Global trend and disparity in the burden of thyroid cancer attributable to high body-mass index from 1990 to 2021 and projection to 2049: a systematic analysis based on the Global Burden of Disease Study 2021 | BMC Public Health

Global disease burden of TC-HBMI in 1990 to 2021

In 2021, the global death cases of TC-HBMI were 5,255 (95%UI, 3,914 to 6,653) and the global DALY cases were 144,955 (95%UI, 109,230 to 184,747), which showed a notable increase compared to 1990. The ASMR was 0.06 (95% UI, 0.05 to 0.08) per 100,000 population, which remained largely unchanged from 1990. Conversely, the ASDR rose from 1.49 (95% UI, 1.12 to 1.90) per 100,000 population in 1990 to 1.68 (95% UI, 1.26 to 2.14) per 100,000 population in 2021. Over the past 32 years, both ASMR and ASDR exhibited an upward trend. The AAPC for ASMR was 0.22 (95% CI, 0.07 to 0.37), while the AAPC for ASDR was 0.38 (95% CI, 0.23 to 0.53). (Fig. 1, Table 1, Fig. 2–A and B) Overall, decomposition analysis showed that population growth was the primary driver, contributing to 60.99% and 62.43% of the increased deaths and DALYs cases between 1990 and 2021 (Fig. 3).

Trends of TC-HBMI by different sexes (A. deaths, B. DALYs), SDI Regions (C. deaths, D. DALYs) from 1990 to 2021, calculated by Joinpoint regression. TC-HBMI, thyroid cancer attributable to high body-mass index; DALYs, the Disability-Adjusted Life Years; AAPC, average annual percent change; APC, average annual percent change

Decomposition analysis in deaths (A) and DALYs (B) of TC-HBMI from 1990 to 2021 by SDI regions and GBD regions. TC-HBMI, thyroid cancer attributable to high body-mass index; DALYs, the Disability-Adjusted Life Years; SDI, socio demographic index

In 2021, the disease burden of TC-HBMI was significantly higher in females compared to males. The death cases of females were 3,225 (95% UI, 2,329 to 4,164), with an ASMR of 0.07 (95% UI, 0.05 to 0.09) per 100,000 population. The DALYs cases for females was 88,120 (95% UI, 64,992 to 114,469), with an ASDR of 1.96 (95% UI, 1.44 to 2.55) per 100,000 population. Notably, the ASMR and ASDR for males grew at a significantly faster rate than that for females. The AAPC of deaths in males was 0.79 (95% CI, 0.68 to 0.90), and the AAPC of DALYs was 0.87 (95% CI, 0.70 to 1.04). In contrast, the AAPC for ASMR and ASDR in females were lower, with the AAPC for ASMR at −0.05 (95% CI, −0.12 to 0.01), indicating a decline in ASMR for females over the 32 years (Fig. 1, Table 1, Fig. 2–A and B).

Disease burden of TC-HBMI by different age groups in 1990 to 2021

For each age group, the absolute cases of death and DALYs were highest for older populations. The highest number of death cases was in 70 to 74 group (711, 95% UI 527 to 898), whereas the highest number of DALYs was in 55 to 59 group (18,589, 95% UI 14,083 to 23,742). This underscored the need for substantial attention and management of the disease burden in these age groups. Regarding rates, the 95 plus group had the highest ASMR (1.33 per 100,000 population, 95% UI 0.78 to 1.81) and ASDR (10.88 per 100,000 population, 95% UI 6.36 to 14.79). Notably, the highest AAPC was observed in both older and younger populations. The top three age groups with the highest AAPC for ASMR were 25 to 29 (AAPC = 1.38, 95% CI 1.21 to 1.56), 20 to 24 (AAPC = 1.36, 95% CI 1.24 to 1.49), and 95 plus (AAPC = 1.22, 95% CI 0.85 to 1.59). Similarly, the top three age groups with the highest AAPC for ASDR were 25 to 29 (AAPC = 1.52, 95% CI 1.34 to 1.70), 20 to 24 (AAPC = 1.47, 95% CI 1.35 to 1.60), and 95 plus (AAPC = 1.18, 95% CI 0.81 to 1.54). The AAPC also indicated that ASDR were rising across all age groups, while the ASMR among the 65 to 69 (AAPC = −0.05, 95% CI −0.18 to 0.09) and 60 to 64 (AAPC = 0, 95% CI −0.25 to 0.25) groups had remained stable and even been a slight decline compared to 1990 (Fig. 1, Table 1).

