Feng Xuan

Hepatocellular carcinoma (HCC), the dominant histological subtype of primary liver cancer, remains a major global health challenge.1 Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infe...

Introduction: Gastrointestinal cancers (GICs) impose substantial health loss in low- and middle-income countries (LMICs). We examined long-term burden patterns and temporal changes from 1990 to 2023. Methods: This ecological secondary analysis used Global Burden of Disease 2023 estimates of disability-adjusted life years (DALYs) and age-standardised DALY rates (ASDRs) for six GIC types in 130 LMICs from 1990 to 2023. Joinpoint regression described temporal trends, and decomposition analysis separated population growth, population aging, and changes in age-specific DALY rates. Results: From 1990 to 2023, total GIC-related DALYs increased from 34.72 to 43.16 million in upper-middle-income countries (UMCs), from 7.20 to 19.76 million in lower-middle-income countries (LMCs), and from 1.88 to 4.69 million in low-income countries (LCs). In UMCs, ASDRs for all GICs except pancreatic cancer declined, especially for esophageal and stomach cancers. In LMCs and LCs, ASDRs for stomach and liver cancers declined, whereas the other four subtypes increased. The shares of global DALYs occurring in UMCs increased for colorectal and pancreatic cancers but decreased for stomach and liver cancers. In contrast, DALYs rose for all six subtypes in LMCs and LCs. Decomposition analysis indicated that population growth and aging were important demographic contributors to the increase in DALYs, whereas the epidemiological changes was negative in UMCs and counterbalanced part of the demographic contribution. Conclusion: The overall DALY burden of GICs increased across LMICs, whereas ASDR trends were heterogeneous across cancer subtypes. These findings support country- and cancer-specific prevention and care priorities.

Background: Female cancers—breast cancer (BC), cervical cancer (CC), ovarian cancer (OC), and uterine cancer (UC)—among women disproportionately affect low- and middle-income countries (LMICs). We quantified mortality patterns and disentangled age, period, and cohort drivers using Global Burden of Disease Study 2023 data. Methods: We assessed age-standardized mortality rates (ASMRs) in LMICs—upper-middle-income countries (UMCs), lower-middle-income countries (LMCs), and low-income countries (LCs)—from 1990 to 2023, estimated average annual percent change (AAPC) and post-2020 annual changes. Age–period–cohort analysis was applied to disentangle age, period, and cohort effects. Results: From 1990 to 2023, total deaths from female cancers among women more than doubled in LMICs, increasing from 410,667 to 1,053,147. LMCs overtook UMCs to become the largest contributor in 2023. ASMR did not move in a single direction across LMICs. While ASMRs declined in UMCs (AAPC: – 0.77%), they increased in LMCs (AAPC: 0.71%) and LCs (AAPC: 1.40%). After 2020, ASMRs rose in all income groups, with the steepest rise in LCs. BC remained the leading cause of death in UMCs and LMCs, while CC predominated in LCs. Age-period-cohort analysis showed period rate ratios declining in UMCs but increasing in LMCs/LCs. For CC in LMCs/LCs, period rate ratios fluctuated slightly and exhibited a minor uptick in 2019– 2023. Cohort rate ratios fell across generations in UMCs but rose in LMCs/LCs. Conclusion: Temporal trends in mortality of female cancers among women in LMICs exhibited stratified patterns rather than uniform improvement: ASMRs declined in UMCs but rose persistently in LMCs and LCs, while absolute deaths increased across all income groups. Distinct subtype-specific trajectories further highlight the need for targeted strategies addressing the unique epidemiological and health system challenges of each cancer. Scaling up screening programs, human papillomavirus vaccination, and access to timely treatment is essential to reverse these trends and achieve equitable reductions in female cancer mortality in LMICs.

