (0.41, 0.88) －0.10 (－0.57, 0.38) 1.18 (0.70, 1.68) 1.21 (0.82, 1.77) －0.67 (－0.99, －0.35) 0.52 (0.31, 0.74) 0.53 (0.36, 0.76) －0.30 (－0.83, 0.23) 21.02 (12.52, 29.98) 21.53 (14.65, 30.94) －0.30 (－0.84, 0.24) Gambia 0.53 (0.37, 0.72) 0.72 (0.48, 1.07) 0.60 (0.34, 0.86) 1.03 (0.71, 1.40) 1.42 (0.94, 2.11) 0.66 (0.40, 0.93) 0.46 (0.32, 0.63) 0.62 (0.41, 0.90) 0.61 (0.32, 0.90) 17.97 (12.47, 24.89) 24.66 (16.05, 35.78) 0.65 (0.36, 0.94) Ghana 1.94 (1.36, 2.67) 2.26 (1.46, 3.30) 0.42 (0.03, 0.81) 3.77 (2.63, 5.18) 4.49 (2.89, 6.56) 0.49 (0.08, 0.90) 1.78 (1.24, 2.42) 2.07 (1.35, 3.15) 0.40 (－0.01, 0.82) 71.12 (49.56, 97.05) 83.15 (53.83, 126.92) 0.44 (0.02, 0.87) Guinea 0.54 (0.37, 0.73) 0.66 (0.44, 0.98) －0.28 (－0.47, －0.09) 1.02 (0.71, 1.40) 1.30 (0.87, 1.91) 0.60 (0.43, 0.77) 0.48 (0.33, 0.64) 0.57 (0.38, 0.83) 0.30 (0.15, 0.44) 18.72 (12.96, 25.16) 22.65 (15.23, 33.20) 0.37 (0.22, 0.52) Guinea-Bissau 1.34 (0.94, 1.85) 1.98 (1.34, 2.87) 1.41 (1.04, 1.78) 2.52 (1.76, 3.48) 3.83 (2.57, 5.54) 1.48 (1.08, 1.87) 1.10 (0.77, 1.47) 1.65 (1.07, 2.37) 1.40 (1.07, 1.73) 44.21 (31.05, 59.13) 66.35 (43.02, 95.44) 1.41 (1.06, 1.76) Liberia 2.28 (1.57, 3.16) 2.62 (1.68, 3.94) 0.68 (0.27, 1.09) 4.37 (3.03, 6.10) 5.24 (3.36, 7.89) 0.80 (0.37, 1.23) 2.07 (1.42, 2.91) 2.36 (1.52, 3.54) 0.85 (0.39, 1.32) 82.31 (56.82, 115.92) 95.11 (61.39, 142.93) 0.90 (0.42, 1.39) Mali 1.82 (1.29, 2.46) 2.09 (1.46, 2.95) 0.21 (－0.09, 0.51) 3.50 (2.50, 4.76) 4.15 (2.90, 5.85) 0.29 (－0.02, 0.60) 1.64 (1.18, 2.24) 1.89 (1.30, 2.74) 0.19 (－0.10, 0.48) 65.81 (47.33, 89.96) 76.42 (52.62, 110.19) 0.23 (－0.07, 0.53) Mauritania 1.60 (1.12, 2.22) 2.05 (1.25, 3.13) 0.75 (0.52, 0.97) 3.05 (2.13, 4.23) 4.13 (2.50, 6.36) 0.91 (0.68, 1.14) 1.46 (1.02, 2.08) 2.05 (1.29, 3.08) 1.08 (0.86, 1.29) 56.51 (39.61, 80.36) 80.10 (50.36, 120.65) 1.10 (0.89, 1.31) Niger 1.03 (0.68, 1.43) 1.12 (0.76, 1.66) 0.08 (－0.17, 0.33) 1.97 (1.30, 2.74) 2.21 (1.49, 3.29) 0.18 (－0.08, 0.45) 0.90 (0.60, 1.27) 0.99 (0.64, 1.45) 0.05 (－0.19, 0.29) 35.02 (23.44, 49.65) 39.07 (25.54, 57.27) 0.10 (－0.16, 0.36) Nigeria 0.97 (0.64, 1.44) 0.74 (0.46, 1.17) －1.07 (－1.18, －0.97) 1.87 (1.23, 2.76) 1.46 (0.90, 2.29) －0.99 (－1.10, －0.88) 0.86 (0.56, 1.28) 0.70 (0.40, 1.15) －0.82 (－0.92, －0.72) 33.79 (21.72, 49.91) 27.40 (15.53, 45.08) －0.81 (－0.92, －0.70) Sao Tome and Principe 1.46 (0.98, 2.03) 1.80 (1.17, 2.75) 1.26 (0.95, 1.57) 2.85 (1.92, 3.97) 3.64 (2.38, 5.54) 1.39 (1.05, 1.72) 1.31 (0.89, 1.80) 1.67 (1.02, 2.52) 1.45 (1.13, 1.76) 51.59 (35.06, 71.29) 66.30 (40.56, 100.54) 1.50 (1.17, 1.84) Senegal 1.54 (1.07, 2.11) 1.75 (1.14, 2.61) 0.26 (－0.00, 0.53) 2.98 (2.07, 4.09) 3.48 (2.28, 5.20) 0.30 (0.03, 0.58) 1.31 (0.93, 1.81) 1.52 (0.95, 2.28) 0.28 (0.01, 0.56) 52.55 (37.34, 72.67) 60.49 (38.14, 90.90) 0.22 (－0.06, 0.50) Sierra Leone 2.93 (1.97, 4.13) 3.29 (2.24, 4.66) 0.21 (－0.21, 0.63) 5.81 (3.89, 8.19) 6.72 (4.53, 9.55) 0.30 (－0.16, 0.76) 2.47 (1.68, 3.44) 2.88 (2.02, 4.12) 0.32 (－0.13, 0.78) 101.50 (68.57, 142.21) 119.11 (83.25, 170.67) 0.35 (－0.13, 0.83) Togo 1.92 (1.36, 2.63) 2.14 (1.41, 3.13) 0.43 (0.03, 0.84) 3.68 (2.60, 5.05) 4.22 (2.76, 6.21) 0.54 (0.11, 0.97) 1.69 (1.20, 2.26) 1.87 (1.20, 2.75) 0.34 (－0.11, 0.80) 66.44 (47.25, 89.24) 74.76 (48.22, 110.19) 0.43 (－0.03, 0.89) American Samoa 0.73 (0.50, 1.02) 0.99 (0.62, 1.47) 1.14 (0.90, 1.38) 1.47 (1.01, 2.08) 2.09 (1.32, 3.12) 1.28 (1.04, 1.52) 0.61 (0.42, 0.85) 0.87 (0.54, 1.33) 1.27 (1.02, 1.52) 24.57 (17.01, 34.41) 35.55 (22.00, 54.31) 1.34 (1.09, 1.59) Bermuda 4.35 (3.65, 5.15) 3.03 (2.48, 3.68) －1.45 (－1.85, －1.05) 9.18 (7.66, 10.89) 7.96 (6.39, 9.80) －0.81 (－1.15, －0.46) 3.69 (3.10, 4.42) 2.30 (1.86, 2.84) －1.72 (－2.18, －1.27) 143.87 (120.56, 172.14) 89.43 (72.31, 110.24) －1.73 (－2.19, －1.28) Cook Islands 1.57 (1.08, 2.20) 2.04 (1.27, 3.06) 0.64 (0.51, 0.77) 3.28 (2.25, 4.62) 4.83 (3.02, 7.27) 1.04 (0.90, 1.18) 1.24 (0.88, 1.71) 1.67 (1.06, 2.54) 0.70 (0.53, 0.87) 50.54 (35.75, 69.76) 67.06 (42.54, 101.78) 0.64 (0.47, 0.80) Greenland 9.30 (6.96, 12.04) 4.51 (3.19, 6.07) －2.15 (－2.27, －2.02) 18.27 (13.67, 23.63) 9.96 (6.97, 13.64) －1.77 (－1.89, －1.65) 7.97 (5.97, 10.29) 3.54 (2.48, 4.89) －2.34 (－2.49, －2.20) 302.14 (225.33, 390.67) 135.59 (94.46, 188.35) －2.31 (－2.46, －2.17) Guam 1.47 (1.20, 1.76) 1.23 (1.02, 1.47) 1.09 (0.02, 2.17) 3.10 (2.53, 3.74) 2.94 (2.38, 3.54) 1.30 (0.25, 2.36) 1.24 (1.01, 1.50) 0.96 (0.80, 1.15) 0.96 (－0.13, 2.05) 49.96 (40.77, 60.39) 39.36 (32.80, 46.97) 0.97 (－0.11, 2.05) Monaco 3.35 (2.34, 4.59) 3.87 (2.50, 5.76) 0.47 (0.31, 0.63) 8.27 (5.73, 11.52) 11.33 (7.35, 16.88) 1.03 (0.86, 1.21) 2.61 (1.83, 3.56) 3.06 (1.88, 4.61) 0.47 (0.36, 0.58) 101.80 (71.12, 138.80) 118.93 (73.27, 179.40) 0.46 (0.34, 0.57) Nauru 2.90 (1.88, 4.26) 2.79 (1.79, 4.16) －0.21 (－0.44, 0.02) 5.65 (3.68, 8.28) 