Shen Zhezheng, Zhang Jingyuan*
Department of Traumatic Orthopedics, Renmin Hospital of Hubei University of Medicine
Abstract：
Cancers excluding non-melanoma skin cancer (NMSC) impose a substantial and growing mortality and disability burden worldwide, largely due to their high malignancy and frequent late-stage diagnosis. Using data from the Global Burden of Disease (GBD) 2021 study, we systematically quantified the impact of key metabolic risk factors—including elevated body mass index (BMI) and fasting plasma glucose (FPG)—on cancers excluding NMSC from 1990 to 2021. Age-standardized rates (ASRs) were used to characterize mortality and disability-adjusted life years (DALYs), and temporal trends were assessed using estimated/average annual percentage change (EAPC/AAPC). We further applied the Das Gupta decomposition method to disentangle the contributions of population growth, population aging, and epidemiological changes to variations in mortality and DALYs, and employed ARIMA and Nordpred models to project the global metabolic risk–attributable burden from 2022 to 2045. Inequalities across countries stratified by sociodemographic index (SDI) levels were evaluated using slope and concentration indices. In 2021, metabolic risk factors accounted for approximately 668,893 deaths and 15,582,767 DALYs due to cancers excluding NMSC, with the global age-standardized mortality rate increasing from 6.587 per 100,000 in 1990 to 7.865 per 100,000 in 2021. High BMI and high FPG were identified as the leading contributors, with DALY EAPCs of 0.424 and 0.768, respectively. Decomposition analysis indicated that population growth and population aging together explained over 80% of the increased burden. Pronounced sex-based and regional heterogeneity was observed: men were more strongly affected by high FPG, whereas women were predominantly impacted by high BMI. High-SDI regions bore a larger absolute burden, while low- and middle-SDI regions showed steeper upward trends over the past three decades. Projections suggest that metabolic risk–related deaths and DALYs for these cancers will continue to rise globally, although a slight decline among men may occur after 2030. These findings highlight the urgent need to strengthen metabolic risk control—particularly targeting high-risk groups such as older women—through lifestyle interventions, early screening, and context-specific cancer prevention strategies across regions with differing levels of socioeconomic development.
Key Words：
global burden of disease; cancers excluding non-melanoma skin cancer; metabolic risk factors; body mass index; fasting plasma glucose; disability-adjusted life years; age-standardized mortality; temporal trends; sociodemographic index
