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. 2023 Oct 1;9(10):1401-1416.
doi: 10.1001/jamaoncol.2023.2960.

The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019

GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators; Amanda Ramos da Cunha  1 , Kelly Compton  2 , Rixing Xu  2   3 , Rashmi Mishra  4 , Mark Thomas Drangsholt  4   5 , Jose Leopoldo Ferreira Antunes  1 , Alexander R Kerr  6 , Alistair R Acheson  2 , Dan Lu  2 , Lindsey E Wallace  2 , Jonathan M Kocarnik  2 , Weijia Fu  2 , Frances E Dean  2   7 , Alyssa Pennini  2 , Hannah Jacqueline Henrikson  2   8 , Tahiya Alam  2 , Emad Ababneh  9 , Sherief Abd-Elsalam  10 , Meriem Abdoun  11 , Hassan Abidi  12 , Hiwa Abubaker Ali  13 , Eman Abu-Gharbieh  14 , Tigist Demssew Adane  15 , Isaac Yeboah Addo  16   17 , Aqeel Ahmad  18 , Sajjad Ahmad  19 , Tarik Ahmed Rashid  20 , Maxwell Akonde  21 , Hanadi Al Hamad  22   23 , Fares Alahdab  24 , Yousef Alimohamadi  25 , Vahid Alipour  26   27 , Sadeq Ali Al-Maweri  28 , Ubai Alsharif  29 , Alireza Ansari-Moghaddam  30 , Sumadi Lukman Anwar  31 , Anayochukwu Edward Anyasodor  32 , Jalal Arabloo  26 , Aleksandr Y Aravkin  2   33   34 , Raphael Taiwo Aruleba  35 , Malke Asaad  36 , Tahira Ashraf  37 , Seyyed Shamsadin Athari  38 , Sameh Attia  39 , Sina Azadnajafabad  40 , Mohammadreza Azangou-Khyavy  40   41 , Muhammad Badar  42 , Nayereh Baghcheghi  43 , Maciej Banach  44   45 , Mainak Bardhan  46   47 , Hiba Jawdat Barqawi  14 , Nasir Z Bashir  48 , Azadeh Bashiri  49 , Habib Benzian  50 , Eduardo Bernabe  51 , Devidas S Bhagat  52 , Vijayalakshmi S Bhojaraja  53 , Tone Bjørge  54   55 , Souad Bouaoud  56   57 , Dejana Braithwaite  58   59 , Nikolay Ivanovich Briko  60 , Daniela Calina  61 , Giulia Carreras  62 , Promit Ananyo Chakraborty  63 , Vijay Kumar Chattu  64   65 , Akhilanand Chaurasia  66 , Meng Xuan Chen  67 , William C S Cho  68 , Dinh-Toi Chu  69 , Isaac Sunday Chukwu  70 , Eunice Chung  2 , Natália Cruz-Martins  71   72 , Omid Dadras  54   73 , Xiaochen Dai  2   34 , Lalit Dandona  2   74   75 , Rakhi Dandona  2   34   74 , Parnaz Daneshpajouhnejad  76   77 , Reza Darvishi Cheshmeh Soltani  78 , Aso Mohammad Darwesh  79 , Sisay Abebe Debela  80 , Meseret Derbew Molla  81 , Fikadu Nugusu Dessalegn  82 , Mostafa Dianati-Nasab  83   84 , Lankamo Ena Digesa  85 , Shilpi Gupta Dixit  86 , Abhinav Dixit  87 , Shirin Djalalinia  88 , Iman El Sayed  89 , Maha El Tantawi  90 , Daniel Berhanie Enyew  91 , Daniel Asfaw Erku  92 , Rana Ezzeddini  93 , Adeniyi