Epidemiological trends and burden of gallbladder and biliary tract cancer in Belt and Road Initiative countries: A comprehensive analysis from the Global Burden of Disease 2021 database.
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BACKGROUND: With increasing life expectancy and aging populations, Belt and Road Initiative (BRI) countries face various levels of gallbladder and biliary tract cancer (GBTC) impact. This study analyzed differences in the burden and trends of GBTC in BRI countries from 1990 to 2021, providing a comprehensive understanding of geographic, temporal, and demographic variations to inform targeted public health strategies. METHODS: Using the Global Burden of Disease (GBD) 2021 database, we examined age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized disability-adjusted life year rate of GBTC across 153 BRI countries. A Bayesian Age-Period-Cohort (BAPC) model analyzed temporal trends (1990-2021) and projected future burden (2035). We assessed the relationship between sociodemographic index (SDI) and GBTC burden, conducted sex- and age-stratified analyses, and evaluated geographic disparities. RESULTS: In 2021, global age-standardized incidence rate was 2.56/100 000 (216 768 cases), with age-standardized prevalence rate 3.69/100 000 (314 465 cases), age-standardized mortality rate 2.04/100 000 (171 961 deaths), and age-standardized disability-adjusted life year rate 43.2/100 000 (3.73 million disability-adjusted life years). Geographic analysis identified Thailand, Korea, and Chile as regions with the highest age-standardized incidence rate and age-standardized mortality rate. Age-standardized disability-adjusted life year rate correlated positively with SDI (R = 0.38) across BRI countries. Between 1990 and 2021, temporal trends showed age-standardized mortality rate and age-standardized disability-adjusted life year rate declined globally (-24.09/100 000 and -26.25/100 000), but South Asia showed increased mortality rate (+33.24/100 000 and +28.15/100 000). Globally, age-standardized mortality rate and age-standardized disability-adjusted life year rate are projected to continue declining through 2035. Sex- and age-stratified analyses revealed that age-specific incidence, prevalence, mortality, and disability-adjusted life year rates increased with age, peaking at 85-90 years. Males had higher rates at 84-94 years, but absolute cases, deaths and disability-adjusted life years were higher in females after 70 years. CONCLUSIONS: GBTC burden in BRI countries varies by regions, SDI, temporal trends, and demographic factors. While overall burden declines, addressing healthcare disparities, environmental risks, and early detection gaps is crucial in high-burden countries and populations. Strengthening collaboration among BRI countries is key to mitigating GBTC burden and advancing public health initiatives.