Rising burden and deepening inequalities: a national study of high BMI-related uterine cancer in the United States using GBD and NHANES data.

OBJECTIVE

Uterine cancer mortality is rising in the U.S. while other cancer deaths decline, posing a major public health challenge. High BMI is the strongest modifiable risk factor, but its full burden and associated inequalities remain poorly characterized.

METHODS

Using data from Global Burden of Disease 2023 and National Health and Nutrition Examination Survey (NHANES, 1999-2023), we assessed national and state-level trends in uterine cancer mortality (age-standardized mortality rate [ASMR]) and disability-adjusted life years (age-standardized disability-adjusted life year rate [ASDR]) from 1990-2023. We employed Joinpoint regression, frontier analysis, and AutoRegressive Integrated Moving Average forecasting. Individual-level BMI associations were evaluated using weighted multivariable logistic regression.

RESULTS

The ASMR and ASDR for high BMI-related uterine cancer in the U.S. significantly exceeded global averages, with the gap widening. The fastest increase occurred during 2009-2017. Significant geographic disparities were identified; West Virginia and Mississippi were consistent hotspots with high burden and rapid growth. A state's socio-demographic index was negatively correlated with the growth rate (estimated annual percentage change) of ASMR (ρ=-0.709) and ASDR (ρ=-0.726), indicating faster deterioration in socioeconomically disadvantaged regions. NHANES analysis confirmed a significant, dose-response relationship between BMI and uterine cancer risk (adjusted odds ratio per 1-unit BMI increase=1.03, 95% confidence interval=1.01-1.06), which strengthened over time. Subgroup analyses revealed stronger associations in obese individuals, non-Hispanic whites, and women aged ≥50 years.

CONCLUSION

High BMI drives the rising and unequal uterine cancer burden in the U.S., underscoring the urgent need for interventions targeting both obesity and health inequities.