National and subnational burden of brain and central nervous system cancers in China and global from 1990 to 2021: results from the global burden of disease study 2021 | Archives of Public Health

Description of the CNS cancer burden in China and worldwide

Incidence of CNS cancer in China and worldwide

In China, the incident cases of CNS cancer increased from 47,364 (95%CI: 34,333 − 59,067) in 1990 to 105,541 (95%CI: 81,401 − 133,527) in 2021, representing a 122.83% cumulative increase.Globally, incident cases rose from 173,086 (95%CI: 147,452 − 194,951) in 1990 to 357,482 (95%CI: 310,457 − 407,433) in 2021, showing a 106.53% cumulative rise.China’s ASIR increased from 4.69 per 100,000 population (95%CI: 3.42–5.85) in 1990 to 6.12 per 100,000 (95%CI: 4.76–7.67) in 2021.The global ASIR rose from 3.75 per 100,000 (95%CI: 3.21–4.21) in 1990 to 4.28 per 100,000 (95%CI: 3.71–4.88) in 2021.During 1990–2021, the AAPC in incidence was 0.86% (95%CI: 0.68–1.05) for China and 0.42% (95%CI: 0.33–0.50) globally. (Table 1,Fig.S1).

Prevalence of CNS cancer in China and worldwide

In terms of prevalence, the number of CNS cancer cases in China increased from 108,115 (95%CI: 77,294–130,965) in 1990 to 305,063 (95%CI: 244,871–387,362) in 2021, representing a cumulative increase of 182.17%.Globally, however, prevalence increased from 434,424 cases (95%CI: 375,266–480,678) in 1990 to 975,279 (95%CI: 857,200–1,096,204) in 2021, marking a 124.50% cumulative rise.China’s ASPR climbed from 9.68 per 100,000 population (95%CI: 6.94–11.76) to 21.23 per 100,000 (95%CI: 16.98–26.56) in 2021.The global ASPR increased from 8.66 per 100,000 (95%CI: 7.55–9.53) to 12.01 per 100,000 (95%CI: 10.54–13.52) between 1990 and 2021.During 1990–2021, China’s AAPC in prevalence grew by 2.53% (95%CI: 2.23–2.84), compared to a global increase of 1.06% (95%CI: 0.95–1.17).(Table 1,Fig.S1).

Mortality of CNS cancer in China and worldwide

Globally, CNS cancers caused 258,627 deaths (95%CI: 222,185–296,134) in 2021, representing an 89.86% increase since 1990.In China, the number of deaths increased by 75.97% between 1990 and 2021.The global ASMR rose marginally from 3.04 per 100,000 (95%CI: 2.58–3.45) in 1990 to 3.06 per 100,000 (95%CI: 2.62–3.50) in 2021.China’s ASMR declined from 4.05 per 100,000 (95%CI: 2.97–5.04) to 3.63 per 100,000 (95%CI: 2.74–4.60) over this period.During 1990–2021, the AAPC in mortality showed a 0.01% increase globally (95%CI: -0.04 to 0.06), contrasting with a 0.34% decrease in China (95%CI: -0.46 to -0.22).(Table 1,Fig.S1).

DALYs of CNS cancer in China and worldwide

Globally, DALYs due to CNS cancers were 5,958,481 (95%CI: 4,871,422-6,901,955) in 1990 and 8,912,595 (95%CI: 7,612,511 − 10,356,061) in 2021, representing a 49.58% increase since 1990.In China, DALYs increased by 19.28% between 1990 and 2021.The global ASDR decreased from 119.88 per 100,000 (95%CI: 99.23-137.57) in 1990 to 107.91 per 100,000 (95%CI: 91.74-125.59) in 2021.China’s ASDR declined from 174.36 per 100,000 (95%CI: 123.93-213.51) to 134.15 per 100,000 (95%CI: 102.90-171.51) during the same period.During 1990–2019, the AAPC in DALYs showed a 0.35% decrease globally (95%CI: -0.41 to -0.28), compared with a 0.87% reduction in China (95%CI: -1.04 to -0.69).(Table 1,Fig.S1).