Disease burden of TC-HBMI by different regions in 1990 to 2021

From the perspective of SDI regions, the ASMR across different SDI regions in 2021 was largely similar, around 0.05 to 0.06 per 100,000 population respectively. However, differences in DALYs indicated varying disease burden across these regions. The highest ASDR occurred in high SDI region (1.75 per 100,000 population, 95% UI 1.32 to 2.20) and the lowest in low SDI region (1.38 per 100,000 population, 95% UI 0.96 to 1.91). Fig S1 illustrated the relationship between disease burden and SDI values, showing that the maximum disease burden occurred around an SDI of approximately 0.6, with burden decreasing as SDI increased or decreased. Conversely, AAPC showed differing trends, with high SDI (AAPC of ASMR = −0.49, 95% CI −0.65 to −0.34; AAPC of ASDR = −0.31, 95% CI −0.48 to −0.14) and high-middle SDI regions (AAPC of ASMR = −0.43, 95% CI −0.66 to −0.20; AAPC of ASDR = −0.36, 95% CI −0.63 to −0.09) showing a downward trend in deaths and DALYs. In contrast, low-middle SDI exhibited rapid growth, with the highest AAPC of ASMR (1.69, 95% CI 1.58 to 1.81) and ASDR (1.76, 95% CI 1.68 to 1.83) among all SDI regions. (Table 1, Fig. 2–C and D, Fig S1).

From the perspective of GBD regions, the three regions with the heaviest disease burden in 2021 were Andean Latin America (ASMR = 0.16 per 100,000 population, 95% UI 0.12 to 0.23; ASDR = 4.26 per 100,000 population, 95% UI 3.03 to 5.89), Central Latin America (ASMR = 0.13 per 100,000 population, 95% UI 0.10 to 0.17; ASDR = 3.39 per 100,000 population, 95% UI 2.57 to 4.40), and Southern Latin America (ASMR = 0.09 per 100,000 population, 95% UI 0.07 to 0.12; ASDR = 2.40 per 100,000 population, 95% UI 1.77 to 3.09). AAPC indicated that Central Europe, Western Europe, Southern Latin America, Central Asia, and High-income Asia Pacific all had AAPC for ASMR and ASDR below 0, suggesting a declining disease burden in these areas. Conversely, South Asia had the highest AAPC for both ASMR and ASDR (2.24, 95% UI 2.02 to 2.46; 2.27, 95% UI 2.16 to 2.38). North Africa, the Middle East, Andean Latin America, Southeast Asia, and Southern Sub-Saharan Africa also showed higher AAPC, indicating upward trends in disease burden (Table 1).

When focusing on specific countries/territories, those with a heavy disease burden in 2021 are noteworthy. Fiji had the highest ASMR (0.25 per 100,000 population, 95% UI 0.16 to 0.36), followed by Bolivia (0.22, 95% UI 0.14 to 0.34) and the United Arab Emirates (0.21, 95% UI 0.15 to 0.30). Meanwhile, the highest ASDR was recorded in Fiji (6.07, 95% UI 3.76 to 8.98), Bolivia (5.67, 95% UI 3.50 to 8.58), and Ecuador (5.12, 95% UI 3.57 to 6.92). The reasons behind rapid upward trends or significant downward trends in disease burden need further investigation. Among 100 countries/territories with AAPC of ASMR below 0, Poland (−2.64, 95% CI −3.71 to −1.57), Czechia (−2.37, 95% CI −2.66 to −2.09), and Croatia (−2.16, 95% CI −2.54 to −1.78) had the lowest values. Cabo Verde (4.5, 95% CI 4.36 to 4.63), Iran (3.36, 95% CI 3.12 to 3.60), and Ecuador (2.93, 95% CI 1.62 to 4.26) reported the highest AAPC of ASMR. Additionally, 75 countries/territories had AAPC of DALYs below 0, with Poland (−2.96, 95% CI −4.04 to −1.86), Slovenia (−2.23, 95% CI −3.00 to −1.45), and Czechia (−2.19, 95% CI −2.46 to −1.92) having the lowest values. Conversely, Cabo Verde (4.93, 95% CI 4.67 to 5.20), Iran (3.63, 95% CI 3.34 to 3.91), and Ecuador (3.16, 95% CI 2.66 to 3.66) experienced the highest AAPC in DALYs. (Fig. 4).

