Emerging patterns and trends in global cancer burden attributable to metabolic factors, based on the Global Burden of Disease Study 2019

Yan Zhang; Yuwei Ding; Ning Zhu; Mi Mi; Yier Lu; Jia Zheng; Shanshan Weng; Ying Yuan

doi:10.3389/fonc.2023.1032749

Emerging patterns and trends in global cancer burden attributable to metabolic factors, based on the Global Burden of Disease Study 2019

Front Oncol. 2023 Jan 19:13:1032749. doi: 10.3389/fonc.2023.1032749. eCollection 2023.

Authors

Yan Zhang¹, Yuwei Ding^{1

2}, Ning Zhu^{1

2}, Mi Mi^{1

2}, Yier Lu^{1

2}, Jia Zheng³, Shanshan Weng¹, Ying Yuan^{1

2

4}

Affiliations

¹ Department of Medical Oncology (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² Zhejiang Provincial Clinical Research Center for CANCER, Hangzhou, Zhejiang, China.
³ Department of Medical Geriatrics, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
⁴ Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.

Abstract

Background: The exponential growth of the cancer burden attributable to metabolic factors deserves global attention. We investigated the trends of cancer mortality attributable to metabolic factors in 204 countries and regions between 1990 and 2019.

Methods: We extracted data from the Global Burden of Disease Study (GBD) 2019 and assessed the mortality, age-standardized death rate (ASDR), and population attributable fractions (PAFs) of cancers attributable to metabolic factors. Average annual percentage changes (AAPCs) were calculated to assess the changes in the ASDR. The cancer mortality burden was evaluated according to geographic location, SDI quintiles, age, sex, and changes over time.

Results: Cancer attributable to metabolic factors contributed 865,440 (95% UI, 447,970-140,590) deaths in 2019, a 167.45% increase over 1990. In the past 30 years, the increase in the number of deaths and ASDR in lower SDI regions have been significantly higher than in higher SDI regions (from high to low SDIs: the changes in death numbers were 108.72%, 135.7%, 288.26%, 375.34%, and 288.26%, and the AAPCs were 0.42%, 0.58%, 1.51%, 2.36%, and 1.96%). Equatorial Guinea (AAPC= 5.71%), Cabo Verde (AAPC=4.54%), and Lesotho (AAPC=4.42%) had the largest increase in ASDR. Large differences were observed in the ASDRs by sex across different SDIs, and the male-to-female ratios of ASDR were 1.42, 1.50, 1.32, 0.93, and 0.86 in 2019. The core population of death in higher SDI regions is the age group of 70 years and above, and the lower SDI regions are concentrated in the age group of 50-69 years. The proportion of premature deaths in lower SDI regions is significantly higher than that in higher SDI regions (from high to low SDIs: 2%, 4%, 7%, 7%, and 9%). Gastrointestinal cancers were the core burden, accounting for 50.11% of cancer deaths attributable to metabolic factors, among which the top three cancers were tracheal, bronchus, and lung cancer, followed by colon and rectum cancer and breast cancer.

Conclusions: The cancer mortality burden attributable to metabolic factors is shifting from higher SDI regions to lower SDI regions. Sex differences show regional heterogeneity, with men having a significantly higher burden than women in higher SDI regions but the opposite is observed in lower SDI regions. Lower SDI regions have a heavier premature death burden. Gastrointestinal cancers are the core of the burden of cancer attributable to metabolic factors.

Keywords: age standardized rate (ASR); average annual percentage change (AAPC); cancer; global burden of disease study (GBD); mortality.

Grants and funding

This study was supported by the Key R&D Program of Zhejiang Province (2021C03125 to YY), the National Natural Science Foundation of China (81872481 to YY, 82000619 to Yang Tian).