5.57 (3.59, 8.29) －0.11 (－0.37, 0.14) 2.49 (1.58, 3.67) 2.57 (1.66, 3.91) 0.03 (－0.27, 0.32) 102.90 (65.37, 151.39) 106.22 (68.28, 161.71) 0.03 (－0.26, 0.33) Niue 1.51 (1.02, 2.11) 1.27 (0.77, 2.02) －0.64 (－0.71, －0.57) 3.10 (2.11, 4.34) 2.69 (1.64, 4.28) －0.50 (－0.59, －0.41) 1.27 (0.87, 1.75) 1.15 (0.69, 1.83) －0.44 (－0.51, －0.38) 52.79 (35.82, 72.66) 47.43 (28.49, 75.40) －0.45 (－0.51, －0.39) Northern Mariana Islands 0.65 (0.45, 1.02) 1.18 (0.82, 1.65) 2.70 (2.14, 3.27) 1.37 (0.94, 2.19) 2.87 (1.95, 4.06) 3.02 (2.45, 3.59) 0.52 (0.36, 0.83) 0.93 (0.65, 1.27) 2.68 (2.09, 3.27) 20.68 (14.39, 33.28) 38.33 (26.80, 52.73) 2.75 (2.17, 3.34) Palau 1.59 (1.10, 2.22) 1.62 (1.12, 2.35) －0.06 (－0.14, 0.03) 3.25 (2.24, 4.52) 3.52 (2.44, 5.10) 0.12 (0.02, 0.22) 1.29 (0.89, 1.79) 1.37 (0.92, 1.98) 0.06 (－0.06, 0.17) 53.38 (36.79, 74.07) 56.93 (38.47, 82.46) 0.05 (－0.06, 0.17) Puerto Rico 4.06 (3.56, 4.62) 1.55 (1.29, 1.85) －2.42 (－2.62, －2.23) 8.57 (7.47, 9.88) 3.96 (3.23, 4.79) －1.81 (－2.01, －1.61) 3.43 (3.00, 3.88) 1.18 (0.97, 1.43) －2.74 (－2.94, －2.54) 136.41 (119.04, 154.92) 47.92 (39.42, 57.67) －2.69 (－2.89, －2.49) Saint Kitts and Nevis 3.15 (2.72, 3.63) 2.28 (1.85, 2.76) －0.62 (－0.91, －0.33) 6.12 (5.26, 7.06) 4.68 (3.81, 5.67) －0.45 (－0.72, －0.18) 2.78 (2.37, 3.27) 1.69 (1.35, 2.06) －1.24 (－1.53, －0.96) 108.81 (92.83, 128.29) 66.20 (52.86, 80.38) －1.24 (－1.52, －0.96) San Marino 1.03 (0.69, 1.45) 0.62 (0.39, 0.95) －2.46 (－2.75, －2.16) 2.56 (1.71, 3.66) 1.98 (1.23, 3.06) －1.63 (－1.94, －1.31) 0.79 (0.51, 1.15) 0.42 (0.25, 0.65) －2.99 (－3.32, －2.67) 30.42 (19.45, 44.01) 16.37 (9.70, 25.31) －2.91 (－3.24, －2.59) Tokelau 0.80 (0.52, 1.15) 0.76 (0.48, 1.17) －0.39 (－0.52, －0.26) 1.60 (1.05, 2.32) 1.58 (1.00, 2.44) －0.23 (－0.38, －0.09) 0.66 (0.42, 0.95) 0.70 (0.42, 1.10) －0.11 (－0.23, 0.01) 26.85 (17.30, 38.55) 28.34 (17.30, 44.60) －0.12 (－0.24, 0.00) Tuvalu 1.77 (1.18, 2.52) 2.23 (1.38, 3.39) 0.55 (0.48, 0.63) 3.48 (2.32, 4.95) 4.57 (2.85, 6.95) －4.03 (－4.56, －3.50) 1.52 (1.00, 2.15) 1.95 (1.22, 3.03) 0.57 (0.46, 0.67) 62.91 (41.08, 89.07) 81.54 (50.58, 126.77) 0.57 (0.46, 0.68) United States Virgin Islands 2.18 (1.78, 2.61) 1.63 (1.24, 2.12) －0.46 (－0.68, －0.25) 4.46 (3.63, 5.34) 3.72 (2.81, 4.84) －0.13 (－0.35, 0.09) 1.86 (1.50, 2.24) 1.33 (0.99, 1.77) －0.61 (－0.82, －0.40) 73.77 (59.65, 88.80) 53.51 (39.78, 70.91) －0.56 (－0.77, －0.34) South Sudan 18.86 (10.98, 