Global burden and regional inequalities of cancer in older adults from 1990 to 2021 and its projection until 2050.

Introduction

Advanced age is a well-established risk factor for cancer and is associated with significantly elevated morbidity and mortality rates among the older adults. Globally, 64% of the 19.3 million new cancer cases reported in 2020 occurred in individuals aged 60 years and older, accounting for 71.3% of all cancer-related deaths [ 1 ]. The five most common cancer sites are the lung, colorectum, prostate, breast, and stomach [ 2 – 4 ]. With the aging of the global population, the incidence and mortality of cancer are increasing, posing significant challenges to health care systems worldwide [ 5 ]. Projections indicate that the proportion of people aged 80 years and above will triple from 157 million in 2022 to 459 million by 2050 [ 6 ]. Correspondingly, the number of cancer diagnoses in this age group are expected to triple over the next few decades. Despite these trends, national and regional efforts to implement strategies addressing cancer in the elderly population have been limited [ 7 , 8 ]. The World Health Organization (WHO) and the United Nations (UN) developed a comprehensive 10-year global action plan in 2020 aimed at ensuring healthy and long lives for older adults. Several countries have also introduced policies focused on the prevention and treatment of cancer in the elderly population [ 9 , 10 ]. However, the current understanding of the impact and challenges of aging on cancer remains insufficient and has not garnered adequate attention [ 11 ].

Global aging will further exacerbate the cancer burden, and the intersection of cancer and aging represents an emerging and significant global public health challenge. Epidemiological trends in cancer among the elderly population are intricate and multifaceted, exhibiting substantial variations across regions and cancer types. Given the substantial increase in cancer incidence among older adults in regions with high sociodemographic index (SDI), establishing a comprehensive public health framework for healthy aging is imperative. Recent studies have underscored the necessity of integrating holistic cancer prevention and management strategies into broader healthy aging initiatives [ 12 ]. This encompasses not only medical interventions but also social support systems, lifestyle modifications, and policy reforms aimed at enhancing the overall health and well-being of aging populations.

Although existing studies have identified general trends in the incidence and mortality of cancer among older adults (aged ≥ 70 years), there remains a notable lack of research specifically addressing the cancer burden among older adults aged 70 years and above. Current databases often provide insufficient stratification of cancer data for this age group, particularly for those aged 80 years and older. This study utilized the newly updated GBD2021, which encompasses data at the global, regional, and national levels, with a particular focus on multidimensional indicators of cancer burden in individuals aged 70 years and older, including incidence and mortality rates. Furthermore, the study examined variations in cancer burden across different SDI levels. It also projected future trends in the cancer burden among older adults up to 2050. By integrating cancer epidemiological characteristics with demographic aging patterns, this research offers a novel perspective on the complex interplay between cancer and aging. It provides critical evidence to support the formulation of more targeted prevention and control strategies, as well as health policies tailored to older adults, thereby addressing current gaps in comprehensive cancer assessment for this vulnerable population.

Definitions

This study employed GBD2021 data released by the Institute for Health Metrics and Evaluation (IHME) in October 2023. The data utilized in this study were sourced from the publicly accessible Global Health Data Exchange platform (< https://ghdx.healthdata.org/gbd-2021 >) and did not involve the collection of personal information, thus ethical approval was not needed. On the basis of GBD2021 data, this study systematically analyzed the epidemiological trends of cancers in individuals aged 70 years and older from 1990–2021 and projected potential future trends. The GBD2021 is a comprehensive international research collaboration that quantified and compared the global burden of health and disease from 1990–2021 through extensive data collection, review, and analysis. While the World Health Organization typically defines old age as 65 years or older, some studies have suggested that it should be defined as starting at 75 years [ 13 ]; this study concentrated on individuals aged 70 years and older. This decision was driven by the constraints in age group categorization within the GBD database.

Sociodemographic Index (SDI)

The survey also incorporated the use of the SDI, a comprehensive indicator that evaluates sociodemographic development by considering key factors such as income levels, educational attainment, and fertility patterns within a specific region or country. Using the SDI, GBD2021 categorizes the data from 204 countries and regions into five strata: low-SDI, low-middle-SDI, middle-SDI, high-middle-SDI, and high-SDI [ 14 ].

Disease burden of cancer in older adults

In this study, we obtained and analyzed GBD2021 data on cancer incidence and mortality among older adults (aged ≥ 70 years) at the global, regional, and national levels. All the estimates are presented with their corresponding 95% uncertainty intervals (UIs). Additionally, morbidity and mortality rates are reported per 100,000 individuals per year. The methodology used in the 2021 GBD study has been comprehensively described in previous publications [ 15 , 16 ].Individuals aged 70 years and over were further subdivided into six age groups: 70–74, 75–79, 80–84, 85–89, 90–94, and 95 + years, with separate sex analyses conducted for males and females. The data utilized in this study were sourced from the publicly accessible Global Health Data Exchange platform (< https://ghdx.healthdata.org/gbd-2021 >) and did not involve the collection of personal information, thus ethical approval was not needed.

