Bladder Cancer Age-Standardized Death Rates Decreased Globally Between 1990 and 2019

Clear global decreases in the age-standardized death rate and the disability-adjusted life years rate were observed among individuals with bladder cancer from 1990 to 2019 despite some countries experiencing an increase in these rates, according to results from the Global Burden of Diseases, Injuries and Risk Factors study 2019 published in BMJ Global Health.

Specifically, during the period from 1990 to 2019, the age-standardized death rate decreased by 15.7% (95% uncertainty interval [UI], 8.6%-21.0%), and the age-standardized disability-adjusted life years (DALY) rate saw a significant decrease of 18.6% (95% UI, 11.2%-24.3%). These bladder cancer cases accounted for 4.39 million (95% UI, 4.09-4.70) DALYs in 2019.

“This study found considerable inter-country variation in the burden of bladder cancer across the period of study,” the investigators wrote. “Although the global age-standardised death, and DALY rates have decreased from 1990 to 2019, there were some countries which registered increases in these rates.”

In 2019, investigators reported that there were 524,000 cases of bladder cancer (95% UI, 476,000-569,000) and 229,000 bladder cancer deaths (95% UI, 211,000-243,000) globally. Among these cases, the age-standardized rate was 6.5 (95% UI, 5.9-7.1) per 100,000, which saw an increase of 4% (95% UI, −4.3%-13.5%) between 1990 and 2019. Additionally, investigators reported an age-standardized death rate of 2.9 (95% UI, 2.7-3.1) per 100,000.

In 2019, age-standardized incidence rates for bladder cancer per 100,000 were highest in western Europe (14.9; 95% UI, 12.8-17.3), central Europe (12.6; 95% UI, 11.0-14.3), and north Africa and the Middle East (9.6; 95% UI, 8.1-11.4). The lowest age-standardized incidence rates were seen in south Asia (2.4; 95% UI, 2.1-2.7), Oceania (2.5; 95% UI, 2.0-3.1) and Andean Latin America (2.5; 95% UI, 2.1-3.1).

In terms age-standardized death rates per 100,000, the highest rates were seen in central Europe (5.3; 95% UI, 4.7-6.0), western Europe (4.8; 95% UI, 4.3-5.1) and north Africa and the Middle East (4.1; 95% UI, 3.5-4.8). The lowest rates were found in central Latin America (1.5; 95% UI, 1.3-1.8), Andean Latin America (1.6; 95% UI, 1.3-2.0) and southeast Asia (1.8; 95% UI, 1.5-2.0).

Comparatively, regions where the global age-standardized incidence rates increased in some global burden of disease regions, including east Asia (55.6%; 95% UI, 26.1%-95.8%), north Africa and the Middle East (52.5%; 21.3%-107.1%) and central Europe (50.3%; 95% UI, 30.3%-70.7%). Central Asia (17.9%; 95% UI, 1.8%-42.7%) saw a significant increase in age-standardized death rates.

When analyzed by sex, global incidence rates of bladder cancer per 100,000 in 2019 were higher among males than females across all age subgroups.

In terms of risk factors, smoking was attributed to 36.8% (95% UI, 28.5%-44.0%) of bladder cancer DALYs, with a high occurrence in males (43.7%; 95% UI, 34.0%-51.8%) vs females (15.2%; 95% UI, 10.9%-19.4%). Moreover, approximately 9.1% (95% UI, 1.9%-19.6%) of DALYs can be linked to elevated fasting plasma glucose, including 9.3% (95% UI, 1.6%-20.9%) in males and 8.4% (95% UI, 1.6%-19.1%) in females.

“National policy makers should consider the allocation of resources for addressing bladder cancer risk factors, as part of comprehensive prevention programmes based on their national estimates, rather than on global or regional estimates, which may be misleading,” the investigators concluded.

Reference

Safiri S, Kolahi AA, Naghavi M; Global Burden of Disease Bladder Cancer Collaborators. Global, regional and national burden of bladder cancer and its attributable risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease study 2019. BMJ Glob Health. 2021;6(11):e004128. doi:10.1136/bmjgh-2020-004128