Global Trends and Risk Factors of Lip and Oral Cavity Cancer from 1990 to 2021: A GBD 2021-Based Analysis

Background Lip and oral cavity cancer (LOCC) is a significant global health burden, largely attributable to behavioral risk factors such as tobacco use, alcohol consumption, and smokeless tobacco chewing. Despite being preventable, LOCC continues to contribute substantially to premature mortality and disability, particularly in regions with limited access to early diagnosis and treatment. This study analyzes global trends and risk factors of LOCC from 1990 to 2021 using data from the Global Burden of Disease (GBD) study to inform targeted public health interventions. Methods Data on age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) were extracted from the GBD 2021 database. The study employed descriptive statistical analysis, joinpoint regression to calculate average annual percentage change (AAPC), and ARIMA modeling for future trend forecasting. Risk factor attribution was assessed using population-attributable fractions (PAF) for smoking, alcohol use, and chewing tobacco. Geographic and socio-demographic disparities were analyzed across 21 GBD regions and five Socio-demographic Index (SDI) categories. Results From 1990 to 2021, low-middle SDI regions exhibited the highest ASMR and DALYs, with a significant increase in burden (AAPC: +0.24% for DALYs). High SDI regions showed declining trends (AAPC: -0.77% for ASMR). Males bore a higher burden than females, though female DALYs rose notably in South Asia due to smokeless tobacco use. South Asia, Eastern Europe, and parts of Sub-Saharan Africa had the highest DALYs, driven by tobacco and alcohol. Smoking and chewing tobacco were the leading risk factors, accounting for over 60% of DALYs in some regions. ARIMA forecasts predicted a stable trend for males but a rising burden among females by 2050. Conclusion The study highlights persistent disparities in LOCC burden, emphasizing the need for region-specific interventions targeting tobacco and alcohol use, especially in low-resource settings. Public health strategies should prioritize gender-sensitive approaches, early detection, and stricter regulation of risk factors to reduce the global LOCC burden.