Age-specific burden of cervical cancer and attributable risk factors in Asia, 1990-2023: A global burden of disease study 2023.
TL;DR
Cervical cancer burden attributable to unsafe sex showed the highest DALY rate among females aged 50-69 years and the highest mortality rate among those aged 70 years or older, and overall, cervical cancer burden exhibited an inverse association with SDI.
Abstract
Background
Despite global elimination initiatives, cervical cancer remains a major public health burden across Asia. We aimed to assess regional and age-specific trends in cervical cancer burden using data from the Global Burden of Disease Study (GBD) 2023.
Methods
We analyzed GBD 2023 to estimate the burden of cervical cancer across 34 Asian countries from 1990 to 2023. Age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALY rate (ASDR) were assessed by region and Socio-demographic Index (SDI), while age-specific rates were evaluated for females aged 15-49, 50-69, and ≥70 years. Cervical cancer was defined as malignant neoplasm of the cervix, and burden attributable to unsafe sex and tobacco use was estimated using population-attributable fractions derived from exposure data and relative risks. Estimates are presented as means with 95% uncertainty intervals (UIs).
Results
In 2023, South Asia exhibited the highest cervical cancer burden, with an ASIR of 22.07 (95% UI, 14.68-33.20) per 100,000 population, whereas High-income Asia Pacific had the lowest ASIR at 11.89 (9.94-14.37). A similar pattern was observed for ASDR: South Asia had the highest rate at 377.19 (95% UI, 255.79-558.38) per 100,000 population, while High-income Asia Pacific exhibited the lowest rate at 96.04 (84.08-109.75). From 1990 to 2023, ASIR and ASDR generally declined across Asia, although substantial regional disparities persisted. Across all five regions, the relative contribution of females aged 15-49 years to cervical cancer burden increased, while that of older age groups generally decreased; however, the absolute incidence rates among females aged 15-49 years increased only in Southeast Asia and High-income Asia Pacific. Cervical cancer burden attributable to unsafe sex showed the highest DALY rate among females aged 50-69 years and the highest mortality rate among those aged 70 years or older. Overall, cervical cancer burden exhibited an inverse association with SDI.
Conclusion
Cervical cancer remains a substantial burden in low-SDI Asian countries, with an increasing relative contribution among females aged 15-49 years. Age-specific and context-specific prevention strategies are urgently needed to reduce inequalities and accelerate elimination efforts in Asia.