Joinpoint regression analysis of the burden of CNS cancer in China and worldwide

Figures 1 and 2 present the Joinpoint regression analyses of ASIR, ASPR, ASMR, and ASDR for CNS cancers in China and globally from 1990 to 2021.During 1990–2021, China demonstrated overall increasing trends in ASIR (AAPC = 0.86%) and ASPR ( AAPC = 2.52%) for CNS cancers.Conversely, decreasing trends were observed for ASMR (AAPC=-0.34%) and ASDR (AAPC=-0.87%).Segment regression analysis revealed significant ASIR increases during 1990–2000 (annual percent change(APC) = 1.03%), 2003–2010 (APC = 0.94%), and 2013–2019 (APC = 1.55%) in China.Non-significant increases occurred during 2000–2003 and 2010–2013, followed by a slight post-2019 decline.ASPR showed sustained increases during 1990–2019, with significant rises in 1990–2001 (1990–1995: APC = 2.19%; 1995–2001: APC = 2.87%) and 2004–2019 (2004–2016: APC = 2.96%; 2016–2019: APC = 4.10%), before declining post-2019.ASMR exhibited a significant increase (APC = 0.33%) during 1990–2001, then a marked decrease (APC=-1.02%) until 2014, with subsequent minor fluctuations.ASDR showed statistically significant decreases (P < 0.05) during 2000–2013 and 2019–2021.Globally, ASIR (AAPC = 0.42%) and ASPR (AAPC = 1.06%) showed overall increases during 1990–2021, while ASMR remained stable (AAPC = 0.01%) and ASDR declined (AAPC=-0.35%).The segmented regression analysis revealed significant increases in the global ASIR of CNS cancers during 1990–2000 (APC = 0.85%), 2003–2018 (APC = 0.44%), and 2018–2021 (APC = 0.72%).The ASPR showed an overall upward trend during 1990–2018, with significant increases in 1990–2001 (1990–1998: APC = 1.33%; 1998–2001: APC = 2.21%) and 2004–2018 (APC = 1.17%), followed by a significant downward trend post-2018 (2018–2021: APC=-0.85%).The ASDR initially increased significantly during 1990–1994 (APC = 0.30%), then transitioned to a decreasing trend post-1994, with notable declines during 1994–2013 (1994–2000: APC=-0.11%; 2000–2007: APC=-0.67%; 2007–2013: APC=-0.39%) and 2018–2021 (APC=-1.21%).

The annual percent change of age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized disability-adjusted life year rate of central nervous system cancer in China from 1990 to 2021 (* means p-values < 0.05 and significant results). (a) Age-standardized incidence rate; (b) Age-standardized prevalence rate; (c) Age-standardized mortality rate; (d) Age-standardized disability-adjusted life year rate

The annual percent change of age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized disability-adjusted life year rate of central nervous system cancer in Global from 1990 to 2021 (* means p-values < 0.05 and significant results). (a) Age-standardized incidence rate; (b) Age-standardized prevalence rate; (c) Age-standardized mortality rate; (d) Age-standardized disability-adjusted life year rate

Burden of CNS cancer in different age groups in China in 1990 and 2021

Figure 3 displays the comparative analysis of case numbers (incidence, prevalence, and mortality) and DALYs across different age groups for CNS cancers in China in 1990 and 2021, along with corresponding crude rates.The case number of incidence analysis revealed that CNS cancers predominantly occurred in individuals under 89 years old, with higher prevalence in the 0–9 and 30–79 age groups. While the < 5 years group showed the highest case numbers in 1990, the 65–69 years group became the predominant cohort in 2021.In both 1990 and 2021, China’s CIR of CNS cancers demonstrated an increasing trend from the 15–19 to 90–94 age groups, with a slight decline between the < 5 and 15–19 age groups, peaking in the 90–94 age group.Regarding prevalence, the peak number of CNS cancer cases in China occurred in the < 5 years age group in 1990, shifting to the 30–34 years group by 2021. Notably, prevalence was significantly higher in 2021 than in 1990 for all age groups above 5 years. The CPR showed a declining trend below age 24, then stabilized with minor fluctuations.For mortality, the age groups with the highest death counts were 0–5 years in 1990 and 65–69 years in 2021.The CMR increased progressively after age 19, peaking in the 90–94 years group in 1990 and the 85–89 years group in 2021.The CDR exhibited a similar trend to CMR, showing age-dependent increases after 19 years.DALYs peaks occurred in the < 5 years group in 1990, contrasting with the 55–59 years group in 2021.

