Trends and projections of gallbladder and biliary tract cancer in China: a comprehensive analysis from 1990 to 2030 based on the Global Burden of Disease Study 2021

Abstract

Background: Gallbladder and biliary tract cancer (GBTC) poses a growing public health challenge in China, with considerable disparities across age and sex. Understanding long-term epidemiological patterns is essential for informing cancer control strategies and future projections.

Methods: Data from the Global Burden of Disease Study 2021 were used to assess GBTC burden in China from 1990 to 2021. Indicators analyzed included incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression, age-period-cohort (APC) analysis, decomposition analysis, and Bayesian APC (BAPC) models were employed to explore temporal trends and project future burden through 2030.

Results: In 2021, China reported 51,720 new GBTC cases, with an age-standardized incidence rate (ASIR) of 2.49 per 100,000. Males exhibited higher burden than females across all indicators. Incidence, prevalence, mortality, and DALYs were highest in older age groups. From 1990 to 2021, China experienced increasing trends in incidence and prevalence, while age-standardized mortality rates (ASMR) declined. Compared to global trends, China's ASIR rose while global rates declined. DALYs decreased in both contexts but more steeply globally. Joinpoint regression revealed sex-specific shifts, with males showing consistent increases in incidence and females experiencing periods of both decline and rise. APC analysis highlighted increasing incidence among post-1950 birth cohorts and decreasing mortality in recent cohorts. Decomposition analysis indicated that rising incidence was driven by epidemiological changes and population growth, while mortality reduction was linked to medical improvements. BAPC models projected a continued rise in incidence, particularly among males.

Conclusions: The burden of GBTC in China is rising, especially among men and older adults. While mortality has improved, incidence continues to grow, highlighting the need for targeted prevention, early detection, and gender-specific public health policies.

Keywords: Biliary tract cancer; China; Epidemiology; Gallbladder cancer; Global Burden of Disease; Joinpoint regression.

Fig. 1

Distribution and rates of incidence, prevalence, and mortality of GBTC in China, 2021. A Total new cases by age and sex. B ASIR per 100,000 by age and sex. C Total prevalence cases by age and sex. D ASPR per 100,000 by age and sex. E Total new deaths by age and sex. F ASMR per 100,000 by age and sex. Abbreviations: GBTC, gallbladder and biliary tract cancer; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate

Fig. 2

Trends in incidence, prevalence, mortality, and burden of GBTC in China, 1990–2021. A Trends in the number of new incidence cases and ASIRs per 100,000 people from 1990 to 2021, by sex. B Trends in the number of prevalence cases and age-standardized prevalence rates per 100,000 people from 1990 to 2021, by sex. C Trends in the number of deaths and age-standardized death rates per 100,000 people from 1990 to 2021, by sex. D Trends in the number of DALYs and age-standardized DALY rates per 100,000 people from 1990 to 2021, by sex. E Trends in the number of YLDs and age-standardized YLD rates per 100,000 people from 1990 to 2021, by sex. F Trends in the number of YLLs and age-standardized YLL rates per 100,000 people from 1990 to 2021, by sex. Abbreviations: GBTC, gallbladder and biliary tract cancer; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost

Fig. 3

Global and China trends in age-standardized rates of GBTC from 1990 to 2021. A Trends in global ASIRs, ASMRs, ASPRs, DALYs rate, YLDs rate, and YLLs rate per 100,000 people from 1990 to 2021. B Trends in China ASIRs, ASMRs, ASPRs, DALYs rate, YLDs rate, and YLLs rate per 100,000 people from 1990 to 2021. Abbreviations: GBTC, gallbladder and biliary tract cancer; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost

Fig. 4

Joinpoint regression analysis of age-standardized rates for GBTC in China from 1990 to 2021. A ASIRs for males (gray line) and females (green line), with the overall population trend represented by the blue line. B ASPRs for males, females, and the overall population. C ASMRs for males and females, along with the total population trend. D DALYs due to GBTC for both sexes and the overall population. E YLDs for males and females, compared to the total population. F YLLs metrics for both sexes, indicating the overall burden of GBTC across the population. Abbreviations: GBTC, gallbladder and biliary tract cancer; ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASPR, age-standardized prevalence rate; DALYs, disability-adjusted life years; YLDs, years lived with disability; YLLs, years of life lost

Fig. 5

Age, period, and cohort effects on the incidence of GBTC in China. A Age specific incidence rates of GBTC according to time periods; each line connects the age specific incidence for a 5-year period. B Age-specific incidence rates of GBTC according to birth cohort; each line connects the age-specific incidence for a 5-year cohort. C Period-specific incidence rates of GBTC according to age groups; each line connects the birth cohort-specific incidence for a 5-year age group. D Birth cohort specific incidence rates of GBTC according to age groups; each line connects the birth cohort-specific incidence for a 5-year age group. Abbreviations: GBTC, gallbladder and biliary tract cancer

Fig. 6

Decomposition analysis of changes in incidence and mortality of GBTC in China. A Decomposition of changes in incidence by factors of aging, epidemiological change, and population growth for both sexes, males, and females. B Decomposition of changes in mortality by factors of aging, epidemiological change, and population growth for both sexes, males, and females. Abbreviations: GBTC, gallbladder and biliary tract cancer

Fig. 7

Projected incidence rates of GBTC in China through 2030 by BAPC analysis. A Predicted ASIRs per 100,000 people for females from 1990 to 2030. B Predicted ASIRs per 100,000 people for males from 1990 to 2030. Abbreviations: GBTC, gallbladder and biliary tract cancer; ASIR, age-standardized incidence rate. BAPC, Bayesian age-period-cohort