Global, regional, national prevalence, mortality, and disability-adjusted life-years of cutaneous squamous cell carcinoma and trend analysis from 1990 to 2021 and prediction to 2045

Abstract

Background: A serious worldwide health concern is cutaneous squamous cell carcinoma (cSCC). For the purpose of creating focused strategies, it is essential to comprehend geographical variations in cSCC prevalence and trends.

Methods: This study utilized data from the 2021 Global Burden of Diseases (GBD) survey to analyze cSCC across 204 countries and territories. We assessed the age-standardized prevalence rate (ASPR), mortality rate (ASMR), disability-adjusted life years (ASDR), and estimated annual percentage changes (EAPCs), with trends stratified by region, country, age, sex, and Sociodemographic Index (SDI). To evaluate disparities in cSCC burden, we combined the SDI with the inequality slope and concentration indices for an international health inequality analysis. Decomposition analysis assessed the effects of population growth, aging, and epidemiological trends on disease burden, while frontier analysis linked cSCC outcomes with socio-demographic development. A Bayesian Age-Period-Cohort (BAPC) model projected future prevalence, mortality, and DALYs, identifying key drivers of cSCC burden.

Results: In 2021, there were 2,275,834 cases of cSCC globally, reflecting a 345% increase since 1990. During this period, the ASPR rose from 14.69 to 26.85 per 100,000, while the ASMR increased slightly from 0.67 to 0.69 per 100,000. Disability-adjusted life years (DALYs) rose from 544,973 to 1,210,874. Among socio-demographic regions, the high SDI region had the highest ASPR, while the middle SDI region exhibited the highest ASMR and ASDR. Decomposition analysis identified population growth and demographic aging as key drivers of the rising ASMR. Countries like Georgia showed significant disparities in frontier analysis, indicating potential for better cSCC management. Health inequality analysis confirmed that the burden was concentrated in nations with higher SDI. By 2045, the global ASPR is projected to reach 64.66, with the ASMR and ASDR expected to decrease to 1.02 and 20.63 per 100,000, respectively.

Conclusion: Over the last three decades, the global burden of cSCC has increased significantly. While mortality rates and DALYs are expected to decline over the next twenty years, the prevalence of cSCC is projected to remain high. This highlights the urgent need to reevaluate preventive efforts aimed at reducing morbidity, particularly in areas with substantial populations over the age of 95.

Keywords: bayesian age-period-cohort (BAPC) model; cutaneous squamous cell carcinoma; decomposition analysis; frontier analysis; global burden of disease; inequality analysis.

Figure 1

Global ASPR (A), ASMR (B) and ASDR (C) of cSCC in 2021 (per 100,000 population). ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 2

Trends in ASPR (A), ASMR (B), and ASDR (C) for cSCC across five Sociodemographic Index (SDI) regions from 1990 to 2021. ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 3

The EAPCs for ASPR (A), ASMR (B), and ASDR (C) due to cSCC from 1990 to 2021, for both sexes, across GBD regions and SDI quintiles. DALYs, disability-adjusted life-years; EAPC, estimated annual percentage change; GBD, Global Burden of Disease; SDI, Socio-demographic Index. ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 4

ASPR (A), ASMR (B), and ASDR (C) for cSCC across different geographical regions in 2021. ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 5

Age-specific patterns by sex for ASPR (A), ASMR (B), and ASDR (C) associated with cSCC at the global level in 2021. Error bars indicate the 95% uncertainty interval (UI) for the number of cases. Shading indicates the 95% UI for the rates. DALYs, disability-adjusted life-years. ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 6

The global trends in ASPR (A), ASMR (B), and ASDR (C) from 2021 to 2045 for cSCC were predicted using Bayesian age-period-cohort (BAPC) models. ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 7

Changes in the ASMR of cSCC according to the three causes from 1990 to 2021 at the global level and by SDI quintile and WHO regions. The black dot represents the overall value of incidence change contributed from all causes. ASMR, age-standardized mortality rate; WHO, World Health Organization; cSCC, cutaneous squamous cell carcinoma.

Figure 8

(A) Frontier analysis of cSCC based on SDI and ASDR from 1990 to 2021. The color scale represents the years from 1990, depicted in black, to 2021, shown in blue. The frontier is delineated in a solid black color. (B) Frontier analysis based on SDI and cSCC ASDR in 2021. The frontier line is black; countries and territories are represented as dots. The top countries with the most considerable effective difference of ASDR from the frontier line are marked in black words; Red dots indicate an increase in ASDR of cSCC from 1990 to 2021; blue dots indicate a decrease in ASDR of cSCC between 1990 and 2021. ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.

Figure 9

1990 and 2021, health inequality regression curves (A) and concentration curves (B) for ASMR of cSCC. Health inequality regression curves (C) and concentration curves (D) for ASDR of cSCC. ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life year rate; cSCC, cutaneous squamous cell carcinoma.