Global burden of brain and central nervous system cancer among people aged 20-64 years, 1992-2021 and projections to 2050: a population-based study

Abstract

Objectives: To estimate the burden, trends, and inequalities of brain and central nervous system cancer (CNS cancer) among adults at global, regional and national level from 1992 to 2021.

Design: Population-based study.

Population: Adults aged 20-64 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2021) from 1992 to 2021.

Main outcome measures: Our primary outcomes comprised age-standardised prevalence, incidence, mortality and disability-adjusted life-years (DALYs) for CNS cancers. The analytical framework incorporated temporal trend analysis through annual percentage change (APC) and average APC (AAPC) metrics, complemented by Bayesian age-period-cohort modelling to assess demographic influences. We employed predictive modelling with decomposition techniques to evaluate contributions from age structure shifts, population dynamics and risk factor modifications, while spatiotemporal Gaussian process regression enabled robust smoothing and trend estimation across continuous time-space dimensions. The study specifically applied frontier analysis methodologies to examine epidemiological patterns of prevalence, incidence, mortality and DALYs within the 20-64 years adult population.

Results: From 1992 to 2021, the global age-standardised prevalence (AAPC 1.04 (95% CI 0.91 to 1.18); p<0.001) and incidence (AAPC 0.23 (95% CI 0.14 to 0.31); p<0.001) of CNS cancer among adults aged 20-64 years increased, while age-standardised DALYs (AAPC -0.28 (95% CI -0.34 to -0.22); p<0.001) and mortality (AAPC -0.27 (95% CI -0.34 to -0.2); p<0.001) decreased. The most significant increase in prevalence (AAPC 1.67 (95% CI 1.47 to 1.87); p<0.001) and incidence (AAPC 0.7 (95% CI 0.61 to 0.79); p<0.001) was observed among those aged 20-24 years. The most significant decrease in DALYs (AAPC -0.45 (95% CI -0.55 to -0.35); p<0.001) and mortality (AAPC -0.46 (95% CI -0.56 to -0.36); p<0.001) was observed among those aged 40-44 years. The rate of increase in prevalence and incidence was lower in high sociodemographic index (SDI) (prevalence: AAPC 0.95 (95% CI 0.8 to 1.11); p<0.001), (incidence: AAPC 0.95 (95% CI 0.8 to 1.11); p<0.001) countries compared with low-SDI countries (prevalence: AAPC 0.5 (95% CI 0.43 to 0.57); p<0.001), (incidence: AAPC 0.12 (95% CI -0.07 to 0.31); p<0.001). DALYs and mortality began to decline in high-SDI countries (DALYs: AAPC -0.52 (95% CI -0.73 to -0.31); p<0.001), (mortality: AAPC -0.5 (95% CI -0.7 to -0.3); p<0.001), but these indicators continue to rise in low-SDI nations (DALYs: AAPC 0.45 (95% CI 0.39 to 0.51); p<0.001), (mortality: AAPC 0.38 (95% CI 0.31 to 0.46); p<0.001). Our predictive analysis found that from 2021 to 2050, the number of CNS cancer cases among people aged 20-64 years will be on the rise globally, which is expected to increase from 186 891 to 245 942, an increase of 31.6%.From 1992 to 2021, the global age-standardised prevalence and incidence of CNS cancer among adults aged 20-64 years increased, while age-standardised DALYs and mortality decreased. The most significant increase in prevalence and incidence was observed among those aged 20-24 years. The most significant decrease in DALYs and mortality was observed among those aged 40-44 years. The rate of increase in prevalence and incidence was lower in high SDI countries compared with low-SDI countries. DALYs and mortality began to decline in high-SDI countries, but these indicators continue to rise in low-SDI nations. Our predictive analysis found that from 2021 to 2050, the number of CNS cancer cases among people aged 20-64 years will be on the rise globally, which is expected to increase from 186 891 to 245 942, an increase of 31.6%.

Conclusions: Significant inequalities exist in age-standardised prevalence, incidence, DALYs and mortality of CNS cancer among countries with varying sociodemographic indices. These disparities highlight the urgent need for targeted clinical guidelines and equitable distribution of global health resources.

Keywords: Health Surveys; Health economics; Health informatics; Neurological oncology; Observational Study.

Figure 1. Joinpoint regression analysis of global HIV prevalence (A), incidence (B), DALYs (C) and mortality (D) in CNS cancer among 20–64 years from 1992 to 2021. AAPC, average APC; APC, annual percentage change; CNS, central nervous system; DALYs, disability-adjusted life-years. ^*P<0.05.

Figure 2. Age-standardised prevalence of CNS cancer among individuals aged 20–64 years across 204 countries worldwide from 1992 to 2021. ASR, age-standardized rate; CNS, central nervous system.

Figure 3. Frontier analysis of age-standardised incidence of CNS cancer among individuals aged 20–64 years across 204 countries worldwide from 1992 to 2021 (A) and in 2021 (B). CNS, central nervous system; SDI, sociodemographic index.

Figure 4. Decomposition analysis of the incidence of CNS cancer among individuals aged 20–64 years globally and across 21 regions from 1992 to 2021 (A) and in 2021 (B). CNS, central nervous system.

Figure 5. Predictive analysis of the number of new cases and incidence (A), the number of deaths and mortality (B) of CNS cancer among individuals aged 20–64 years globally from 1992 to 2050. ASR, age-standardized rate; CNS, central nervous system.