Francis Fagbamigbe  94   95 , Luca Falzone  96   97 , Getahun Fetensa  98 , Takeshi Fukumoto  99 , Piyada Gaewkhiew  100   101 , Silvano Gallus  102 , Mesfin Gebrehiwot  103 , Ahmad Ghashghaee  104 , Paramjit Singh Gill  105 , Mahaveer Golechha  106 , Pouya Goleij  107 , Ricardo Santiago Gomez  108 , Giuseppe Gorini  109 , Andre Luiz Sena Guimaraes  110 , Bhawna Gupta  111 , Sapna Gupta  112 , Veer Bala Gupta  113 , Vivek Kumar Gupta  114 , Arvin Haj-Mirzaian  115   116 , Esam S Halboub  117   118 , Rabih Halwani  14   119 , Asif Hanif  120 , Ninuk Hariyani  121   122 , Mehdi Harorani  123 , Hamidreza Hasani  124 , Abbas M Hassan  36 , Soheil Hassanipour  125   126 , Mohammed Bheser Hassen  2   127 , Simon I Hay  2   34 , Khezar Hayat  128   129 , Brenda Yuliana Herrera-Serna  130 , Ramesh Holla  131 , Nobuyuki Horita  132   133 , Mehdi Hosseinzadeh  134   135 , Salman Hussain  136   137 , Olayinka Stephen Ilesanmi  138   139 , Irena M Ilic  140 , Milena D Ilic  141 , Gaetano Isola  142 , Abhishek Jaiswal  143 , Chinmay T Jani  144 , Tahereh Javaheri  145 , Umesh Jayarajah  146   147 , Shubha Jayaram  148 , Nitin Joseph  149 , Vidya Kadashetti  150 , Eswar Kandaswamy  151 , Shama D Karanth  152 , Ibraheem M Karaye  153 , Joonas H Kauppila  154   155 , Harkiran Kaur  74 , Mohammad Keykhaei  40   156 , Yousef Saleh Khader  157 , Himanshu Khajuria  158 , Javad Khanali  40   41 , Mahalaqua Nazli Khatib  159 , Hamid Reza Khayat Kashani  160 , Mohammad Amin Khazeei Tabari  161   162 , Min Seo Kim  163   164 , Farzad Kompani  165 , Hamid Reza Koohestani  166 , G Anil Kumar  74 , Om P Kurmi  167   168 , Carlo La Vecchia  169 , Dharmesh Kumar Lal  74 , Iván Landires  170   171 , Savita Lasrado  172 , Caterina Ledda  173 , Yo Han Lee  174 , Massimo Libra  97 , Stephen S Lim  2   34 , Stefan Listl  175   176 , Platon D Lopukhov  60 , Ahmad R Mafi  177 , Rashidul Alam Mahumud  178 , Ahmad Azam Malik  120   179 , Manu Raj Mathur  180   181 , Sazan Qadir Maulud  182 , Jitendra Kumar Meena  183 , Entezar Mehrabi Nasab  184 , Tomislav Mestrovic  2   185 , Reza Mirfakhraie  186 , Awoke Misganaw  34   187 , Sanjeev Misra  188 , Prasanna Mithra  149 , Yousef Mohammad  189 , Mokhtar Mohammadi  190 , Esmaeil Mohammadi  191   192 , Ali H Mokdad  2   34 , Mohammad Ali Moni  193 , Paula Moraga  194 , Shane Douglas Morrison  195 , Hamid Reza Mozaffari  196 , Sumaira Mubarik  197 , Christopher J L Murray  2   34 , Tapas Sadasivan Nair  198 , Sreenivas Narasimha Swamy  199 , Aparna Ichalangod Narayana  200 , Hasan Nassereldine  2 , Zuhair S Natto  201   202 , Biswa Prakash Nayak  158 , Serban Mircea Negru  203 , Haruna Asura Nggada  204   205 , Hasti Nouraei  206 , Virginia Nuñez-Samudio  207   208 , Bogdan Oancea  209 , Andrew T Olagunju  210   211 , Ahmed Omar Bali  212 , Alicia Padron-Monedero  213 , Jagadish Rao Padubidri  214 , Anamika Pandey  74 , Shahina Pardhan  215 , Jay Patel  216   217 , Raffaele Pezzani  218   219 , Zahra Zahid Piracha  220 , Navid Rabiee  221   222 , Venkatraman Radhakrishnan  223 , Raghu Anekal Radhakrishnan  200 , Amir Masoud Rahmani  224 , Vahid Rahmanian  225 , Chythra R Rao  226 , Sowmya J Rao  227 , Goura Kishor Rath  228 , David Laith Rawaf  229   230 , Salman Rawaf  231   232 , Reza Rawassizadeh  233 , Mohammad Sadegh Razeghinia  234   235 , Nazila Rezaei  40 , Negar Rezaei  40   236 , Nima Rezaei  237   238 , Aziz Rezapour  26 , Abanoub Riad  239   240 , Thomas J Roberts  241   242 , Esperanza Romero-Rodríguez  243 , Gholamreza Roshandel  244 , Manjula S  245 , Chandan S N  245 , Basema Saddik  246 , Mohammad Reza Saeb  247 , Umar Saeed  220   248 , Mohsen Safaei  249 , Maryam Sahebazzamani  250   251 , Amirhossein Sahebkar  252   253 , Amir Salek Farrokhi  254 , Abdallah M Samy  255   256 , Milena M Santric-Milicevic  140   257 , Brijesh Sathian  22   258 , Maheswar Satpathy  259   260 , Mario Šekerija  261   262 , Subramanian Senthilkumaran  263 , Allen Seylani  264 , Omid Shafaat  265   266 , Hamid R Shahsavari  267 , Erfan Shamsoddin  268   269 , Mequannent Melaku Sharew  270 , Javad Sharifi-Rad  271 , Jeevan K Shetty  272 , K M Shivakumar  273 , Parnian Shobeiri  192   274 , Seyed Afshin Shorofi  275   276 , Sunil Shrestha  277 , Sudeep K Siddappa Malleshappa  278 , Paramdeep Singh  279 , Jasvinder A Singh  280   281 , Garima Singh  282   283 , Dhirendra Narain Sinha  284   285 , Yonatan Solomon  286 , Muhammad Suleman  287   288 , Rizwan Suliankatchi Abdulkader  289 , Yasaman Taheri Abkenar  290 , Iman M Talaat  14   291 , Ker-Kan Tan  292 , Abdelghani Tbakhi  293 , Arulmani Thiyagarajan  294 , Amir Tiyuri  295   296 , Marcos Roberto Tovani-Palone  297   298 , Bhaskaran Unnikrishnan  299 , Bay Vo  300 , Simona Ruxandra Volovat  301   302 , Cong Wang  303 , Ronny Westerman  304 , Nuwan Darshana Wickramasinghe  305 , Hong Xiao  306   307 , Chuanhua Yu  197 , Deniz Yuce  308 , Ismaeel Yunusa  309 , Vesna Zadnik  310 , Iman Zare  311 , Zhi-Jiang Zhang  312 , Mohammad Zoladl  313 , Lisa M Force  2   34   314 , Fernando N Hugo  315
Affiliations