Joinpoint regression model

The joinpoint regression model was used to compute the average annual percentage change (AAPC) for cancer incidence and mortality rates among two sexes, five SDI regions, six age groups, and 33 types of cancers. This analysis aimed to summarize the temporal trends in cancer incidence and mortality among the elderly population from 1990–2021. The model incorporates up to five join points to identify key turning points in the trend of indicator change. The number of join points was determined on the basis of preliminary observations and analysis of the data trends. For model selection, the permutation test was employed as the primary method, with a default significance level of ɑ = 0.05 and 4499 replications. The permutation test assessed the statistical significance of the join points by randomly permuting the time points in the datasets. This approach effectively minimized potential statistical bias that may arise from nonnormal data distributions or small sample sizes. In cases where the permutation test did not yield statistically significant results, the Bayesian information criterion (BIC) was used as an alternative model selection criterion. The model with the lowest BIC value was selected to ensure an optimal balance between model complexity and goodness of fit.

The AAPC can be computed via the following formula:

β i represents the slope of the ith connection point, and W i represents the weight of the ith connection point. The estimated annual percent change (EAPC) in rates was calculated when the EAPC fell within a positive or negative range within a given confidence interval greater or less than zero, indicating an increasing or decreasing trend over time. Here, “rate” refers to either incidence or mortality.

Pearson rank correlation analysis

Given the substantial variations in the SDI distribution across 21 regions and 204 countries, Pearson rank correlation analysis was employed to assess the associations between the incidence and mortality rates of cancers in older adults (aged ≥ 70 years) and the SDI in these regions from 1990 to 2021.

Autoregressive integrated moving average (ARIMA) models

ARIMA models were applied to forecast future trends in cancer incidence and mortality rates. The ARIMA model integrates both an autoregressive (AR) component and a moving average (MA) component, forming a comprehensive forecasting framework. The fundamental assumption underlying the ARIMA model is that the data series consists of time-dependent random variables, whose autocorrelation structure can be effectively modeled. This allowed for the prediction of future values on the basis of historical observations. The general mathematical representation of the ARIMA model is as follows: Yₜ = φ₁Yₜ₋₁ + φ₂Yₜ₋₂ + … + φₚYₜ₋ₚ + eₜ − θ₁eₜ₋₁ − … − θ q e t−q . A prerequisite for applying the ARIMA model was that the time series must be stationary, i.e., it exhibits a constant mean and variance over time and is devoid of trends or seasonal patterns. The ARIMA prediction model automatically optimized the (p, d, q) parameters via the minimization of the corrected Akaike information criterion (AICc) via the auto.arima() function. The time series was required to satisfy stationarity after differencing, as verified by the KPSS test ( p < 0.05), and the residuals were required to exhibit no autocorrelation, as confirmed by the Ljung–Box test (p > 0.05). A parametric bootstrap method was employed to generate 95% confidence intervals for the prediction intervals covering the period from 2022 to 2050.

Statistical analyses and graphical representations were conducted via R software (version 4.2.1) and joinpoint software (version 5.2.0). A p -value threshold of less than 0.05 was set as the criterion for statistical significance.

Results

Temporal trends of incidence, mortality and rates worldwide for cancer in people older than 70 years from 1990–2021

The results of the incidence, mortality, corresponding rates, and joinpoint regression models based on incidence and mortality rates for cancer in the older population (aged ≥ 70 years) worldwide from 1990 to 2021 are shown in Fig. 1 and Table 1 . Although the incidence rate of cancer in older people steadily increased in both sexes from 1990–2021, a downward trend in the mortality rate was found in both sexes.

From 1990–2021, high-SDI regions presented significant increases in incidence rates (AAPC = 1.03 (0.83, 1.23)) and a notable decreases in mortality rates (AAPC = −0.47 (−0.51, −0.43)). In contrast, low-middle- and low-SDI regions experienced increases in both incidence rates and mortality rates.

From 2010 to 2021, the incidence and mortality rates for 15 of 33 types of cancer increased, including liver cancer; kidney cancer; tracheal, bronchial, and lung cancer; pancreatic cancer. For 6 types of cancer, the incidence rate increased, whereas the mortality rate decreased, including colorectal cancer and non-Hodgkin lymphoma. The incidence and mortality rates for the remaining 12 types of cancer decreased, exemplified by cervical, ovarian, and esophageal cancers. The three types that exhibited a significant upward trend in incidence were neuroblastoma and other peripheral nervous cell tumors, nonmelanoma skin cancer and malignant skin melanoma. Additionally, the three cancers with the most significant decreases in incidence and mortality rates were stomach cancer, Hodgkin lymphoma and nasopharyngeal cancer. The three cancers with the most significant increases in mortality rates were nonmelanoma skin cancer, other peripheral nervous cell tumors, malignant skin melanoma and brain and central nervous system cancer..