Background: High body mass index (BMI) is a significant modifiable risk factor for cancer, yet its global burden in older adults (aged ≥60 years) remains incompletely understood. Methods: Using Global Burden of Disease Study 2021 data, we estimated disability-adjusted life-years (DALYs) and age-standardized DALY rates (ASDRs) for total and 11 high BMI-related cancers from 1990 to 2021. Trends were assessed using average annual percentage change. Inequalities were measured using the slope index of inequality and concentration index. Additionally, decomposition and frontier analyses were utilized to examine driving factors and explore improvement potential. Results: Global cancer-related DALYs attributable to high BMI in older adults increased from 2.11 million in 1990 to 5.40 million in 2021, with ASDR rising from 439.99 to 497.15 per 100,000 population. Males showed greater increases despite lower ASDR. From 1990 to 2021, Asia and Africa experienced the steepest increases, while Europe and America recorded the highest ASDRs in 2021. High Socio-demographic Index (SDI) regions consistently reported the highest ASDRs in both 1990 and 2021, whereas low-middle SDI regions exhibited the most rapid increase during this period. The global ASDRs for most cancers increased from 1990 to 2021, with colorectal cancer demonstrating the highest ASDR among men and breast cancer among women in 2021. DALY growth was largely attributed to population expansion (133.04%) through decomposition analysis. Inequalities have narrowed but remained predominantly concentrated in higher SDI countries. Frontier analysis identified several high SDI countries, such as the United Arab Emirates, Slovakia, and Qatar, with substantial potential for burden reduction. Conclusion: The cancer burden attributable to high BMI in older adults has risen substantially since 1990, with marked geographic, socioeconomic, and cancer-site disparities. Targeted high BMI reduction strategies in aging populations are critical to mitigating future cancer burden and reducing inequalities.

Background: This study aimed to assess temporal trends, health inequities and potential improvements in the burden of head and neck cancer (HNC) in middle-aged and older adults between 1990 and 2021, focusing on three major subtypes: larynx, nasopharynx, and lip/oral cavity cancers. Methods: A secondary analysis of the Global Burden of Disease Study (GBD) 2021 was performed, using age-standardised incidence rates (ASIR) and age-standardised disability-adjusted life years (ASDR) to quantify the burden of HNC. The average annual percent change was calculated to analyzed trends. The slope index of inequality (SII) and the concentration index quantified health inequities. Frontier analysis identified regions with potential for improvement. Result: In 2021, there were approximately 650,205 new cases of overall HNC globally, resulting in 9,621,610 DALYs, with ASIR and ASDR both declining since 1990. ASIR exhibited a decrease for laryngeal and nasopharyngeal cancers, in contrast to an increase for lip and oral cavity cancers. ASDR decreased across all cancer types. The SII showed a notable shift in ASDR from countries with higher socio-demographic indices (SDI) in 1990 to those with lower SDI countries by 2021. Meantime, the concentration index revealed a worsening inequality in lower SDI countries. Frontier analyses across 204 countries and territories indicated that certain high SDI countries could effectively reduce ASDR for HNCs. Conclusion: The global burden of HNCs shown considerable regional disparities. Health inequalities have persisted, with lower SDI regions bearing a heavier burden, particularly in laryngeal and lip/oral cavity cancers. Developing tailored national cancer control plans and enhancing international medical cooperation are essential to reduce HNC burden and promote equitable health outcomes.

Background: High body mass index (BMI) is a well-established modifiable risk factor for cancer. This study aims to assess temporal trends and contributing factors in cancer mortality attributable to high BMI in Asia from 1992 to 2021.Methods: Data were obtained from the Global Burden of Disease (GBD) study. We analyzed mortality attributable to high BMI for total cancer and 11 specific subtypes across 34 Asian countries and five GBD regions from 1992 to 2021. Age-standardized mortality rates (ASMRs), average annual percentage change (AAPC), and age-period-cohort effects were calculated. Decomposition analysis quantified the contributions of aging, population growth, and epidemiological change to the changes in cancer deaths.Result: From 1992 to 2021, high BMI-related cancer deaths in Asia rose from 29,908 to 123,693, with ASMR increasing from 1.42 to 2.46 per 100,000 (AAPC: 1.92%, 95% CI: 1.85–1.98). South Asia experienced the most rapid ASMR growth (AAPC: 3.16%), while High-income Asia Pacific showed a decline after 1997. Sex-specific analyses revealed that colorectal, liver, and leukemia in males and colorectal, breast, and uterine cancers in females contributed most to ASMRs. Decomposition analysis indicated that the change in deaths was mainly driven by epidemiological change (118.20%), followed by population growth (115.54%) and aging (79.83%). Age-period-cohort analysis demonstrated rising mortality risks in successive birth cohorts, particularly in East and South Asia, while period and cohort effects declined in High-income Asia Pacific. Local drift analyses showed increasing mortality trends in older age groups across most regions.Conclusion: The burden of cancer ASMR attributable to high BMI in Asia has risen substantially over the past three decades. Substantial heterogeneity exists across regions, countries, sexes, and cancer types. Targeted prevention strategies and cancer control policies are urgently needed to address this rising public health challenge.

