Dietary risk factors and cancer mortality burden from 1990 to 2021: a comparative study of China and global regions with varying sociodemographic development levels based on the Global Burden of Disease database

Abstract

Objective: To analyze temporal trends of diet-attributable cancer mortality in China (1990-2021), compare patterns between China and regions with varying development levels, and explore gender-specific characteristics to inform targeted prevention strategies.

Study design: Cross-sectional and time-series analyses.

Methods: We conducted cross-sectional and time-series analyses of nine dietary risk factors across China, the global region, and five Socio-demographic Index (SDI) - stratified regions. Joinpoint regression models quantified temporal trends through Annual Percent Change (APC) and Average Annual Percent Change (AAPC).

Results: Diet-attributable cancer deaths in China decreased from 9.9% (95% CI: 2.2-20.5%) to 6.3% (95% CI: 2.1-12.8%) during 1990-2021. China's 2021 attribution (6.3%) was below the global average (6.8%), exceeding high-SDI regions (5.8%) but below middle-SDI regions (7.4%). Low vegetable intake showed the largest decline (3.0 to 0.3%), while high red meat consumption increased (1.6 to 2.0%). Red meat's impact was greater in females, while inadequate plant consumption affected males more significantly. Dietary factors most influenced colorectal cancer in China (39.2%). China's diet-attributable cancer mortality decreased by 53.0% (from 18.4 to 8.7 per 100,000), exceeding global reductions (35.5%).

Conclusion: This study identified distinct regional patterns in diet-attributable cancer mortality. China's profile reflects its transition between development levels-decreasing vegetable-deficiency risks while increasing red meat consumption. Globally, attribution patterns are shifting from plant food inadequacy toward animal product excess, with persistent gender disparities.

Keywords: Global Burden of Disease (GBD); cancer mortality; dietary risk factors; regional comparison; socio-demographic index.

Figure 1

Comparative analysis of dietary risk factors’ attribution to cancer types in china and global regions with temporal patterns (1990–2021). The top panels show attribution proportions of nine dietary risk factors to different cancer types in China (left) and globally (right). Colors represent cancer types. Bottom panels display heatmaps illustrating temporal changes in attribution proportions across four time periods, revealing China’s transition from low vegetable intake dominance toward high red meat consumption, while globally, high red meat intake maintained the highest attribution proportion throughout the study period.

Figure 2

Joinpoint Regression Analysis of Dietary Risk Factors’ Impact on Cancer Mortality in China and Global Regions (1990–2021). Left panels show joinpoint regression analyses of age-standardized cancer mortality rates attributable to nine dietary risk factors in China, with significant joinpoints marked by vertical lines. Right panels display corresponding global trends. Tables below each graph present Annual Percent Change (APC) values for identified segments. APC represents the percentage change per year within each segment, while AAPC (Average Annual Percent Change) indicates the overall average annual percentage change for the entire period. Side panels compare overall temporal trends between China and global regions.

Figure 3

Gender Differences in Dietary Risk Factors’ Attribution to Cancer Mortality Across Different Time Periods in China vs. Global Regions (1990–2021). The left column shows data for China across four time periods (1990–1998, 1999–2007, 2008–2015, 2016–2021), while the right column displays corresponding global data for the same time periods. In each chart, dietary risk factors are listed on the y-axis, with attribution proportion (%) on the x-axis.

Figure 4

Multidimensional Comparative Analysis of Dietary Risk Factors’ Impact on Cancer Mortality Across Regions with Different Socioeconomic Development Levels (1990–2021). This figure presents a comprehensive six-panel visualization of dietary risk factors’ impact on cancer mortality across different regions and cancer types. Top Row (Three Heatmaps): Left panel: Average attribution proportion (%) of nine dietary risk factors to all cancer mortality by region. Middle panel: Comparative ranking of dietary risk factors across regions, with darker blue indicating higher ranking positions. Right panel: Regional comparison of dietary risks’ impact on different cancer types. Bottom Row (Two Graphs): Left panel: Temporal trends of age-standardized cancer mortality rates (per 100,000) attributable to all dietary risk factors from 1990 to 2021. Right panel: Regional comparison of major dietary risk factors’ average annual percent change (AAPC).