As depicted in Fig. 1 A and Table 1 , although the highest number of cancer cases was observed in the age groups of 70–74 (AAPC = 0.4 (0.34, 0.46)) and 75–79 (AAPC = 0.36 (0.23, 0.49)), the increase in the incidence rate from 2010 to 2021 was significantly lower than that in the 85–89 (AAPC = 0.72 (0.5, 0.95)) and 90–94 (AAPC = 0.82 (0.63, 1.01)) age groups. Furthermore, the highest number of deaths was found in the 70–74 and 75–79-year-old age groups, but these groups experienced the most substantial decrease in mortality rates. In contrast, while the number of deaths in individuals aged 85 years and older was relatively low, the reduction in mortality rates was minimal or even showed a significant upward trend, as shown in Fig. 1 B and Table 1 . The aforementioned findings revealed no significant differences between the male and female groups.

Regional disparities in the incidence and mortality rates of various cancers among people older than 70 years in 2021

The heatmap presented in Fig. 2 illustrates the rankings of 33 cancer incidence rates (Fig. 2 A) and mortality rates (Fig. 2 B) among individuals aged 70 years and older across 21 regions and 5 SDI regions. Overall, the annual incidence and mortality rates of the 33 cancers were generally consistent in 2021. Neuroblastoma and other peripheral nervous cell tumors ranked last in terms of mortality and incidence rates across all regions. In 2021, with the exception of low-SDI regions, the annual incidence and mortality rates of tracheal, bronchial, and lung cancer were within the top five across the remaining four SDI regions. The top four cancers in terms of both incidence and mortality rates were colorectal cancer; prostate cancer; tracheal, bronchial, and lung cancer; and gastric cancer. Compared with that in other SDI regions, the incidence of pancreatic cancer mortality was significantly greater in high- and high-middle-SDI regions. Interestingly, in 21 regions, the incidence and mortality rates of cervical cancer exhibited the greatest heterogeneity at the regional level. The regional disparities in the incidence rates of esophageal cancer were also noteworthy. Unlike other regions, the lip and oral cavity had the third highest incidence rate of cancer, which was the leading cause of mortality in South Asia. Furthermore, liver cancer had the third highest incidence and mortality rate in western sub − Saharan Africia.

Global disease burden assessment of total cancers in people older than 70 years in 204 countries and territories, in 2021

The global map revealed significant heterogeneity in incidence rates and their corresponding EAPCs, as well as mortality rates and their corresponding EAPCs, for cancers in older adults (aged ≥ 70 years) across various countries and territories in 2021, as displayed in Fig. 3 and Supplementary Fig. 1. In North America, the United States of America, Canada, and Greenland; Australasia, New Zealand; and several countries in Northern, Western, and Central Europe, the highest cancer incidence rates among older adults were observed in 2021. Conversely, the majority of countries in Africa and Southeast Asia reported lower incidence rates (Fig. 3 A). In the analysis of the incidence rate trends from 1990–2021, the United States of America exhibited a notable increase in the incidence rate, whereas Canada and Greenland demonstrated a decline. Furthermore, both Australia and New Zealand in Oceania experienced significant reductions in incidence rates. Similarly, Saudi Arabia, Iraq, and Egypt in the Middle East also displayed a marked upward trend (Fig. 3 B). As illustrated in Supplementary Fig. 1, in 2021, Greenland in North America, Mongolia in Asia, Bolivia in South America, Zimbabwe in Africa, and several European countries presented significantly elevated mortality rates. However, from 1990–2021, Greenland and Bolivia experienced a marked decline in mortality rates. Conversely, mortality rates have continued to rise in Zimbabwe, Mongolia, and several European nations. Furthermore, while cancer mortality among the elderly population in India remains relatively low, it has demonstrated a significant upward trend. In contrast, Kazakhstan, Turkmenistan, and Uzbekistan in Central Asia have maintained low mortality rates with a notable downward trend.

Trends in incidence rates and mortality rates for older adults across 21 regions according to the SDI from 1990–2021

The observed and expected incidence and mortality rates of cancer in older adults across 21 regions from 1990–2021 are presented in Supplementary Fig. 2. The global incidence rate among older adults in 2021 was higher than expected, while the mortality rate was significantly lower than expected. Until 2021, the incidence rate (Supplementary Fig. 2 A) of cancer in older people was significantly higher than anticipated in only two regions, namely, high-income North America and Western Europe, whereas the remaining 19 regions continue to experience lower-than-expected rates. Additionally, the mortality rate exceeded expectations in only two regions: western sub-Saharan Africa and eastern sub-Saharan Africa (Supplementary Fig. 2B). The incidence rate of cancer in older adults in the 21 regions basically tended to increase with increasing SDI, which indicated a positive correlation between the incidence rate of cancer in the older population and the SDI. The mortality rate exhibited an S-shaped trend, initially decreasing, subsequently increasing, and finally decreasing again. These findings demonstrated that the burden of cancer among the elderly population initially tended to decrease, then subsequently increased, and finally decreased with increasing SDI values. The mortality-to-incidence ratio (MIR) of colorectal cancer among adults aged 70 years and older by SDI for 2019 and 2021 was presented in Supplementary materials. Between 2019 and 2021, MIR declined in every SDI quintile, with the largest decrease observed in the high-SDI group (from 0.46 to 0.30). Reductions of 0.18, 0.23, 0.06, and 0.04 were recorded for the high-middle, middle, low-middle, and low-SDI regions, respectively. These trends suggested a global improvement in diagnosis and treatment, yet the smaller declines in lower-SDI settings underscored persistent inequities in resource access.

