Global, regional, and national burdens of bladder cancer in individuals aged 60 years and older from 1990 to 2021: a cross-sectional study.

BACKGROUND

Bladder cancer (BC) is a leading global malignancy, disproportionately affecting older adults. However, comprehensive studies on its epidemiological burden specifically in this age group remain limited.

METHODS

Using data from the Global Burden of Disease (GBD) 2021, we analyzed BC incidence, prevalence, mortality, and disability-adjusted life years (DALYs) among adults aged ≥ 60 years from 1990 to 2021. We employed joinpoint regression to identify temporal trend changes, decomposition analysis to quantify drivers of burden, and age-period-cohort modeling to distinguish the effects of age, time period, and birth cohort. Frontier analysis was used to benchmark performance relative to sociodemographic development, and we forecasted burden up to 2050 using GBD ensemble models. All analyses were conducted using R software (v4.2.3).

RESULTS

From 1990 to 2021, global geriatric BC cases increased approximately 1.4-fold, driven by population growth and aging; age-standardized prevalence rate (ASPR) rose from 196 to 211 per 100,000, while incidence (ASIR), mortality (ASMR), and DALY rates (ASDALYs) declined slightly. Projections to 2050 indicate a near doubling of prevalent cases (~ 4.54 million) alongside continued declines in ASIR, ASMR, and ASDALYs. In 2021, high-SDI regions (e.g., North America, Western Europe) had the highest burden, whereas Oceania had the lowest. ASPR and ASIR correlated positively with SDI until ~ 0.8; ASMR and ASDALYs peaked around SDI 0.78 before declining. EAPCs for all metrics rose, then fell with SDI, decreasing significantly beyond ~ 0.72. Sex-based disparities widened, and socioeconomic gaps persisted. Higher-SDI countries showed greater potential for reducing BC burden in older adults.

CONCLUSIONS

This comprehensive analysis reveals a complex global landscape: successful control of age-standardized BC rates in the elderly is being counteracted by population growth and aging, leading to rising absolute burdens. The significant and growing disparities by sex, region, and SDI level highlight an urgent need for targeted, equitable policy interventions. Future health system planning must account for the escalating number of older BC patients, requiring integrated prevention and sustainable care models to manage this challenge.