Global and regional burden of nasopharyngeal cancer in older adults attributable to smoking and high alcohol use from 1990 to 2021

Abstract

Background: Nasopharyngeal cancer (NPC) poses a considerable global health burden, with behavioral risk factors such as smoking and high alcohol use contributing to disparities across sociodemographic groups. The growing aging population faces heightened vulnerability to NPC due to prolonged exposure to these modifiable risks, yet comprehensive analyses of aging-specific burden patterns remain limited.

Methods: Utilizing the Global Burden of Disease 2021 data, we conducted a systematic evaluation of NPC burden attributable to smoking and alcohol use across 204 countries from 1990 to 2021. Age-stratified analyses focused on older adults (≥60 years), incorporating three analytical dimensions: Sociodemographic Index (SDI) quintiles, sex-specific disparities, and geospatial heterogeneity. Age-standardized mortality (ASMR) and age-standardized DALY rates (ASDRs) were calculated with 95% uncertainty intervals. Temporal trends were quantified via estimated annual percentage changes (EAPCs). Bayesian age-period-cohort modeling projected disease burden through 2050.

Results: From 1990 to 2021, smoking and high alcohol use contributed substantially to the NPC burden globally, with older adults exhibiting distinct risk profiles. Decline in smoking-related burden in global ASDR was observed, yet older adults in low and middle SDI regions retained disproportionately high rates. Rise in alcohol-related burden in certain regions (e.g., Southeast Asia and Caribbean) was particularly pronounced among older age groups. Middle and high-middle SDI regions consistently exhibited the highest ASDR for both risk factors, with older adults contributing a significant share of disability-adjusted life years (DALYs). Older males faced the highest DALY burdens, with extreme older male-to-female disparities persisting across age groups. Population aging will amplify absolute DALY burdens among older adults by 2050.

Conclusion: Behavioral risk factors such as tobacco and alcohol use remain key contributors to the burden of nasopharyngeal cancer in older persons, with significant regional, gender, and demographic differences. There is an urgent need to develop targeted public health policies focusing on smoking cessation and alcohol control that take into account the health needs of older persons.

Keywords: GBD; alcohol use; healthy aging; nasopharyngeal cancer; smoking use.

Figure 1

Time trends of age-standardized DALY rate (per 100,000 population) for NPC attributable to behavioral factors from 1990 to 2021, globally, across five SDI regions and in GBD regions. The figure illustrates the contributions of smoking (purple line) and high alcohol use (green line) to NPC DALYs.

Figure 2

EAPC values of ASMR and ASDR (per 100,000 population) for NPC attributable to behavioral factors in 21 GBD regions (1990–2021). (A) EAPC of ASMR by region for smoking. (B) EAPC of ASDR by region for smoking. (C) EAPC of ASMR by region for high alcohol use. (D) EAPC of ASDR by region for high alcohol use.

Figure 3

Spatial distribution of ASMR and ASDR (per 100,000 population) for NPC attributable to behavioral factors in 2021. (A) ASMR by region for smoking. (B) ASDR by region for smoking. (C) ASMR by region for high alcohol use. (D) ASDR by region for high alcohol use.

Figure 4

Spatial distribution of EAPC for ASMR and ASDR (per 100,000 population) of nasopharyngeal cancer attributable to behavioral factors from 1990 to 2021. (A) EAPC of ASMR by region for smoking. (B) EAPC of ASDR by region for smoking. (C) EAPC of ASMR by region for high alcohol use. (D) EAPC of ASDR by region for high alcohol use.

Figure 5

Age-specific sex ratio (older male vs. female) of nasopharyngeal cancer attributable to behavioral factors in 2021. (A) Age-specific sex ratio of mortality due to smoking. (B) Age-specific sex ratio of DALYs due to smoking. (C) Age-specific sex ratio of mortality due to high alcohol use. (D) Age-specific sex ratio of DALYs due to high alcohol use.

Figure 6

Age-specific trends of DALY rate (per 100,000 population) for nasopharyngeal cancer attributable to smoking from 1990 to 2021.

Figure 7

Age-specific trends of DALY rate (per 100,000 population) for nasopharyngeal cancer attributable to high alcohol use from 1990 to 2021.

Figure 8

The proportion of ASMR and ASDR for nasopharyngeal cancer attributable to behavioral risk factors in 1990 and 2021. (A) The proportion of ASMR due to smoking and high alcohol use (1990 vs. 2021). (B) Proportion of ASDR due to smoking and high alcohol use (1990 vs. 2021). The figure is categorized by global, various SDI regions, and GBD regions.

Figure 9

From 1990 to 2021, the age-standardized mortality rate and DALY rate of nasopharyngeal cancer caused by behavioral factors in 21 GBD regions were classified by the SDI. The expected values based on SDI and burden indicators for all locations are represented by black lines. Statistical test results are shown at the top left of each subplot. (A) ASMR for smoking. (B) ASMR for high alcohol use. (C) ASDR for smoking. (D) ASDR for high alcohol use. ASMR, Age-Standardized Mortality Rate; ASDR, Age-Standardized DALY Rate; DALY, Disability-Adjusted Life Years; SDI, Sociodemographic Index.

Figure 10

The projected trends of age-standardized DALY rate (per 100,000 population) for nasopharyngeal cancer attributable to behavioral factors from 1990 to 2050. The figure illustrates the trends of DALY rates due to smoking and high alcohol use in female and male populations. DALY, Disability-Adjusted Life Year.