Clinics (Sao Paulo, Brazil) · 2026
Comparative analysis of female breast cancer burden in China along the global sociodemographic gradient: risk attribution, decomposition, and age-period-cohort evidence from GBD 2021.
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Si Yixin, Liu Jialin, Xu Liuqiyu, Ye Wenya, Li Jiating, Peng Yun, Hu Zhen
Аннотация
OBJECTIVE: To assess temporal changes in female breast cancer burden in China from 1990 to 2021, its global and Socio-Demographic Index (SDI) status, attributable risks, death drivers and age-period-cohort (APC) features based on GBD 2021 data.
METHODS: We extracted data on incidence, deaths, DALYs and seven attributable risks for China, the world and five SDI regions. Estimated Annual Percentage Change (EAPC) analyzed age-standardized rate trends. Shapley decomposition divided attributable death changes into population growth, aging, age-specific mortality and Population Attributable Fraction (PAF). APC models estimated temporal drifts.
RESULTS: From 1990 to 2021, the Age-Standardized Incidence Rate (ASIR) increased from 24.54 to 29.36 per 100,000 (EAPC = 0.30%, 95% CI: 0.20 to 0.41%) in China, whereas the Age-Standardized Mortality Rate (ASMR) decreased from 10.65 to 6.46 per 100,000 (EAPC = -2.02%, 95% CI -2.20 to -1.85%). By 2021, both rates were lower in China than in the global population and all five SDI regions. The leading PAFs for Disability-Adjusted Life-Years (DALYs) burden were high red meat intake, secondhand smoke, high fasting plasma glucose, high body mass index, and low physical activity. Decomposition showed that increasing risk-specific attributable deaths were mainly driven by population growth and ageing, while declining age-specific mortality contributed negatively. Incidence net drift was 0.232%/year; mortality net drift was -2.115%/year.
CONCLUSION: China showed a transitional breast cancer burden pattern, characterized by slowly rising incidence, declining age-standardized mortality, and a shift toward metabolic risk contribution. Population ageing and metabolic risk accumulation may continue to increase the absolute burden despite improvements in mortality risk.
METHODS: We extracted data on incidence, deaths, DALYs and seven attributable risks for China, the world and five SDI regions. Estimated Annual Percentage Change (EAPC) analyzed age-standardized rate trends. Shapley decomposition divided attributable death changes into population growth, aging, age-specific mortality and Population Attributable Fraction (PAF). APC models estimated temporal drifts.
RESULTS: From 1990 to 2021, the Age-Standardized Incidence Rate (ASIR) increased from 24.54 to 29.36 per 100,000 (EAPC = 0.30%, 95% CI: 0.20 to 0.41%) in China, whereas the Age-Standardized Mortality Rate (ASMR) decreased from 10.65 to 6.46 per 100,000 (EAPC = -2.02%, 95% CI -2.20 to -1.85%). By 2021, both rates were lower in China than in the global population and all five SDI regions. The leading PAFs for Disability-Adjusted Life-Years (DALYs) burden were high red meat intake, secondhand smoke, high fasting plasma glucose, high body mass index, and low physical activity. Decomposition showed that increasing risk-specific attributable deaths were mainly driven by population growth and ageing, while declining age-specific mortality contributed negatively. Incidence net drift was 0.232%/year; mortality net drift was -2.115%/year.
CONCLUSION: China showed a transitional breast cancer burden pattern, characterized by slowly rising incidence, declining age-standardized mortality, and a shift toward metabolic risk contribution. Population ageing and metabolic risk accumulation may continue to increase the absolute burden despite improvements in mortality risk.