Predicted global trends in the incidence and mortality rates of cancers in older adults based on the SDI over the next 28 years, from 2022- 2050

ARIMA models predicted that from 2022–2050, cancer occurrence rates in older adults will continue to rise, especially in high-SDI regions (Fig. 4 ). Mortality rates are projected to decline, with the most significant reductions occurring in high-SDI regions (Fig. 5 ).

Discussion

To the best of our knowledge, this is the first comprehensive study to investigate the epidemiological trends of cancers in individuals aged over 70 years from 1990–2021, utilizing the recently updated GBD2021 database. Our findings indicated that during this period, the incidence of cancer among the elderly population rose, whereas the mortality rate declined, with no notable differences observed between sexes. These observations were consistent with the outcomes reported in prior studies [ 17 , 18 ]. In the high-SDI region, there was a marked increase in the cancer incidence rate alongside a substantial decrease in the mortality rate. Conversely, both the occurrence and mortality rates of cancer increased in low-middle and low-SDI regions. Furthermore, our analysis revealed that the cancer incidence rate among the elderly population across the 21 regions generally exhibited an increasing trend as the SDI increased, whereas the mortality rate demonstrated an S-shaped pattern characterized by an initial decline, followed by an increase, and subsequently another decline as the SDI increased. To further elucidate these trends, we employed the ARIMA model to quantitatively forecast the future trajectories of cancer incidence and mortality rates among the elderly population in the five SDI regions for the subsequent 28 years. Our findings suggest that the cancer incidence rate among older adults will persistently increase from 2022 to 2050, with the most significant increase expected in the high-SDI region. Concurrently, the cancer mortality rate among older adults is projected to decrease, with the most pronounced reduction occurring in the high-SDI region, whereas the mortality rates in other SDI regions are expected to remain relatively stable.

The increasing incidence rate in high SDI regions may be correlated with these regions having transitioned into aging societies, although a causal relationship could not be definitively established from the available data. In addition, it was crucial to examine the influence of socioeconomic status (SES) and comorbidities on cancer diagnosis and prognosis in older adults. Recent studies have demonstrated that individuals with low SES and multiple comorbidities are more likely to experience delayed cancer diagnosis and poorer outcomes [ 19 ]. These factors may further exacerbate regional disparities in cancer incidence and mortality rates. Research has indicated that population aging in high-SDI regions contributes most significantly to cancer incidence [ 17 ]. This trend implies that nations undergoing rapid socioeconomic development may face the challenge of an increasing proportion of older adult cancer patients within their future health care systems [ 17 ]. The impact of the COVID-19 pandemic on cancer diagnosis must be carefully evaluated, especially within resource-constrained health systems. Recent studies indicate that the pandemic caused substantial delays or overlooked diagnoses of cancer, potentially leading to an increase in cancer-related mortality in the short term [ 20 ]. This underscores the critical importance of developing resilient health systems capable of sustaining essential cancer services during public health emergencies. Furthermore, the decline in mortality rates may be attributed to cancer prevention and management, including improvements in medical care, screening strategies, and the enforcement of tobacco control policies [ 21 , 22 ]; further individual-level or longitudinal data are needed to establish a causal relationship. The increase in incidence and mortality rates in middle-low and low-SDI regions was due primarily to population growth [ 17 ]. The larger population base resulted in a greater absolute number of cancer cases among older adults in these regions than among those in developed countries. Furthermore, the higher incidence rates observed in developed nations could be ascribed to the presence of more sophisticated and reliable cancer registries, which facilitated more precise and thorough reporting of incidence. The swift increase in the incidence rate in rapidly developing countries may also be attributed to the increase in the quality of cancer registries during this period. However, current health systems in these areas still face significant challenges in providing comprehensive cancer care, including screening, diagnosis, treatment, rehabilitation, and palliative care [ 23 ]. The above phenomenon may explain the ongoing increase in mortality rates in these regions. To address these challenges, targeted resource allocation for screening programs in developing countries is recommended. This could include international funding support and training of health care workers to enhance early cancer detection and improve patient outcomes.We further calculated MIR for colorectal cancer among adults aged 70 years and older across the five SDI regions. An MIR approaching or exceeding 1 indicates that deaths nearly equal or surpass incident cases, reflecting inadequate early detection and treatment, whereas a substantially lower MIR signifies timely diagnosis, effective intervention, and higher survival. From 2019 to 2021, MIR declined in every SDI region, with the largest decrease observed in the high-SDI region (0.46 to 0.30). In contrast, the low-SDI region showed only a modest reduction (1.06 to 1.02), remaining close to 1, underscoring the persistently high mortality attributable to limited resources. Targeted investments in screening infrastructure and workforce training in lower-SDI settings are therefore essential to narrow this survival gap.

