Comparative Analysis of Disease Burden and Risk Factor Attribution for Urological Cancers in Six High-Growth GBD...

Prostate cancer (PCa), bladder cancer (BCa), and kidney cancer (KC) are the predominant urological cancers in older adults, posing substantial global health burdens. This study aimed to identify regions with the most rapid growth in combined urological cancer burden and characterize their distinct epidemiological profiles, risk factor attributions, and future trajectories.

We aggregated age-standardized incidence rates (ASIRs) for PCa, BCa, and KC across 21 Global Burden of Disease (GBD) regions (1990-2021), identifying six high-growth regions using the estimated annual percentage change (EAPC) of the combined ASIR. We analysed mortality-to-incidence ratios (MIRs), risk factor-attributable mortality, disability-adjusted life year (DALY) decomposition, and autoregressive integrated moving average (ARIMA) projections to 2036. DALYs were further decomposed into years of life lost (YLLs) and years lived with disability (YLDs).

Six high-growth regions were identified: Eastern Europe, Central Europe, North Africa and Middle East (NAME), High-income Asia Pacific (HIAP), Southeast Asia (SEA), and Andean Latin America (ALA). High body mass index (BMI) has surpassed tobacco as the leading attributable risk factor for KC mortality globally (2021 male age-standardized mortality rate [ASMR] in Eastern Europe: 2.91 [95% uncertainty interval (UI): 2.07-3.74] vs. 1.88 [1.15-2.62] per 100,000 for tobacco). Tobacco use remains the leading attributable risk factor for BCa mortality, though declining in most regions, except Central European women (EAPC 1.23 [0.78-1.69]). Eastern and Central Europe showed the steepest increases in PCa DALY rates (Central Europe: from 145.54 to 301.56 per 100,000). Decomposition analyses revealed that epidemiological changes were associated with burden increases in high-human development index (HDI) regions, whereas population growth and aging predominated in NAME, SEA, and ALA. ARIMA projections indicate rising PCa incidence and mortality in Eastern Europe through 2036.

Eastern and Central Europe require urgent, evidence-based interventions targeting rapid disease burden growth and high baseline rates. Low-to-middle HDI regions should implement proactive policies to reduce future risks driven by demographic transitions and the adoption of westernized lifestyle.