Burden of cancer and associated risk factors in China from 1990 to 2021, with projections to 2050 : a systematic analysis for the Global Burden of Disease Study 2021

Background In China, the incidence and mortality rates of cancer have shown a significant upward trajectory from 1980/1990 to 2021, resulting in an escalating public health burden. Identifying key risk factors is critical for improving cancer prevention and management strategies. This study primarily analyzes cancer incidence and mortality data, with a particular focus on understanding the patterns and underlying factors that contribute to these trends. Methods Data from the Global Burden of Disease 2021 study were utilized. A combination of statistical analyses, decomposition analysis, Joinpoint regression analysis, and Bayesian Age-Period-Cohort modeling were employed to examine temporal trends of various cancer types across different sexes and age groups. Additionally, risk factors were identified and projected trends for the five leading cancer types were analyzed. Results In 2021, cancer accounted for 24.07% of all deaths in China. Lung, stomach, esophageal, colorectal, and liver cancers collectively accounted for 71.08% of cancer-related mortality. While age-standardized death rates (ASDR) for most cancers decreased from 1980 to 2021, age-standardized incidence rates (ASIR) significantly increased. Male cancer mortality was nearly 1.8 times higher than that of females, though both sexes shared similar leading cancer types. Notably, breast cancer ranked among the top five causes of cancer-related deaths in women. Mortality peaked in the 70–74 age group for both sexes. The incidence of breast cancer was higher in females at younger ages, while males surpassed females in incidence from age 60 onward. Behavioral and environmental risk factors, particularly tobacco use and air pollution, have the greatest impact on lung cancer. Decomposition analysis revealed that the increase in cancer mortality was predominantly driven by population aging. By 2050, colorectal cancer incidence is expected to rise, while liver cancer is projected to continue its downward trend. Conclusion The cancer profile of China has shifted over the past 30 years. The decline in ASDR indicates improvements in treatment and management, while the rise in ASIR reflects both increased risk exposure and enhanced detection capabilities. In light of aging demographics, economic development, and environmental changes, identifying predominant cancer types and their associated risk factors is essential for developing effective control strategies and targeted interventions.