In this study, we identified substantial regional disparities in cancer incidence and mortality among individuals aged 70 years and older in 2021. North America exhibited high incidence rate in 2021, with an increasing trend in the United States and a decreasing trend in Canada and Greenland. The United States is currently experiencing a demographic and health transition characterized by rapid population aging, particularly due to the aging of baby boomers (those born between 1946 and 1964), who are reaching retirement age and living longer than previous generations [ 24 ]. This demographic shift was a significant contributor to the increasing cancer incidence rate among older adults in America. Previous research has demonstrated a 1.1% annual decrease in overall cancer incidence in Canada since 2012. This reduction is attributed to the successful implementation of cervical and colorectal cancer screening programs, as well as modifications in prostate and thyroid cancer testing protocols and a decline in smoking rates [ 25 ]. Similarly, Australasia and New Zealand, which experienced higher cancer incidence rates among the elderly population in 2021, also experienced substantial decreases in cancer incidence rates. The higher cancer incidence rates in Oceania were primarily due to advanced screening efforts; for instance, Australia and New Zealand reported the highest estimated prostate cancer incidence rates compared with other countries, likely a result of increased adoption of prostate-specific antigen (PSA) testing in these regions [ 26 ]. The observed downward trend in cancer incidence across Oceania can be ascribed to vaccination initiatives and tobacco and alcohol control measures, particularly in Australia and New Zealand, where reduced smoking prevalence has contributed to a decline in the incidence of lung cancer [ 27 ].

Most countries in Africa reported lower cancer incidence rates. Moreover, although cancer mortality among older adults in India remains relatively low, it has clearly increased. Studies have demonstrated that the cancer infrastructure in African countries is suboptimal. Fewer than half of these countries have developed comprehensive cancer policies, strategies, or action plans; fewer than two-thirds have established cancer registries. Additionally, there is a notable lack of low-cost screening options, such as mammography for breast cancer, which is the leading malignancy among African women [ 28 ]. Public primary health care provides mammography services in only 15 African countries. Furthermore, Africa has the lowest physician density and offers a very limited level of care compared with other regions globally and WHO regions [ 28 ]. Owing to a lower willingness to undergo screening and treatment, along with the prevalence of comorbidities, frailty, and a decline in functional status, cancer management in the elderly population may be more complex in regions such as Africa, posing greater challenges to health care systems [ 17 ]. This phenomenon may explain the paradox of low cancer incidence but increasing mortality rates among older adults in Africa.

The 70–79-year-old age group presented the highest incidence and mortality rates for cancer; however, it also demonstrated the most significant reductions in both incidence and mortality. Conversely, individuals aged 85 and over experienced fewer cancer-related deaths, yet the decrease in mortality was minimal or, in some instances, showed a clear upward trend. This phenomenon could be attributed to the generally poorer health status and shorter life expectancy of this demographic, as well as the lower prevalence of cancer screening programs, leading to potential underdiagnosis. Additionally, older adults with cancer often present with multiple comorbidities, which can result in their inability to endure or opt out of intensive cancer treatments [ 18 ].

Among the 21 regions, cervical cancer exhibited the greatest heterogeneity in both incidence and mortality at the regional level. This variability was attributed to poverty and the lack of resources and infrastructure for cervical cancer screening and treatment [ 29 , 30 ]. Regional disparities in the incidence of esophageal cancer were also significant. In the United States and other Western countries, the majority of esophageal cancers were linked to smoking and excessive alcohol consumption. Chronic gastroesophageal reflux disease (GERD), Barrett's esophagus, obesity, and smoking are additional risk factors for esophageal cancer [ 31 ]. Specifically, lip and oral cavity cancer ranked as the third most common cancer and the leading cause of cancer-related mortality in South Asia. South Asian countries, including India, Bangladesh, Pakistan, and Sri Lanka, were identified as being at elevated risk for the development of oral cancer [ 32 , 33 ]. Data from the World Health Organization (WHO) indicate that these nations accounted for approximately 40% of globally diagnosed oral cancer cases [ 34 , 35 ]. Furthermore, the prevalence of oral cancer in these regions was nearly twice the global average [ 33 , 36 ]. The primary driver of this high incidence was the practice of chewing betel nut and tobacco. These customs were prevalent across nearly all age groups and generations in South Asia [ 37 , 38 ]. Despite its lower nicotine content compared with smoking tobacco, chewing tobacco may pose a greater carcinogenic risk because of prolonged contact with the oral mucosa [ 39 ]. Furthermore, liver cancer had the third highest incidence and mortality rates in West sub-Saharan Africa, which was predominantly associated with chronic viral hepatitis B and C, aflatoxin exposure, and iron overload [ 40 ]. Africa, as a whole, is considered a region with a high prevalence of hepatitis B virus (HBV). In certain countries south of western Sahara, including Nigeria, Namibia, Gabon, Cameroon, and Burkina Faso, HBV infection reached superendemic levels. The proportion of chronic carriers of hepatitis B surface antigen (HBsAg) in the general population exceeded 8% [ 41 , 42 ].