25.90) 15.31 (10.31, 22.67) －0.85 (－1.02, －0.68) 36.82 (21.31, 50.82) 30.16 (20.23, 44.81) －0.83 (－1.01, －0.64) 16.56 (9.66, 22.59) 13.52 (9.09, 19.73) －0.84 (－1.06, －0.63) 681.97 (395.75, 933.27) 555.48 (373.83, 811.04) －0.85 (－1.08, －0.62) Sudan 2.06 (0.94, 3.14) 2.00 (1.02, 3.32) －0.53 (－0.64, －0.41) 4.11 (1.86, 6.31) 4.44 (2.25, 7.43) －0.24 (－0.39, －0.10) 1.75 (0.81, 2.69) 1.67 (0.83, 2.71) －0.57 (－0.68, －0.47) 70.38 (32.21, 108.53) 67.20 (33.26, 109.46) －0.56 (－0.67, －0.45) ASIR: Age-standardized incidence rate; 95%UI: 95% uncertainty interval; EAPC: Estimated annual percentage change; 95%CI: 95% confidence interval; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized DALY rate; DALY: Disability-adjusted life year. 附表 3 2023年20~60岁人群食管癌疾病负担的影响因素分解分析数据
Region Change in number of incident cases Change in number of prevalent cases Change in number of deaths Change in DALYs Aging Population growth Epidemiological change Aging Population growth Epidemiological change Aging Population growth Epidemiological change Aging Population growth Epidemiological change Global 37 193.94 76 595.54 －77 579.79 75 045.63 165 941.19 －124 571.22 32 312.50 64 418.54 －69 501.41 1 179 992.46 2 530 392.64 －2 608 187.33 High SDI 3 506.98 29 545.86 －35 399.30 4 711.36 67 879.69 －53 088.85 3 419.71 23 998.44 －33 247.80 97 844.06 920 960.76 －1 286 683.7 High-middle SDI 22 017.18 26 407.29 －53 097.41 42 835.57 55 383.77 －95 946.80 19 436.39 22 559.70 －48 145.12 701 232.31 871 961.94 －1 820 060.14 Middle SDI 3 669.37 4 070.83 －3 034.78 7 225.72 8 351.70 －4 552.35 3 224.97 3 509.88 －2 671.29 122 288.05 138 669.97 －103 311.93 Low-middle SDI 4 601.02 7 734.15 7 481.37 9 266.59 15 972.08 17 553.06 4 146.44 6 862.55 7 273.83 165 679.16 283 119.56 313 185.58 Low SDI 7 311.97 8 405.20 2 551.52 15 025.83 17 228.63 7 164.20 6 223.33 7 151.70 3 202.24 261 132.65 299 091.95 126 457.46 Andean Latin America 83.21 80.90 －93.22 167.76 171.99 －162 71.35 67.69 －81.78 2 776.43 2 778.41 －3 348.11 Australasia 62.65 154.06 －19.64 160.11 460.12 178.21 46.73 105.48 －51.47 1 622.56 4 049.40 －1 889.87 Caribbean 113.98 246.54 9.61 －67.19 563.76 281.69 101.58 210.43 15.52 3 545.48 8 301.07 395.4 Central Asia 307.46 970.63 －2 304.67 593.3 1 924.68 －4 433.94 271.71 840.37 －2 015.53 10 401.95 33 002.27 －78 855.27 Central Europe －677.32 865.45 －540.08 －1 359.62 1 715.04 －861.27 －586.19 752.6 －507.11 －22 534.37 29 001.26 －20 637.35 Central Latin America 473.67 456.73 －563.27 940.7 978.68 －1 010.17 416.07 387.12 －501.43 15 757.32 15 716.77 －20 134.77 Central Sub-Saharan Africa 764.30 669.66 63.29 1 542.32 1 341.99 204.27 661.55 580.38 96.45 27 933.33 24 283.05 3 185.74 East Asia 26 805.64 38 925.31 －83 565.68 49 821.60 82 467.45 －145 740.44 24 010.53 33 003.04 －76 226.82 824 736.80 1 259 708.89 －2 891 189.30 Eastern Europe －1793.25 2 020.99 －1 393.83 －3 621.05 4 064.42 －2 132.91 －1 532.48 1 730.55 －1 360.20 －57 788.30 66 003.44 －51 809.52 Eastern Sub-Saharan Africa 3985.79 3 968.62 －447.24 8 186.51 8 059.80 －418.04 3 355.73 3 352.29 183.18 144 098.88 141 805.32 2 360.68 High-income Asia Pacific －755.69 1 721.73 －2 305.76 －2 621.80 5 541.03 －3 253.71 －464.59 1 116.56 －2 100.86 －18 570.11 42 263.98 －79 264.90 High-income North America 144.08 2 236.83 －807.54 －238.18 6 081.27 －540.19 201.62 1 637.44 －839.24 4 074.86 63 231.67 －30 917.75 North Africa and Middle East 1 283.14 1 095.63 －701.64 2 809.99 2 495.12 －555.27 1 067.32 893.82 －720.53 42 561.36 36 248.30 －28 420.57 Oceania 31.01 27.52 1.12 63.77 57.91 10.56 26.17 22.98 2.68 1 074.05 964.22 141.64 South Asia 9 302.28 12 539.89 13 751.8 18 916.21 26 111.21 32 704.03 8 357.14 11 114.19 13 162.52 334 541.65 457 748.08 558 441.17 Southeast Asia 2 584.41 2 979.93 426.12 5 175.35 6 320.54 2 083.13 2 248.73 2 524.32 406.79 85 614.04 101 463.05 14 935.38 Southern Latin America 71.98 444.18 －730.35 136.93 940.03 －1 306.16 63.19 373.43 －665.16 2 286.29 14 435.47 －25 335.92 Southern Sub-Saharan Africa 1 002.78 1 202.48 －1 024.29 1 946.93 2 352.38 －1 962.99 777.85 929.03 －1 266.41 30 309.18 36 545.60 －48 924.08 Tropical Latin America 1 432.44 1 709.40 －1 613.97 2 757.14 3 484.44 －2 817.79 1 261.27 1 467.15 －1 479.18 46 954.17 57 794.29 －58 618.61 Western Europe －1 393.31 3 979.81 －3 304.96 －4 056.39 10 051.21 －2 866.82 －984.02 3 054.94 －3 488.37 －41 230.70 116 959.43 －135 162.16 Western Sub-Saharan Africa 658.86 613.27 －23.74 1 321.31 1 221.48 35.17 583.73 544.78 2.98 24 092.97 22 249.28 434.88 DALY: Disability-adjusted life year; SDI: Socio-demographic index. 附表 4 2024－2050年全球20~60岁人群食管癌疾病负担预测