The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019

GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators et al. JAMA Oncol. .

Abstract

Importance: Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.

Objective: To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.

Evidence review: The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.

Findings: In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.

Conclusions and relevance: In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cunha reported grants from the São Paulo Research Foundation during the conduct of the study. Ms Compton reported grants from the Bill & Melinda Gates Foundation and St. Jude Children’s Research Hospital, which partially funded their employment at the Institute for Health Metrics and Evaluation at University of Washington during the conduct of the study. Ms Xu reported grants from the Bill & Melinda Gates Foundation and St. Jude Children’s Research Hospital during the conduct of the study. Prof Antunes reported support from the University of São Paulo School of Public Health during the conduct of the study and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the Ministry of Health (Brazil’s official government agency). Dr Kerr reported grants or contracts from the National Institute of Dental and Craniofacial Research; payment for expert testimony; leadership or fiduciary roles in board, society, committee, or advocacy groups; paid or unpaid support from the American Board of Oral Medicine as a director; and other support from a Subaward budget. Ms Lu reported grants from the Bill & Melinda Gates Foundation and St. Jude Children’s Research Hospital, which partially funded her employment at the Institute for Health Metrics and Evaluation at University of Washington during the conduct of the study. Dr Kocarnik reported grants from the Bill & Melinda Gates Foundation during the conduct of the study. Ms Dean reported grants from the Institute for Health Metrics and Evaluation during the conduct of the study. Dr A. Ahmad reported support from Shaqra University. Dr Anwar reported support from the NUS-UGM Seed Grant from the Tahir Foundation. Prof Benzian reported institutional support as a fellow at the Stellenbosch Institute of Advanced Study. Dr Dai reported grants from the Bill & Melinda Gates Foundation during the conduct of the study and grants from Bloomberg Philanthropies outside the submitted work. Prof Gill reported support from the National Institute for Health and Care Research as a senior investigator. The views expressed in this article are those of the authors and not necessarily those of the National Institute for Health and Care Research or the UK Department of Health and Social Care. Prof V. Gupta reported grant support from the National Health and Medical Research Council of Australia. Prof V. K. Gupta reported funding support from the National Health and Medical Research Council. Dr Hussain reported support from Operational Programme Research, Development and Education. Dr Joseph reported support from the Department of Community Medicine at Kasturba Medical College, Mangalore of the Manipal Academy of Higher Education. Prof Kauppila reported support from the Sigrid Jusélius Foundation and the Finnish Cancer Foundation. Prof Khatib reported support from the Global Evidence Synthesis Initiative (GESI) and the School of Epidemiology and Public Health at Datta Meghe Institute of Higher Education and Research (DMIHER). Prof Landires reported support as a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaria Nacional de Ciencia y Tecnologia (SENACYT). Dr Morrison reported grants from The Plastic Surgery Foundation outside the submitted work. Prof Nuñez-Samudio reported support as a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaria Nacional de Ciencia y Tecnologia (SENACYT). Dr Piracha reported support from the International Center of Medical Sciences Research (ICMSR). Prof R. Radhakrishnan reported support from Wellcome Trust/DBT India Alliance. Prof Riad reported support from the NPO Systemic Risk Institute (LX22NPO5101), funded by the European Union’s NextGenerationEU. Dr Roberts reported personal fees from Biocon Biologics Ltd and grants from the National Cancer Institute outside the submitted work. Prof Saeed reported support from the International Center of Medical Sciences Research (ICMSR). Dr Samy reported support from Ain Shams University and the Egyptian Fulbright Mission Program. Dr Šekerija reported personal fees from Roche and Johnson & Johnson outside the submitted work. Dr Shahsavari reported support from the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. Mr Shrestha reported being a Doctor of Philosophy (PhD) student from the School of Pharmacy at Monash University Malaysia and received the Graduate Research Merit Scholarship to pursue his PhD. Prof J. Singh reported consultant fees from Scipher, Crealta/Horizon, MediSys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, ClearView Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, Mediq, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, the