Figure 4 compares case counts (including incidence, prevalence, and mortality) and DALYs across age groups for CNS cancers at the global level in 1990 and 2021, with corresponding crude rates.Analysis of incidence cases revealed a bimodal age distribution pattern in CNS cancers across all age groups, with incidence peaks in the < 5 years and 60–69 years age groups. The highest case numbers occurred in the < 5 years group in 1990 and shifted to the 65–69 years group by 2021, mirroring the pattern observed in China.The CIR showed consistent patterns in both 1990 and 2021: a modest decline from < 5 to 15–19 years, followed by an increase until 75–79 years. While the peak occurred at 75–79 years in 1990 before stabilizing, it shifted to the 90–94 years group by 2021.Prevalence analysis demonstrated peak case numbers in the < 5 years group in 1990. By 2021, elevated prevalence persisted across all age groups under 75 years, with significantly higher case numbers above 5 years compared to 1990. The CPR exhibited a steady global increase annually.Mortality analysis showed bimodal distributions, with peak death counts in the 60–64 years group in 1990 and 65–69 years group in 2021. Mortality counts in the < 5 years age group were higher in 1990 than in 2021, whereas older age groups showed substantially elevated mortality in 2021 compared to 1990.The CMR demonstrated a progressive age-dependent increase beyond 19 years.Peak mortality occurred in the 75–79 years group in 1990 and 85–89 years group in 2021.The CDR showed a similar increasing trend with age beyond 19 years, consistent with Chinese data.DALYs peaks occurred in the < 5 years group in 1990 and 55–59 years group in 2021.While China and global patterns showed similar trends in incidence and DALYs across age groups, China maintained relatively stable mortality rates, contrasting with the global pattern of progressively increasing mortality with age.

Comparative of the incidence, prevalence, deaths, and disability-adjusted life years counts, along with the crude rates, by age group in China from 1990 and 2021. (a) Incident cases and crude incidence rate; (b) Prevalent cases and crude prevalence rate; (c) Death cases and crude mortality rate; (d) Disability-adjusted life years counts and crude disability-adjusted life year rate; Bar charts represent counts; lines represent crude rates

Comparative of the incidence, prevalence, deaths, and disability-adjusted life years counts, along with the crude rates, by age group in Global from 1990 and 2021. (a) Incident cases and crude incidence rate; (b) Prevalent cases and crude prevalence rate; (c) Death cases and crude mortality rate; (d) Disability-adjusted life years counts and crude disability-adjusted life year rate; Bar charts represent counts; lines represent crude rates

Gender disparities in the burden of CNS cancer in different age groups in China

Figures 5 and 6 present the case counts (including incidence, prevalence, and mortality) and DALYs of CNS cancers by age group and sex in China for 1990 and 2021.In 1990, both sexes exhibited peak incidence cases in the 0–5 year age group. Case numbers declined with age from 5 to 30 years and beyond 60 years, while generally increasing between 30 and 60 years despite a modest dip at 45–49 years.By 2021, the incidence cases peak had shifted to the 65–69 year age group for both sexes, with cases predominantly concentrated in individuals above 30 years.Prevalence cases analysis revealed that in 1990, cases were predominantly concentrated in individuals under 30 years, peaking in children below 9 years. By contrast, in 2021 cases were primarily distributed among 30–60 years, with peaks at 50–54 years for females and 30–34 years for males.Across all age groups in both 1990 and 2021, no significant differences were observed in case numbers between males and females, consistent with global prevalence patterns.Mortality cases analysis showed deaths in China were concentrated in children under 9 years and adults above 35 years for both sexes in 1990 and 2021.The trends in DALYs paralleled those observed for mortality cases, although females exhibited slightly lower DALYs than males in age groups below 75 years.In 1990, DALY peaks for both sexes occurred in the < 5 years group, whereas by 2021, the peaks had shifted to the 55–59 years group.

