Trends and Projections of Bladder Cancer Burden in Iraq from 1990 to 2035: Global Burden of Disease Study 2023-based Analysis

Abstract

Background: Iraq carries a disproportionately high burden of bladder cancer compared with global averages, with limited contemporary epidemiological characterization. This study provides a comprehensive analysis of BC burden in Iraq using GBD-2023 data from 1990 to 2023, with projections to 2035. Subjects and Methods: Data were extracted from the GBD-2023 database. Incidence, deaths, DALYs, YLLs, and YLDs were analyzed. Average annual percentage change was computed using log-linear regression. Risk factors were assessed through GBD-2023 comparative risk assessment data. Projections to 2035 used join point-derived trend parameters applied to UN World Population Prospects 2024. Results: In 2023, Iraq recorded 4,866 new BC cases, 1,848 deaths, and 48,433 DALYs, increases of 482.9%, 329.6%, and 349.6%, respectively, from 1990. The age-standardized incidence rate (ASIR) rose from 10.52 to 19.15 per 100,000 compared to a global fall from 7.25 to 6.30 per 100,000. Iraq's ASIR in 2023 was 3.0 times the global average; its age-standardized mortality rate was 3.4 times the global figure; and its age-standardized DALY rate was 3.7 times the global figure. Female rates rose proportionally faster (AAPC: +2.35% vs +1.94%). Smoking contributed 33.6% of DALYs in 2023, down from 36.9% in 1990, while the contribution of hyperglycemia rose from 8.3% to 12.6%. Approximately 8,400 BC cases are projected by 2035. Conclusions: Iraq carries an increasingly disproportionate bladder cancer burden compared to global rates, with significantly rising age-standardized rates in contrast to the declining global trend. Two modifiable risk factors should be prioritized in future targeted intervention: smoking and hyperglycemia.