Impact of high body mass index on gallbladder and biliary tract cancer burden in China: a comprehensive analysis of trends from 1990 to 2021

Abstract

Background: Gallbladder and biliary tract cancer (GBTC) is a significant health burden in China, exacerbated by the rising prevalence of high body mass index (BMI). Understanding the trends and factors contributing to mortality and disability associated with GBTC is crucial for targeted public health interventions.

Methods: We utilized data from the Global Burden of Disease (GBD) Study to assess the burden of GBTC attributable to high BMI in China from 1990 to 2021. Age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed. Joinpoint regression and decomposition analyses were conducted to evaluate trends and identify contributing factors, including aging, population growth, and epidemiological changes. Gender-specific differences were also assessed.

Results: In 2021, GBTC deaths attributable to high BMI in China reached 4,053, with males experiencing a higher overall burden than females, particularly in older age groups. While females showed a higher mortality and overall burden in the 60 to 79 age range, this trend reversed in older age brackets, with males experiencing steeper increases in mortality and disability-related indicators beyond age 80. The age-standardized DALYs rate mirrored this pattern, with higher rates in males in advanced age groups. From 1990 to 2021, China saw a steady increase in GBTC burden attributable to high BMI, contrasting with a global decline. Joinpoint analysis indicated marked rises in mortality and DALYs rates after 2005, especially in males. Decomposition analysis identified population growth and aging as major drivers of increased deaths, while epidemiological changes primarily contributed to rising DALYs, with a stronger impact observed in males.

Conclusions: The burden of GBTC attributable to high BMI in China has increased substantially over the last three decades, driven by population growth, aging, and epidemiological shifts. The trends highlight a growing gender disparity, with males experiencing a greater rise in mortality and disability. Public health strategies targeting obesity and metabolic risk factors are critical to mitigating the increasing GBTC burden.

Keywords: China; Epidemiological change; Gallbladder and biliary tract cancer; Global Burden of Disease; High body mass index.

Fig. 1

Distribution of deaths, DALYs, YLDs, and YLLs attributable to high BMI in GBTC in China in 2021 by age and sex. A The number of deaths. B The number of DALYs. C The number of YLDs. D The number of YLLs. DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 2

Age-specific rates of deaths, DALYs, YLDs, and YLLs attributable to high BMI in GBTC in China in 2021, by sex. A The rate of deaths by age and sex. B The rate of DALYs. C The rate of YLDs. D The rate of YLLs. DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 3

Trends in the number and age-standardized rates of deaths, DALYs, YLDs, and YLLs attributable to high BMI in GBTC in China, 1990–2021, by sex. A The number of deaths and age-standardized death rates. B The number of DALYs and age-standardized DALY rates. C The number of YLLs and age-standardized YLL rates. D The number of YLDs and age-standardized YLD rates. DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 4

Comparison of the number and crude rates of deaths, DALYs, YLDs, and YLLs attributable to high BMI in GBTC in China by age group for 1990 and 2021. A The number of deaths and crude death rates. B The number of DALYs and crude DALY rates. C The number of YLDs and crude YLD rates. D The number of YLLs and crude YLL rates. DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 5

Global and China trends in age-standardized rates of deaths, DALYs, YLDs, and YLLs attributable to high BMI in GBTC from 1990 to 2021. A The global trend of age-standardized rates. B The age-standardized trends for China. DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 6

Joinpoint analysis of age-standardized rates for deaths, DALYs, YLDs, and YLLs attributable to high BMI in GBTC in China from 1990 to 2021. A The trend in age-standardized death rates. B The trend in age-standardized DALYs rate. C The trend in YLDs rate. D The trend in YLLs rate. DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 7

Age-specific annual percent changes (APC) in age-standardized death rates attributable to high BMI in GBTC in China. A The age-specific APCs in death rates according to time periods; each line connects the age-specific APCs for a specific time period. B The age-specific APCs in death rates according to birth cohorts; each line connects the APCs for a specific birth cohort over time. C The period-specific APCs in death rates according to age groups; each line connects the APCs for a specific age group across different periods. D The birth cohort-specific APCs in death rates according to age groups; each line connects the cohort-specific APCs for a 5-year age group across different birth cohorts. This figure illustrates the varying trends in death rates due to high BMI by age, time period, and birth cohort. BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 8

Age-specific annual percent changes (APC) in age-standardized DALYs rates attributable to high BMI in GBTC in China. A The age-specific APCs in DALYs rates according to time periods; each line connects the age-specific APCs for a specific time period. B The age-specific APCs in DALYs rates according to birth cohorts; each line connects the APCs for a specific birth cohort over time. C The period-specific APCs in DALYs rates according to age groups; each line connects the APCs for a specific age group across different periods. D The birth cohort-specific APCs in DALYs rates according to age groups; each line connects the cohort-specific APCs for a 5-year age group across different birth cohorts. This figure highlights the trends in DALYs rates due to high BMI, showing variations by age, time period, and birth cohort. DALYs, disability-adjusted life years; BMI, body mass index; GBTC, gallbladder and biliary tract cancer

Fig. 9

Decomposition analysis of changes in deaths and DALYs attributable to high BMI in GBTC in China from 1990 to 2021, by aging (yellow), epidemiological changes (green), and population growth (orange). The black dots representing the sum of the effects of these factors. A Decomposition of changes in deaths for both sexes, males, and females. B Decomposition of changes in DALYs for both sexes, males, and females. DALYs, disability-adjusted life years; BMI, body mass index; GBTC, gallbladder and biliary tract cancer