Changing trends in the disease burden of non-melanoma skin cancer globally from 1990 to 2019 and its predicted level in 25 years

Abstract

Background: The disease burden of non-melanoma skin cancer (NMSC) has become a significant public health threat. We aimed to conduct a comprehensive analysis to mitigate the health hazards of NMSC.

Methods: This study had three objectives. First, we reported the NMSC-related disease burden globally and for different subgroups (sex, socio-demographic index (SDI), etiology, and countries) in 2019. Second, we examined the temporal trend of the disease burden from 1990 to 2019. Finally, we used the Bayesian age-period-cohort (BAPC) model integrated nested Laplacian approximation to predict the disease burden in the coming 25 years. The Norpred age-period-cohort (APC) model and the Autoregressive Integrated Moving Average (ARIMA) model were used for sensitivity analysis.

Results: The disease burden was significantly higher in males than in females in 2019. The results showed significant differences in disease burden in different SDI regions. The better the socio-economic development, the heavier the disease burden of NMSC. The number of new cases and the ASIR of basal cell carcinoma (BCC) were higher than that of squamous cell carcinoma (SCC) in 2019 globally. However, the number of DALYs and the age-standardized DALYs rate were the opposite. There were statistically significant differences among different countries. The age-standardized incidence rate (ASIR) of NMSC increased from 54.08/100,000 (95% uncertainty interval (UI): 46.97, 62.08) in 1990 to 79.10/100,000 (95% UI: 72.29, 86.63) in 2019, with an estimated annual percentage change (EAPC) of 1.78. Other indicators (the number of new cases, the number of deaths, the number of disability-adjusted life years (DALYs), the age-standardized mortality rate (ASMR), and the age-standardized DALYs rate) showed the same trend. Our predictions suggested that the number of new cases, deaths, and DALYs attributable to NMSC would increase by at least 1.5 times from 2020 to 2044.

Conclusions: The disease burden attributable to NMSC will continue to increase or remain stable at high levels. Therefore, relevant policies should be developed to manage NMSC, and measures should be taken to target risk factors and high-risk groups.

Keywords: Burden; Global; Non-melanoma skin cancer; Predict; Trend.

Fig. 1

Numbers and age-standardized rates of NMSC-related incidence (a and b), deaths (c and d), and DALYs (e and f) across countries. Abbreviations: DALYs: disability-adjusted life years; NMSC: non-melanoma skin cancer

Fig. 2

Trends in the NMSC-related ASIR (a and b), ASMR (c and d), and the age-standardized DALYs (e and f) by sex globally: observed (dashed lines) and predicted rates of the BAPC model (solid lines). The blue region shows the upper and lower limits of the 95% UIs. Abbreviations: DALYs: disability-adjusted life years; NMSC: non-melanoma skin cancer; BAPC: Bayesian age-period-cohort; UIs: uncertainty intervals

Fig. 3

Trends in NMSC-related numbers of incidence cases (a and b), deaths cases (c and d), and DALYs cases (e and f) by sex globally: observed (before 2019) and predicted (after 2019) numbers. Shading indicates if the rate remained stable (baseline reference), decreased by 1% per year (optimistic reference, lower limit), and increased by 1% per year (pessimistic reference, upper limit) based on the observed rate in 2019. The curve formed by the triangle is the prediction result of the BAPC model. Abbreviations: DALYs: disability-adjusted life years; NMSC: non-melanoma skin cancer; BAPC: Bayesian age-period-cohort

Fig. 4

Trends in NMSC-related number of incidence cases (a and b), deaths cases (c and d), and DALYs cases (e and f) by sex globally: observed (before 2019) and predicted (after 2019) numbers. Shading indicates if the rate remained stable (baseline reference), decreased by 1% per year (optimistic reference, lower limit), and increased by 1% per year (pessimistic reference, upper limit) based on the observed rate in 2019. Three methods are used in the prediction. The red line is calculated by the predicted rate of each 5 years group and the average population size of the 5 year group. The blue line method is to calculate the rate of each group in terms of the predicted rate of each 5 years group and the average population situation of the 5 year group. The yellow line is calculated by the predicted rate of each 5 years group and the annual population situation. Abbreviations: DALYs: disability-adjusted life years; NMSC: non-melanoma skin cancer

Fig. 5

Trends in NMSC-related incidence (a and b), deaths (c and d), and DALYs rates (e and f) by sex globally: observed (solid lines) and predicted rates of the Norpred APC model (dashed lines). Abbreviations: DALYs: disability-adjusted life years; NMSC: non-melanoma skin cancer; APC: age-period-cohort