Time ASIR (95%UI)/(×10－5) ASPR (95%UI)/(×10－5) ASMR (95%UI)/(×10－5) ASDR (95%UI)/(×10－5) 2024 3.72 (3.49, 3.95) 8.66 (8.14, 9.18) 3.09 (2.87, 3.31) 123.13 (113.68, 132.59) 2025 3.69 (3.40, 3.99) 8.64 (7.98, 9.30) 3.06 (2.78, 3.33) 122.01 (110.51, 133.52) 2026 3.67 (3.32, 4.01) 8.62 (7.84, 9.39) 3.03 (2.71, 3.35) 120.92 (107.65, 134.19) 2027 3.64 (3.25, 4.03) 8.60 (7.72, 9.48) 3.00 (2.64, 3.36) 119.85 (105.00, 134.70) 2028 3.62 (3.19, 4.06) 8.59 (7.61, 9.57) 2.98 (2.58, 3.37) 118.86 (102.55, 135.17) 2029 3.61 (3.13, 4.08) 8.59 (7.51, 9.67) 2.96 (2.53, 3.39) 117.98 (100.29, 135.68) 2030 3.60 (3.08, 4.11) 8.60 (7.43, 9.78) 2.94 (2.47, 3.40) 117.24 (98.22, 136.25) 2031 3.59 (3.04, 4.14) 8.63 (7.36, 9.89) 2.93 (2.43, 3.42) 116.63 (96.33, 136.93) 2032 3.59 (3.00, 4.18) 8.66 (7.30, 10.01) 2.92 (2.39, 3.45) 116.17 (94.61, 137.72) 2033 3.60 (2.97, 4.22) 8.70 (7.25, 10.15) 2.91 (2.35, 3.47) 115.86 (93.05, 138.66) 2034 3.61 (2.94, 4.27) 8.76 (7.22, 10.30) 2.91 (2.32, 3.50) 115.70 (91.64, 139.76) 2035 3.62 (2.92, 4.33) 8.83 (7.19, 10.47) 2.91 (2.29, 3.54) 115.71 (90.37, 141.04) 2036 3.64 (2.90, 4.39) 8.91 (7.17, 10.65) 2.92 (2.26, 3.58) 115.86 (89.24, 142.48) 2037 3.67 (2.88, 4.45) 9.00 (7.16, 10.84) 2.93 (2.23, 3.62) 116.11 (88.19, 144.03) 2038 3.69 (2.87, 4.52) 9.09 (7.15, 11.04) 2.93 (2.21, 3.66) 116.44 (87.21, 145.68) 2039 3.72 (2.85, 4.59) 9.19 (7.14, 11.24) 2.94 (2.19, 3.70) 116.82 (86.26, 147.39) 2040 3.75 (2.84, 4.66) 9.29 (7.13, 11.45) 2.96 (2.17, 3.75) 117.28 (85.36, 149.20) 2041 3.78 (2.83, 4.74) 9.40 (7.12, 11.68) 2.97 (2.14, 3.79) 117.81 (84.51, 151.12) 2042 3.82 (2.82, 4.82) 9.51 (7.12, 11.91) 2.98 (2.12, 3.84) 118.41 (83.68, 153.13) 2043 3.85 (2.81, 4.90) 9.62 (7.10, 12.14) 3.00 (2.10, 3.89) 119.03 (82.86, 155.20) 2044 3.89 (2.80, 4.98) 9.73 (7.08, 12.37) 3.01 (2.08, 3.94) 119.66 (82.02, 157.30) 2045 3.92 (2.78, 5.07) 9.83 (7.05, 12.60) 3.03 (2.06, 3.99) 120.32 (81.16, 159.47) 2046 3.96 (2.77, 5.16) 9.93 (7.02, 12.84) 3.04 (2.04, 4.05) 121.02 (80.30, 161.75) 2047 4.00 (2.75, 5.25) 10.04 (6.98, 13.09) 3.06 (2.02, 4.11) 121.78 (79.42, 164.13) 2048 4.04 (2.74, 5.35) 10.14 (6.93, 13.35) 3.08 (2.00, 4.16) 122.56 (78.50, 166.62) 2049 4.09 (2.72, 5.45) 10.25 (6.88, 13.63) 3.10 (1.98, 4.23) 123.34 (77.50, 169.17) 2050 4.13 (2.70, 5.56) 10.36 (6.81, 13.92) 3.12 (1.95, 4.29) 124.09 (76.41, 171.78) ASIR: Age-standardized incidence rate; 95%UI: 95% uncertainty interval; ASPR: Age-standardized prevalence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized DALY rate; DALY: Disability-adjusted life year. -
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