Consistent with prior research [ 1 , 17 ], our study revealed a significant shift in global cancer patterns from 1990 to 2021. The incidence of infection-related cancers, such as gastric and cervical cancers, declined, whereas the incidence of lifestyle-associated cancers, including colorectal, lung, and thyroid cancers, increased. These findings suggest that interventions such as expanded immunization programs, enhanced antiviral treatments, and more frequent screening tests could effectively reduce cancer incidence and mortality. Moreover, promoting a healthy lifestyle remains a crucial preventive measure against cancer. Population aging was the most significant factor contributing to the increased incidence of prostate, pancreatic, lung, and colorectal cancers, with individuals aged 60 years and older accounting for more than 60% of the total cases and deaths from these cancers [ 43 ]. Consequently, health policies to address the growing demand for cancer management among older adults are imperative [ 17 , 44 ].

Our study had several limitations. First, the data utilized from GBD2021 are derived from the Burden of Disease Prediction database rather than empirical observations. Second, the GBD databases only encompass information with comprehensive registration details, potentially resulting in a paucity of reliable data from underdeveloped or developing countries where registration systems may be inadequate. Finally, owing to the focus on individuals aged 70 years and older, it was not feasible to obtain age-standardized relevant data concurrently. Despite these limitations, this study offers valuable insights into the current and temporal patterns of the global cancer burden of older adults (aged ≥ 70 years) and provides robust evidence for the formulation of more precise and effective public health strategies. We propose the following public health strategies: allocate resources to cancer screening programs in low-SDI countries via international funding, capacity building, and training for health care workers; enhance cancer registry infrastructure by implementing robust data collection and reporting systems; promote cancer prevention and health education initiatives that encourage healthy lifestyles and early detection through screening; foster intersectoral collaboration among health care providers, policy-makers, and community leaders to comprehensively address the needs of individuals with cancer comprehensively; and establish specialized geriatric oncology services in high-SDI countries with aging populations. These measures could contribute to reducing global disparities in cancer care and improving patient outcomes.

In summary, our research has demonstrated a global rise in cancer incidence alongside a declining trend in cancer mortality among the elderly population from 1990 to 2021, with notable variations across different regions and age cohorts. The study forecasted that these trends are likely to persist for the subsequent 28 years. Consequently, it was imperative that all nations and territories implement proactive strategies to address the escalating cancer incidence rate in older adults adequately and further reduce mortality rates and the strain on health care infrastructure.

Supplementary Information

Supplementary Material 1: Supplementary Table 1. EAPC of CRC in older adults based on incidence rate on the levels 204 countries and territories, 1990-2021. Supplementary Table 2. EAPC of CRC in older adults based on mortality rate on the levels 204 countries and territories, 1990-2021. Supplementary Table 3. Predicted global trends of incidence rates of CRC in older adults over the next 28 years. Supplementary Table 4. Predicted global trends of incidence rates of CRC in older adults in High SDI regions over the next 28 years. Supplementary Table 5. Predicted global trends of incidence rates of CRC in older adults in Middle-high SDI regions over the next 28 years. Supplementary Table 6. Predicted global trends of incidence rates of CRC in older adults in Middle SDI regions over the next 28 years. Supplementary Table 7. Predicted global trends of incidence rates of CRC in older adults in Middle-low SDI regions over the next 28 years. Supplementary Table 8. Predicted global trends of incidence rates of CRC in older adults in Low SDI regions over the next 28 years. Supplementary Table 9. Predicted global trends of mortality rates of CRC in older adults over the next 28 years. Supplementary Table 10. Predicted global trends of mortality rates of CRC in older adults in High SDI regions over the next 28 years. Supplementary Table 11. Predicted global trends of mortality rates of CRC in older adults in Middle-high SDI regions over the next 28 years. Supplementary Table 12. Predicted global trends of mortality rates of CRC in older adults in Middle SDI regions over the next 28 years. Supplementary Table 13. Predicted global trends of mortality rates of CRC in older adults in Middle-low SDI regions over the next 28 years. Supplementary Table 14. Predicted global trends of mortality rates of CRC in older adults in Low SDI regions over the next 28 years. Supplementary Table 15. The 33 types of cancers were ranked in descending order based on the EAPC value of incidence rates. Supplementary Table 16. The 33 types of cancers were ranked in descending order based on the EAPC value of mortality rates. Supplementary Table 17. Mortality-to-Incidence Ratio (MIR) of colorectal cancer in old individuals by Socio-demographic Index (SDI), 2019 and 2021. Supplementary Table 18. Regional Cancer Risk Factors

Supplementary Material 2: Supplementary Figure 1. The mortality rate (A) of cancers in older adults (age ³ 70 years) and its EAPC (B) on the levels 204 countries and territories, 1990-2021. EAPC: Estimated average percentage change

Supplementary Material 3: Supplementary Figure 2. Trend of incidence (A) and mortality (B) rate of cancers in older adults among 22 regions based on SDI. For each region, points from left to right depict estimates from each year from 1990 to 2021, with expected values displayed as the black line

Acknowledgements

Not applicable.