National Institutes of Health, and the American College of Rheumatology; institutional research support from Zimmer Biomet Holdings; food and beverage payments from Intuitive Surgical/Philips Electronics North America; stock options in atai Life Sciences, Kintara Therapeutics, Intelligent Bio Solutions, Acumen Pharmaceuticals, TPT Global Tech, Vaxart, Aytu BioPharma, Adaptimmune Therapeutics, GeoVax, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, and Charlotte’s Web Holdings; previous stock options in Amarin, Viking, and Moderna; serving on the speaker’s bureau of Simply Speaking; and serving as a member of Outcome Measures in Rheumatology (OMERACT), an organization that develops outcome measures in rheumatology and receives arms-length funding from 8 companies. Dr Suliankatchi Abdulkader reported support from Indian Council of Medical Research National Institute of Epidemiology. Mr Tovani-Palone reported support from the Saveetha Institute of Medical and Technical Sciences. Prof Unnikrishnan reported support from Kasturba Medical College, Mangalore of the Manipal Academy of Higher Education. Prof Yu reported support from the National Natural Science Foundation of China (No. 82173626). Dr Force reported grants from the Bill & Melinda Gates Foundation during the conduct of the study, as well as grants from St. Baldrick’s Foundation and the American Society of Clinical Oncology, subcontracting for St. Jude Children’s Research Hospital, and loan repayment from the National Institutes of Health Loan Repayment Program outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Global Maps of Age-Standardized Mortality Rates for Lip, Oral, and Other Pharyngeal Cancer for Both Sexes Combined in 2019
Each map represents estimates at the national level and for the age range of 20 to older than 95 years. Quintiles are based on age-standardized mortality rates per 100 000 person-years. There are several geographic locations where estimates are not available (eg, Western Sahara, French Guiana) because they were not modeled locations in the Global Burden of Diseases, Injuries, and Risk Factors Study 2019; these locations are white on the maps. eFigure 6 in Supplement 1 provides global maps showing the age-standardized incidence rate quintiles for lip and oral cavity cancer and other pharyngeal cancer among both sexes in 2019. eFigures 7 through 10 in Supplement 1 provide additional global maps of age-standardized mortality and incidence rates for lip and oral cavity cancer and other pharyngeal cancer in male and female individuals separately in 2019.
Figure 2.
Figure 2.. Global Absolute Cases and Deaths and Age-Specific Incidence and Mortality Rates for Lip, Oral, and Other Pharyngeal Cancer by Age Group and Sex in 2019
Bars indicate absolute numbers, with error bars representing 95% uncertainty intervals. Lines indicate rates, with shaded areas representing respective 95% uncertainty intervals. For an additional version of this Figure showing absolute disability-adjusted life years and age-specific disability-adjusted life year rates (per 100 000), see eFigure 11 in Supplement 1.
Figure 3.
Figure 3.. Time Trends of Age-Standardized Death and Incidence Rates for Lip, Oral, and Other Pharyngeal Cancer From 1990 to 2019 by Socio-demographic Index (SDI) Quintile
Rates represent both sexes combined and are expressed per 100 000 person-years. See eFigure 3 and eTable 7 in Supplement 1 for details and definitions of the SDI quintiles. For additional versions of this Figure, showing time trends of deaths, incidence, and disability-adjusted life years, see eFigure 12 (by SDI quintile), eFigure 13 (by sex), eFigure 14 (by 10-year age group), and eFigure 15 (by Global Burden of Diseases, Injuries, and Risk Factors Study super-region) in Supplement 1.
Figure 4.
Figure 4.. Proportion of Deaths Attributable to Risk Factors for Lip, Oral, and Other Pharyngeal Cancer by Age Group and Sex Globally in 2019
eFigure 16 in Supplement 1 provides further information on deaths attributable to risk factors for lip, oral, and other pharyngeal cancers in 2019 by Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study world region. eFigure 17 in Supplement 1 provides further information on risk-attributable disability-adjusted life-years for lip, oral, and other pharyngeal cancers by 5-year age groups globally and by GBD study world region. For Tables summarizing the underlying results of risk-attributable deaths and disability-adjusted life-years by country or territory, see eTable 12 (for lip and oral cavity cancer) and eTable 13 (for other pharyngeal cancer) in Supplement 1. An additional version of this Figure showing percentage totals for each category is provided in eFigure 18 in Supplement 1. aThe chewing tobacco and smoking risk factors were modeled with lower age restrictions of 30 years in the GBD 2019 study; thus, estimates were not produced for these risk factors in the age groups of 20 to 24 years and 25 to 29 years.
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