Global burden and inequalities of bladder cancer attributable to high fasting plasma glucose: Trends 1990-2021 and Projections to 2040.

Bladder cancer (BC) is a major global health issue, with higher incidence in males and significant regional disparities. High fasting plasma glucose (HFPG), a key metabolic risk factor, is linked to BC, but its global burden and future trends remain underexplored. We calculated the number of BC deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) related to HFPG using data from the Global Burden of Disease 2021 database. Temporal trends were assessed using estimated annual percentage change, and inequalities were analyzed using a socio-demographic index. The Bayesian age-period-cohort model projected future burden to 2040. All analyses included 95% uncertainty intervals. In 2021, HFPG accounted for 7.9% of global BC deaths and 7.4% of DALYs. From 1990 to 2021, HFPG-related BC deaths increased by 288.3%, and DALYs increased by 263.4%. Males and older populations bore a higher burden, with ASMR and ASDR showing moderate global increases (estimated annual percentage change: 0.65 for ASMR; 0.48 for ASDR). High-income regions, particularly North America and Central Europe, had the highest ASMR and ASDR. Projections indicate a significant decline in HFPG-related BC burden by 2040, especially among males. The global burden of BC attributable to HFPG has risen significantly, with high-income regions and older males most affected. Despite projected declines by 2040, targeted prevention strategies, including lifestyle interventions and improved metabolic risk factor management, are essential to reduce future burdens and address disparities globally.