Authors’ contributions

Conceptualization, data curation, formal analysis，investigation，resources and software were conducted by Ting Ma, Ziyan Weng, Shiqi Zhou, Longhai Feng, Zhaofu Qin and Dening Ma. Ting Ma and Ziyan Weng were responsible for validation, visualization and methodology. Project administration and supervision were conducted by Dening Ma and Zhaofu Qin. Ting Ma performed the writing—original draft. Deing Ma performed the funding acquisition and writing—review & editing. All authors read and approved the final manuscript.

Funding

This work is supported by the This work was supported by the Zhejiang Province Traditional Chinese Medicine Science and Technology Project (2024ZL324).

Data availability

Data for this study can be obtained from the Global Health Data Exchange website ( https://ghdx.healthdata.org/gbd-2021 ).

Declarations

Ethics approval and consent to participate

Not required as this study used public data aggregated on the level of country and global, and no personal information was collected.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Ting Ma and Ziyan Weng contributed equally to this works.

Contributor Information

Zhaofu Qin, Email: qzfwmu@163.com.

Dening Ma, Email: madeningsdu@163.com.

References

1. Sung H, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.

2. GBD 2019 Colorectal Cancer Collaborators. Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol 2022;7(7):627–647

3. Kocarnik JM, et al. Cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years for 29 cancer groups from 2010 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. JAMA Oncol. 2022;8(3):420–44.

4. Caines A, Selim R, Salgia R. The changing global epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2020;24(4):535–47.

5. Li L, et al. Nowcasting and forecasting global aging and cancer burden: analysis of data from the GLOBOCAN and global burden of disease study. J Natl Cancer Cent. 2024;4(3):223–32.

6. Shah R, et al. Updated cancer burden in oldest old: a population-based study using 2022 Globocan estimates. Cancer Epidemiol. 2025 Apr;95:102716.

7. Amuthavalli Thiyagarajan J, et al. The UN Decade of healthy ageing: strengthening measurement for monitoring health and wellbeing of older people. Age Ageing. 2022 Jul 1;51(7):afac147.

8. GBD 2019 Cancer Risk Factors Collaborators. The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022;400(10352):563–591.

9. Hasbrouck L. Healthy people 2030: an improved framework. Health Educ Behav. 2021;48(2):113–4.

10. Sun D, et al. Cancer burden in China: trends, risk factors and prevention. Cancer Biol Med. 2020;17(4):879–95.

11. Pilleron S, et al. Aging and the cancer burden in Latin America and the Caribbean: time to act. J Geriatr Oncol. 2019;10(5):799–804.

12. Gianfredi V, et al. Aging, longevity, and healthy aging: the public health approach. Aging Clin Exp Res. 2025;37(1):125.

13. Orimo H. Reviewing the definition of elderly. Nihon Ronen Igakkai Zasshi. 2006;43(1):27–34.

14. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159)1859–1922.

15. GBD 2021 Diseases and Injuries Collaborators.Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024;403(10440);2133–2161.

16. GBD 2021 Risk Factors Collaborators. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024 403(10440);2162–2203.

17. Ju W, et al. The occurence of cancer in ageing populations at global and regional levels, 1990 to 2019. Erratum in: Age Ageing. 2023 Nov 2;52(11):afad226.

18. Xu J, et al. Trends analysis of cancer incidence, mortality, and survival for the elderly in the United States, 1975–2020. Cancer Med. 2024;13(15):e70062.

19. Pennisi F, et al. Comorbidities, socioeconomic status, and colorectal cancer diagnostic route. JAMA Netw Open. 2025;8(5):e258867.

20. Pennisi F, et al. Impact of the Covid pandemic on timely cancer diagnosis across European healthcare settings: a scoping review. Ann Ig. 2024;36(2):194–214.

21. Soerjomataram I, Bray F. Planning for tomorrow: global cancer incidence and the role of prevention 2020–2070. Nat Rev Clin Oncol. 2021;18(10):663–72.

22. Sullivan R, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol. 2015;16(11):1193–224.

23. National Academies of Sciences, E., et al., The National Academies Collection: Reports funded by National Institutes of Health, in Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. 2017, National Academies Press (US). Copyright 2017 by the National Academy of Sciences. All rights reserved.: Washington (DC).

24. Jones CH, Dolsten M. Healthcare on the brink: navigating the challenges of an aging society in the United States. NPJ Aging. 2024;10(1):22.

25. Warkentin MT, et al. Progress in site-specific cancer mortality in Canada over the last 70 years. Sci Rep. 2024;14(1):5688.

26. Schafer EJ, et al. Recent Patterns and Trends in Global Prostate Cancer Incidence and Mortality: An Update. Eur Urol. 2025 Mar;87(3):302-313.

27. Wu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980–2021: a systematic analysis for the GBD 2021. J Hematol Oncol. 2024;17(1):119.

28. Sharma R, et al. Mapping cancer in Africa: a comprehensive and comparable characterization of 34 cancer types using estimates from GLOBOCAN 2020. Front Public Health. 2022;10:839835.

