Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021

Abstract

To evaluate the changing trend and cross-country inequality of bladder cancer (BC) burden over the past 30 years and further predict the trend until 2036. Based on the Global Burden of Disease (GBD) 2021 study, the global incidence, mortality, and disability-adjusted life years (DALYs) of bladder cancer from 1990 to 2021 were obtained. We described the distribution of BC at global, regional and national levels and overall/local trends. The age-period-cohort analysis, decomposition analysis and inequality analysis related to socio-demographic index (SDI) were conducted. Additionally, we predicted the future trend of BC burden using Bayesian age-period-cohort model. In the GBD 2021, the global incidence number of BC was 540,310, doubling compared to that in 1990. However, the age-standardized rate (ASR) drops from 6.90 to 6.35. The changes in bladder cancer mortality and DALYs are similar. The ratio of ASRs of burden between males and females is approximately 4:1. Interestingly, in regions with middle SDI, low-middle SDI, and low SDI, the ASR of incidence has shown an upward trend to varying degrees in recent 10 years. Central Europe has the highest ASR of DALYs. China bore the heaviest burden of bladder cancer and experienced the greatest increase in the burden of bladder cancer. Globally, population growth, aging, and epidemiological changes accounted for 89.83%, 83.91%, and - 73.74% of the changes in DALYs respectively. The absolute inequality related to the SDI increases significantly. The slope index of inequality for DALYs increases from 79.84 to 115.60, and the concentration index slightly decreases to 0.26 in 2021. The prediction showed that the ASRs of the three indicators of bladder cancer would continue to decline from 2022 to 2036. Despite a downward trend in ASRs from 1990 to 2021, the global bladder cancer burden has generally increased with regional and country variations. The burden growth pattern driven by population growth and aging may potentially increase the burden number in the future. Burden is concentrated in high-SDI countries and there are signs indicating a shift towards lower-SDI countries. These findings highlighted challenges in BC prevention and management.

Keywords: Bladder cancer; Disability-adjusted life years; Epidemiology; Global burden of disease; Health inequality; Incidence; Mortality; Socio-demographic index; Urology.

Fig. 1

The global burden of bladder cancer in 204 countries or territories in 2021. (A) The incidence number of bladder cancer. (B) The age-standardized incidence rate of bladder cancer. (C) The mortality number of bladder cancer. (D) The age-standardized mortality rate of bladder cancer. (E) The DALYs number of bladder cancer. (F) The age-standardized DALYs rate of bladder cancer. ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate; DALYs, disability-adjusted life years.

Fig. 2

The EAPC of age-standardized rate of bladder cancer burden at the global and regional levels. EAPC, estimated annual percentage change; SDI, socio-demographic index.

Fig. 3

The global burden changes of bladder cancer in 204 countries or territories from 1990 to 2021. (A) The incidence number change of bladder cancer. (B) The EAPC of age-standardized incidence rate of bladder cancer. (C) The mortality number change of bladder cancer. (D) The EAPC of age-standardized mortality rate of bladder cancer. (E) The DALYs number change of bladder cancer. (F) The EAPC of age-standardized DALYs rate of bladder cancer. ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate; DALYs, disability-adjusted life years; EAPC, estimated annual percentage change.

Fig. 4

The joinpoint analysis of age-standardized DALYs rate of bladder cancer from 1990 to 2021. (A) The age-standardized DALYs rate change of bladder cancer globally. (B) The age-standardized DALYs rate change of bladder cancer in high SDI region. (C) The age-standardized DALYs rate change of bladder cancer in high-middle SDI region. (D) The age-standardized DALYs rate change of bladder cancer in middle SDI region. (E) The age-standardized DALYs rate change of bladder cancer in low-middle SDI region. (F) The age-standardized DALYs rate change of bladder cancer in low SDI region. APC, annual percentage change; DALYs, disability-adjusted life years; SDI, socio-demographic index.

Fig. 5

The effects of age, period, and cohort on the risk of bladder cancer burden globally. (A) The age effect of relative incidence risk of bladder cancer. (B) The age effect of relative mortality risk of bladder cancer. (C) The period effect of relative incidence risk of bladder cancer. (D) The period effect of relative mortality risk of bladder cancer. (E) The birth cohort effect of relative incidence risk of bladder cancer. (F) The birth cohort effect of relative mortality risk of bladder cancer. RR, relative risk.

Fig. 6

The decomposition analysis of the burden of bladder cancer from 1990 to 2021. (A) The decomposition analysis of incidence number change in overall sexes. (B) The decomposition analysis of incidence number change in male. (C) The decomposition analysis of incidence number change in female. (D) The decomposition analysis of deaths number change in overall sexes. (E) The decomposition analysis of deaths number change in male. (F) The decomposition analysis of deaths number change in female. (G) The decomposition analysis of DALYs number change in overall sexes. (H) The decomposition analysis of DALYs number change in male. (I) The decomposition analysis of DALYs number change in female. The black dot denotes the overall value of the change resulting from all three components. For each component, the magnitude of a positive value suggests a corresponding increase in burden attributed to the component; the magnitude of a negative value suggests a corresponding decrease in burden attributed to the component. DALYs, disability-adjusted life-years; SDI, sociodemographic index.

Fig. 7

The SDI-related health inequality analysis for the burden of bladder in 1990 and 2021, globally. (A) The SDI-related health inequality regression for incidence of bladder cancer. (B) The concentration curves for incidence of bladder cancer. (C) The SDI-related health inequality regression for mortality of bladder cancer. (D) The concentration curves for mortality of bladder cancer. (E) The SDI-related health inequality regression for DALYs of bladder cancer. (F) The concentration curves for DALYs of bladder cancer. DALYs, disability-adjusted life-years; SDI, sociodemographic index.

Fig. 8

The predicted age-standardized rate of bladder cancer burden from 2022 to 2036 by sexes globally. (A) The predicted ASIR from 2022 to 2036 in male. (B) The predicted ASIR from 2022 to 2036 in female. (C) The predicted ASMR from 2022 to 2036 in male. (D) The predicted ASMR from 2022 to 2036 in female. (E) The predicted ASDR from 2022 to 2036 in male. (F) The predicted ASDR from 2022 to 2036 in female. ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate; DALYs, disability-adjusted life-years.