Introduction: Immune checkpoint inhibitors (ICIs) have redefined cancer therapeutics. However, they may provoke immune-related adverse events (irAEs), with diabetes potentially altering their patterns. We aimed to investigate whether diabetic cancer patients exhibit a distinctive or intensified irAE pattern. Methods: We performed a real-world, retrospective pharmacovigilance study of ICIs using the FDA Adverse Event Reporting System from 2011 to 2025. Reports listing anti-PD-1 (Nivolumab, Pembrolizumab, Cemiplimab), anti-PD-L1 (Atezolizumab, Avelumab, Durvalumab), and anti-CTLA-4 (Ipilimumab, Tremelimumab) agents as suspected drugs were extracted. Disproportionality signals were identified with 4 algorithms: Bayesian Confidence Propagation Neural Network, Reporting Odds Ratio, Proportional Reporting Ratio, and Multi-item Gamma Poisson Shrinker. Time-to-onset was calculated from therapy start to event date, modelled with Weibull distributions, and compared across subgroups with non-parametric tests. Results: Of 22,775,812 FAERS reports, 1886 involved ICIs used in cancer patients with comorbid diabetes. 423 (22.4 %) were fatal and 1463 (77.6 %) non-fatal. Men predominated (71.5 %), and 63.0 % of patients were aged 65-85 years. Combination therapy (anti-CTLA-4 plus PD-1 or PD-L1) accounted for the highest death proportion (29.6 %). Disproportionality analysis revealed the strongest preferred-term signals for pneumonitis/interstitial lung disease, hypothyroidism, and colitis among all diabetic cancer patients receiving ICI therapy. At the system-organ-class level, endocrine, hepatobiliary, and blood/lymphatic disorders showed the most consistent risk across agents. Weibull modelling demonstrated an early-failure pattern (shape β < 1) with a median time-to-onset of 126.6 days overall, shortening to 90.9 days with combination therapy. Fatal subgroup occurred sooner than non-fatal subgroup (median 106.7 vs 132.5 days; P = 0.004). Conclusion: Diabetic cancer patients experienced the full spectrum of ICI-associated toxicities, with combination treatments linked to greater lethality. Multidisciplinary surveillance during the first 3-4 months of therapy, glycemic control, and long-term follow-up may be essential to optimize benefit and minimize harm in this expanding population.

The objective of this study was to quantify the temporal patterns and cross-country inequities in the quality of care for gastrointestinal (GI) cancers from 1990 to 2021. Using data from the 2021 Global Burden of Disease Study, which employs advanced methodologies such as Bayesian meta-regression and the Cause of Death Ensemble model to produce robust health estimates, we conducted a secondary analysis of esophageal cancer, stomach cancer, and colorectal cancer at global, regional, and national levels. Principal component analysis was applied to evaluate 4 key ratios: mortality-to-incidence, disability-adjusted life years-to-prevalence, prevalence-to-incidence, and years of life lost-to-years lived with disability. The most influential component derived from this analysis was defined as the quality of care index (QCI), which was constructed to assess the quality of care for GI cancers. Scores were then calculated and scaled on a 0 to 100 range, with higher scores reflecting a better status. Temporal trends in QCI were evaluated using estimated annual percentage change, and associations with the sociodemographic index (SDI) were explored via Spearman correlation analysis. Cross-country inequalities in QCI were quantified using the slope index of inequality for absolute inequalities and the concentration index for relative inequalities. Global age-standardized QCI improved from 1990 to 2021: esophageal cancer from 23.86 to 41.13, stomach cancer from 39.58 to 57.57, colorectal cancer from 65.67 to 80.68. Spearman analysis revealed a positive correlation between higher SDI values and improved age-standardized QCI for all GI cancers. However, absolute and relative inequalities persist. At the SDI regional and GBD super regional levels, varied change patterns were observed, with most regions experiencing worsening inequalities. Notably, females exhibited more pronounced inequities in QCI than males. Our study reveals significant improvements in GI cancer care quality, yet substantial inequities persist. Equitable resource allocation and global collaboration are crucial to mitigate these inequities.