29. Zhao M, et al. Global, regional, and national burden of cervical cancer for 195 countries and territories, 2007–2017: findings from the Global burden of Disease Study 2017. BMC Womens Health. 2021;21(1):419.

30. Zhang X, et al. Trends of cervical cancer at global, regional, and national level: data from the Global Burden of Disease study 2019. BMC Public Health. 2021;21(1):894.

31. Fan J, et al. Global trends in the incidence and mortality of esophageal cancer from 1990 to 2017. Cancer Med. 2020;9(18):6875–87.

32. Shield KD, et al. The global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2012. CA Cancer J Clin. 2017;67(1):51–64.

33. Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol. 2015;8(9):11884–94.

34. Bray F, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

35. Ferlay J, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

36. Ghantous Y, Abu Elnaaj I. [global incidence and risk factors of oral cancer]. Harefuah. 2017;156(10):645–9.

37. Banerjee SC, et al. Gutka and tambaku paan use among South Asian immigrants: a focus group study. J Immigr Minor Health. 2014;16(3):531–9.

38. Changrani J, et al. Paan and gutka use in the United States: a pilot study in Bangladeshi and Indian-Gujarati immigrants in New York City. J Immigr Refug Stud. 2006;4(1):99–110.

39. Xie L, Shang Z. Burden of oral cancer in Asia from 1990 to 2019: estimates from the global burden of disease 2019 study. PLoS ONE. 2022;17(3):e0265950.

40. Okeke E, et al. Epidemiology of liver cancer in Africa: current and future trends. Semin Liver Dis. 2020;40(2):111–23.

41. FouelifackYmele F, et al. High rates of hepatitis B and C and HIV infections among blood donors in Cameroon: a proposed blood screening algorithm for blood donors in resource-limited settings. J Blood Transfus. 2012;2012:458372.

42. Tao I, et al. Seroepidemiology of hepatitis B and C viruses in the general population of Burkina Faso. Hepat Res Treat. 2014;2014:781843.

43. de Martel C, et al. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health. 2020;8(2):e180–90.

44. Cao W, Chen W. Cancer screening in the aging population: where do we stand and what can we do? J Natl Cancer Cent. 2022;2(3):127–9.

Associated Data

Supplementary Materials

Supplementary Material 1: Supplementary Table 1. EAPC of CRC in older adults based on incidence rate on the levels 204 countries and territories, 1990-2021. Supplementary Table 2. EAPC of CRC in older adults based on mortality rate on the levels 204 countries and territories, 1990-2021. Supplementary Table 3. Predicted global trends of incidence rates of CRC in older adults over the next 28 years. Supplementary Table 4. Predicted global trends of incidence rates of CRC in older adults in High SDI regions over the next 28 years. Supplementary Table 5. Predicted global trends of incidence rates of CRC in older adults in Middle-high SDI regions over the next 28 years. Supplementary Table 6. Predicted global trends of incidence rates of CRC in older adults in Middle SDI regions over the next 28 years. Supplementary Table 7. Predicted global trends of incidence rates of CRC in older adults in Middle-low SDI regions over the next 28 years. Supplementary Table 8. Predicted global trends of incidence rates of CRC in older adults in Low SDI regions over the next 28 years. Supplementary Table 9. Predicted global trends of mortality rates of CRC in older adults over the next 28 years. Supplementary Table 10. Predicted global trends of mortality rates of CRC in older adults in High SDI regions over the next 28 years. Supplementary Table 11. Predicted global trends of mortality rates of CRC in older adults in Middle-high SDI regions over the next 28 years. Supplementary Table 12. Predicted global trends of mortality rates of CRC in older adults in Middle SDI regions over the next 28 years. Supplementary Table 13. Predicted global trends of mortality rates of CRC in older adults in Middle-low SDI regions over the next 28 years. Supplementary Table 14. Predicted global trends of mortality rates of CRC in older adults in Low SDI regions over the next 28 years. Supplementary Table 15. The 33 types of cancers were ranked in descending order based on the EAPC value of incidence rates. Supplementary Table 16. The 33 types of cancers were ranked in descending order based on the EAPC value of mortality rates. Supplementary Table 17. Mortality-to-Incidence Ratio (MIR) of colorectal cancer in old individuals by Socio-demographic Index (SDI), 2019 and 2021. Supplementary Table 18. Regional Cancer Risk Factors

Supplementary Material 2: Supplementary Figure 1. The mortality rate (A) of cancers in older adults (age ³ 70 years) and its EAPC (B) on the levels 204 countries and territories, 1990-2021. EAPC: Estimated average percentage change

Supplementary Material 3: Supplementary Figure 2. Trend of incidence (A) and mortality (B) rate of cancers in older adults among 22 regions based on SDI. For each region, points from left to right depict estimates from each year from 1990 to 2021, with expected values displayed as the black line

Data Availability Statement

Data for this study can be obtained from the Global Health Data Exchange website ( https://ghdx.healthdata.org/gbd-2021 ).