Decomposing the global burden of cancers: quantifying the contributions of disease severity changes across regions and time (1990-2021).

BACKGROUND

Cancer poses a significant challenge to society and public health. Our objective was to systematically quantify the effect of disease severity changes on cancer-related disability-adjusted life years (DALYs), thereby enabling cross-regional, temporal, and cancer-type comparisons.

METHODS

This secondary analysis obtained data on prevalence, DALYs, and population size from 1990 to 2021 from the Global Burden of Disease 2021. Unlike conventional analyses, a four-factor decomposition analysis was applied to attribute DALY changes to population growth, aging, prevalence shifts, and disease severity changes from 1990 to each subsequent year. We focused on the absolute and relative contributions of disease severity changes to DALY variations. Comparative analyses were subsequently stratified by region, sociodemographic index (SDI), sex, and cancer type.

RESULTS

Between 1990 and 2021, a reduction in neoplasms-related DALYs attributed to disease severity changes was observed globally for both sexes combined, with a total decrease of 81 963.31 thousand (52.68%) by 2021. Significantly, males (n = -56 172.28 thousand; -62.73%) exhibited greater absolute and relative contributions than females (n = -28 558.95 thousand; -42.35%). High (n = -30 317.14 thousand; -67.01%) and middle SDI (n = -32 958.22 thousand; -80.36%) regions showed a more pronounced decline than low-middle SDI (n = -5869.18 thousand; -37.48%) and low SDI (n = -2881.96 thousand; -41.62%) regions. Nationally, China (n = -44 306.96 thousand) demonstrated the largest absolute contribution, while Qatar (-337.34%) exhibited the highest relative proportion. Globally, absolute contributions were greatest for lung (n = -12 228.72 thousand), colorectal (n = -9334.10 thousand), and gastric (n = -8504.91 thousand) cancers. The highest relative proportions were for testicular (-80.81%), thyroid (-75.28%), and nasopharyngeal (-75.11%) cancers. Notably, mesothelioma saw an increase in DALYs due to disease severity changes.

CONCLUSIONS

Variations in cancer-related DALYs attributed to disease severity changes exhibited substantial heterogeneity. These findings could offer valuable insights for policy makers to develop and improve cancer control, with the vision of a world where cancer in preventable and every survivor remains healthy.