Figures 7 and 8 present the case numbers (incidence, prevalence, and mortality) and DALYs of CNS cancers by age group and sex globally for 1990 and 2021.In 1990, the number of deaths and incidence exhibited bimodal distributions across sexes, with peaks in infants children and older adults. Prevalence cases peaked predominantly in children under 5 years, while DALYs showed less pronounced bimodality, also peaking in the under-5 population.By 2021, incidence and mortality had transitioned to unimodal distributions, with substantially reduced representation in young children and concentration in 50–79 years. Prevalence became more evenly distributed across age groups, while DALYs developed a bimodal pattern concentrated in older age groups.

Comparison of the number of incidence, prevalence, mortality, and disability-adjusted life years of central nervous system cancer in males and females of different age groups in China in 1990. (a) Incidence; (b) Prevalence; (c) Mortality; (d) Disability-adjusted life years

Comparison of the number of incidence, prevalence, mortality, and disability-adjusted life years of central nervous system cancer in males and females of different age groups in China in 2021. (a) Incidence; (b) Prevalence; (c) Mortality; (d) Disability-adjusted life years

Comparison of the number of incidence, prevalence, mortality, and disability-adjusted life years of central nervous system cancer in males and females of different age groups in global in 1990. (a) Incidence; (b) Prevalence; (c) Mortality; (d) Disability-adjusted life years

Comparison of the number of incidence, prevalence, mortality, and disability-adjusted life years of central nervous system cancer in males and females of different age groups in global in 2021. (a) Incidence; (b) Prevalence; (c) Mortality; (d) Disability-adjusted life years

Trends in the burden of CNS cancer disease in China and worldwide

Figures 9 and 10 compare the disease burden and age-standardized rates of CNS cancers between males and females across all age groups in China and globally from 1990 to 2021. Supplementary Figures S2-S7 present the Joinpoint regression analysis of ASIR, ASPR, ASMR and ASDR for CNS cancers in both sexes in China and globally from 1990 to 2021. Figure 9 demonstrates that both sexes in China exhibited increasing trends in incidence, mortality, and prevalence cases from 1990 to 2021. While males showed higher incidence and mortality cases than females, the sex gap in incidence cases narrowed over time whereas the mortality cases disparity widened.Females consistently displayed higher prevalence cases than males, with this sex difference showing a progressive increase.DALYs cases remained relatively stable throughout the study period (1990–2021). Figure 10 reveals globally increasing trends in incidence, prevalence, mortality, and DALYs cases for both sexes from 1990 to 2021, with males consistently exceeding females. The male-female disparities in incidence, mortality, and DALYs cases progressively widened, while the prevalence cases gap narrowed toward parity. Figure 9a presents the ASIR of CNS cancers in Chinese males and females. The ASIR increased steadily from 1990 to 2019, peaked in 2019, and then declined slightly in the following two years. While male incidence rates were consistently higher than female rates, the sex-based disparity remained stable over time.From 1990 to 2019, the ASPR of CNS cancers showed a marked increase in both sexes, followed by a slight decline from 2019 to 2021. Females consistently exhibited higher ASPR than males, and this sex gap widened over time.In contrast, the global ASIR and ASPR of CNS cancers remained relatively stable across age groups, differing slightly from the trends observed in China (Fig. 10a).Additionally, Fig. 9c demonstrates that in 1990, significant sex-based disparities existed in both death counts and ASMR of CNS cancers across all age groups, with males showing markedly higher ASMR than females. Over time, this disparity increased, although the overall ASMR exhibited a modest decline.The ASDR followed a similar pattern to the ASMR.

Comparison of all-age cases and age-standardized rates of incidence, prevalence, mortality and disability-adjusted life years among men and women in China from 1990 to 2021. (a) Incident cases and age-standardized incidence rate; (b) Prevalent cases and age-standardized prevalence rate; (c) Death cases and age-standardized mortality rate; (d) Disability-adjusted life years counts and age-standardized disability-adjusted life year rate. Bar charts represent counts; lines represent age-standardized rates

Comparison of all-age cases and age-standardized rates of incidence, prevalence, mortality and disability-adjusted life years among men and women in global from 1990 to 2021. (a) Incident cases and age-standardized incidence rate; (b) Prevalent cases and age-standardized prevalence rate; (c) Death cases and age-standardized mortality rate; (d) Disability-adjusted life years counts and age-standardized disability-adjusted life year rate. Bar charts represent counts; lines represent age-standardized rates