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Peer-reviewedCC BYFrontiers in oncology

Global, regional and national cancer burden and trends of middle-aged and older populations: a GBD 2021-based analysis, prediction and prevention.

  • Ruokai Sun1
  • Feng Shi2
  • Yinsi Tang3
  • Huicong Song4,5
  • Jiamin Song1
  • Lirong Yan6
  • Yang Chen7
  • Hongfei Yan1,8,9,10
10 affiliations
  1. 1Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
  2. 2Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China.
  3. 3Department of Gastroenterology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
  4. 4Department of Oncology, The Affiliated Hospital of Chifeng University, Chifeng, Inner Mongolia, China.
  5. 5Department of Respiratory and Infectious Disease of Geriatrics, The First Hospital of China Medical University, Shenyang, China.
  6. 6Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
  7. 7Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, China.
  8. 8Provincial Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, Liaoning, China.
  9. 9Clinical Cancer Research Center of Shenyang, The First Hospital of China Medical University, Shenyang, Liaoning, China.
  10. 10Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, Liaoning, China.
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Abstract

Background

Middle-aged and older adults (MAOs; defined as individuals aged ≥40 years) account for the global cancer burden, contributing to 70-80% of cases. Characterizing cancer profiles in this demographic is essential for developing targeted prevention and treatment strategies to mitigate global impacts.Methods

Using Global Burden of Diseases (GBD) 2021 data, we analyzed incidence, prevalence, mortality and Disability-Adjusted Life Years (DALYs) for 31 cancers among MAOs (aged≥40) across 204 countries/21 regions(1990-2021). Trends were quantified via Joinpoint regression, and autoregressive integrated moving-average (ARIMA) models projected the burden through 2035. Risk attribution utilized population attributable fractions across Socio-demographic Index (SDI) quintiles. An order-independent Shapley decomposition attributed projected cancer incidence changes during 2021-2035 to population growth, aging, and age-specific incidence rate shifts.Results

In 2021, MAOs accounted for 48,804,114 incident cases and 9,434,210 deaths. Females exhibited a 1.14-fold higher age-standardized incidence rate (ASIR) than males, yet males had a higher age-standardized mortality rate (ASMR). Projections suggested a continued rise in cancer burden through 2035. Peak incidence occurred in ages 60-69 and the highest mortality in ages 70-79. Breast cancer was the main cancer in females; tracheal/bronchus/lung cancer in males. Tracheal/bronchus/lung cancer dominated mortality across all groups except middle-aged women (breast cancer). High-SDI regions bore the greatest burden, characterized by tracheal/bronchus/lung and colorectal cancers, while low-SDI regions shifted toward breast, cervical and stomach cancer. Risk factor analysis from 2010-2021 revealed rising metabolic risks, with high body mass index (BMI) and fasting plasma glucose-attributable DALYs increasing by 12.39% and 11.36% respectively, especially in high-SDI regions. Conversely, while most behavioral risks declined, smoking remained the leading risk factor, contributing over 60% to lung cancer DALYs. In low-SDI regions, behavioral drivers such as unsafe sex (accounting for >90% of cervical cancer risk) and air pollution remained the dominant persistent risks.Discussion

This study, the first focusing on MAOs' global cancer burden, reveals heterogeneous patterns by age, gender, and SDI. Lung cancer was the leading cause of death (smoking as main risk). Metabolic risks rose in high-SDI regions, behavioral risks in low-SDI regions. In conclusion, MAOs' cancer burden will rise through 2035; region-specific precision strategies are essential.

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Cite

BibTeXRIS
BibTeX
@article{sun2026global,
  title = {{Global, regional and national cancer burden and trends of middle-aged and older populations: a GBD 2021-based analysis, prediction and prevention.}},
  author = {Ruokai Sun and Feng Shi and Yinsi Tang and Huicong Song and Jiamin Song and Lirong Yan and Yang Chen and Hongfei Yan},
  journal = {Frontiers in oncology},
  year = {2026},
  month = oct,
  doi = {10.3389/fonc.2026.1859604},
  url = {https://europepmc.org/article/MED/42908789},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Global, regional and national cancer burden and trends of middle-aged and older populations: a GBD 2021-based analysis, prediction and prevention.
AU  - Ruokai Sun
AU  - Feng Shi
AU  - Yinsi Tang
AU  - Huicong Song
AU  - Jiamin Song
AU  - Lirong Yan
AU  - Yang Chen
AU  - Hongfei Yan
PY  - 2026
DA  - 2026/10/07
JO  - Frontiers in oncology
DO  - 10.3389/fonc.2026.1859604
UR  - https://europepmc.org/article/MED/42908789
AB  - Background  Middle-aged and older adults (MAOs; defined as individuals aged ≥40 years) account for the global cancer burden, contributing to 70-80% of cases. Characterizing cancer profiles in this demographic is essential for developing targeted prevention and treatment strategies to mitigate global impacts.Methods  Using Global Burden of Diseases (GBD) 2021 data, we analyzed incidence, prevalence, mortality and Disability-Adjusted Life Years (DALYs) for 31 cancers among MAOs (aged≥40) across 204 countries/21 regions(1990-2021). Trends were quantified via Joinpoint regression, and autoregressive integrated moving-average (ARIMA) models projected the burden through 2035. Risk attribution utilized population attributable fractions across Socio-demographic Index (SDI) quintiles. An order-independent Shapley decomposition attributed projected cancer incidence changes during 2021-2035 to population growth, aging, and age-specific incidence rate shifts.Results  In 2021, MAOs accounted for 48,804,114 incident cases and 9,434,210 deaths. Females exhibited a 1.14-fold higher age-standardized incidence rate (ASIR) than males, yet males had a higher age-standardized mortality rate (ASMR). Projections suggested a continued rise in cancer burden through 2035. Peak incidence occurred in ages 60-69 and the highest mortality in ages 70-79. Breast cancer was the main cancer in females; tracheal/bronchus/lung cancer in males. Tracheal/bronchus/lung cancer dominated mortality across all groups except middle-aged women (breast cancer). High-SDI regions bore the greatest burden, characterized by tracheal/bronchus/lung and colorectal cancers, while low-SDI regions shifted toward breast, cervical and stomach cancer. Risk factor analysis from 2010-2021 revealed rising metabolic risks, with high body mass index (BMI) and fasting plasma glucose-attributable DALYs increasing by 12.39% and 11.36% respectively, especially in high-SDI regions. Conversely, while most behavioral risks declined, smoking remained the leading risk factor, contributing over 60% to lung cancer DALYs. In low-SDI regions, behavioral drivers such as unsafe sex (accounting for >90% of cervical cancer risk) and air pollution remained the dominant persistent risks.Discussion  This study, the first focusing on MAOs' global cancer burden, reveals heterogeneous patterns by age, gender, and SDI. Lung cancer was the leading cause of death (smoking as main risk). Metabolic risks rose in high-SDI regions, behavioral risks in low-SDI regions. In conclusion, MAOs' cancer burden will rise through 2035; region-specific precision strategies are essential.
SN  - 2234-943X
ER  -