Global, G20, and China burden of malignant neoplasms of bone and articular cartilage from 1990 to 2050: trends, projections, and ecological associations with healthcare expenditure.
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BACKGROUND: Malignant neoplasms of bone and articular cartilage (MNBAC) are rare cancers with substantial fatality and disability. Long-term comparative trends and ecological associations between healthcare expenditure and MNBAC mortality across China, G20 countries, and globally remain insufficiently defined. METHODS: Global Burden of Disease (GBD) 2021 estimates were used to assess prevalence, incidence, mortality, and disability-adjusted life years (DALYs) during 1990-2021. Estimated annual percentage changes (EAPCs) characterized trends, and Bayesian age-period-cohort (BAPC) models projected age-standardized rates to 2050 with temporal hold-out validation. Healthcare expenditure-mortality associations were examined using lagged correlations (0-7 years), Benjamini-Hochberg correction, and first-difference sensitivity analyses. RESULTS: China showed substantially greater increases in MNBAC burden than G20 countries and globally. China's age-standardized prevalence, incidence, mortality, and DALY rates (ASPR, ASIR, ASMR, ASDR) increased from 4.1 to 9.2, 0.7 to 1.4, 0.6 to 0.9, and 20.2 to 29.5 per 100,000, with EAPCs of 3.47%, 3.37%, 2.21%, and 1.86%, respectively. Burden was generally higher among males and older adults, with a smaller adolescent peak for several measures. Age-standardized rates were projected to decline through 2050 across all settings, particularly in China, although long-term uncertainty widened. Raw-series correlations between expenditure and mortality were strongest at 2 years in China (r=-0.82), 4 years in G20 countries (r=-0.91), and 4 years globally (r=-0.60), but were non-significant after first differencing. CONCLUSION: China experienced a distinct increase in MNBAC burden through 2021 despite projected declines. Inverse expenditure-mortality associations in raw series were not robust to first differencing, warranting cautious, non-causal interpretation.