Global burden in 2021 and trends from 1990 to 2021 of TC-HBMI by different countries/territories. Notes: (A) ASMR, (B) ASDR, (C) AAPC of ASMR, (D)AAPC of ASDR. TC-HBMI, thyroid cancer attributable to high body mass index; DALYs, the Disability-Adjusted Life Years; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate; AAPC, average annual percent change

Trends of global burden of TC-HBMI from 1990 to 2021 by age-period-cohort model

From a global perspective, Fig. 2 showed that the global ASMR and ASDR increased the fastest from 2007 to 2010, with APCs of 0.93 and 1.08, respectively. However, there was a decline from 2010 to 2021 with APCs of 0.15 and 0.26. The overall growth rate in recent years was lower than the average growth rate over the past 32 years. Among SDI regions, low SDI region experienced the fastest growth in ASMR and ASDR in recent years, with APCs reaching 1.37 and 1.40 from 2015 to 2021. Conversely, high-middle SDI region showed the most significant decrease in disease burden, with APCs of ASMR and ASDR from 2010 to 2021 being −0.94 and −0.97. Additionally, the notable increase in disease burden among youth over the past decade cannot be overlooked. Figure S4 indicated that from 2015 to 2021, the APCs of ASMR and ASDR for the 25 to 29 group were higher than for other age groups, at 1.50 and 1.49.

Comparison of the disease burden of TC-HBMI and the overall TC disease burden

In this study, we quantified the contribution of HBMI to the total burden of TC by calculating the proportion of the TC-HBMI disease burden to the total TC disease burden. Specifically, we divided the TC-HBMI deaths and DALYs by the corresponding total TC values and multiplied by 100%. Among all age groups, the highest proportion of deaths (12.61%) occurred in the 55 to 59 group, while the highest proportion of DALYs (12.79%) was observed in the 50 to 54 group. Higher proportions were mainly concentrated in the middle-aged and older populations aged 45 to 70 (Fig. 5-A). Regionally, the highest proportion was found in high-income North America, North Africa and the Middle East, while the lowest was in South Asia. When it turned to SDI regions, the proportion was highest in high SDI and high-middle SDI regions (Fig. 5-B, C). We also compared the growth trends of the TC-HBMI disease burden from 1990 to 2021 with that of the overall TC burden. Figures 5–D and E showed that the AAPC of ASMR and ASDR for TC-HBMI was higher than the corresponding values for TC across all age groups and regions. This clearly indicated that HBMI was an increasingly significant risk factor for the TC disease burden, which required adequate attention.

The proportion of deaths and DALYs of TC-HBMI among all deaths and DALYs of TC and a comparison of the AAPC from 1990 to 2021 of deaths and DALYs of the above two. (A) by ages, (B) by SDI regions and sexes, (C) by GBD regions, (D) a comparison of the AAPC by ages and sexes, (E) a comparison of the AAPC by SDI regions and GBD regions. TC-HBMI, thyroid cancer attributable to high-body mass index; DALYs, the Disability-Adjusted Life Years; AAPC, average annual percent change; SDI, socio demographic index

Projection of TC-HBMI disease burden from 2022 to 2049

Predictive models indicated a projected increase in the cases of deaths and DALYs worldwide from 2022 to 2049, reaching an estimated 128,556 (95% CI, 39 to 26,772) and 318,523 (95% CI, 41,307.34 to 615,613.67). The ASR also showed a gradual upward trend, with ASMR projected to reach 0.08 (95% CI, 0 to 0.17) per 100,000 population and ASDR to reach 2.30 (95% CI, 0.29 to 4.46) per 100,000 population by 2049. Females would continue to bear a greater disease burden, with an ASMR of 0.08 (95% CI, 0 to 0.15) per 100,000 population and an ASDR of 2.48 (95% CI, 0.70 to 4.27) per 100,000 population, both higher than those of males (Fig. 6). Table 2 predicted the ASMR and ASDR for different ages until 2049, indicating that the disease burden among the elderly remained a key area of concern. To highlight HBMI as a risk factor for the disease burden of TC, this study compared the projected disease burden changes for TC and TC-HBMI by 2049. The findings showed that the ASMR and ASDR of TC would gradually decline from 2022 to 2037, but would rise again from 2038 to 2049. Overall, the projected ASMR (0.52 per 100,000 population, 95% CI 0.09 to 0.96) and ASDR (14.58 per 100,000 population, 2.80 to 26.36) for 2049 were similar to those in 2021 (ASMR=0.53 per 100,000 population, 95% CI 0.50 to 0.56; ASDR=14.57 per 100,000 population, 95% CI 14.37 to 14.77). In contrast, the ASMR and ASDR for TC-HBMI showed a continuous increase, indicating that HBMI as an increasingly significant risk factor for TC must receive further attention.

Projection of TC-HBMI and TC by different sexes from 2022 to 2049, calculated by Bayesian age-period-cohort model. A deaths, B DALYs. TC-HBMI, thyroid cancer attributable to high body-mass index; DALYs, the Disability-Adjusted Life Years