The burden of cancers and their variations across the states of US the global burden of disease study 1990-2021

Yan Tong; Yao Kong; Hui Hu; Zhaoxia Liu; Lai Zhiqing

doi:10.1097/JS9.0000000000004090

The burden of cancers and their variations across the states of US the global burden of disease study 1990-2021

Int J Surg. 2025 Nov 19. doi: 10.1097/JS9.0000000000004090. Online ahead of print.

Authors

Yan Tong¹, Yao Kong¹, Hui Hu², Zhaoxia Liu¹, Lai Zhiqing³

Affiliations

¹ Center for Reproductive Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
² Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
³ Department of Ultrasonic, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

PMID: 41717763
DOI: 10.1097/JS9.0000000000004090

Abstract

Background: Previous reports on cancer incidence and mortality in the U.S. and its regions include findings from the National Cancer Registry, the Sample Registration System's cause of death data, and GLOBOCAN. This analysis leverages data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to inform decision-making and track progress on health at the state level.

Methods: Using the GBD 2021 methods, we estimated the incidence of 35 cancer types, along with associated deaths and disability-adjusted life years (DALYs) across all U.S. states from 1990 to 2021. We present overall incidence, DALYs, and death rates, along with trends for each cancer type, highlighting regional variations in cancer burden. Additionally, we examine the contribution of major risk factors to cancer DALYs in the U.S.

Results: In 2021, the U.S. reported 16,225,338 new cancer cases, 715,189 cancer deaths, and 16,056,105 DALYs from cancer. The age-standardized incidence rate (ASIR) was 3304.90 per 100,000, while the age-standardized mortality rate (ASMR) was 120.86 per 100,000. The age-standardized DALY rate (ASDR) stood at 2964.51 per 100,000. We define a new concept, the "cancer belt." primarily in the southern U.S., showed ASMR and ASDR rates more than 20% higher than the national average. This belt includes Kentucky, West Virginia, Mississippi, Arkansas, Alabama, Tennessee, Louisiana, and Oklahoma. Between 1990 and 2021, females experienced a higher incidence number and ASIR with an upward trend, while males had more DALYs number, deaths number, and higher ASDR and ASMR, although both rates showed significant declines. This emphasizes the need for healthcare policies addressing gender disparities.Prostate cancer was the leading cancer type in males (ASIR: 108.04), while tracheal, bronchus, and lung cancer dominated male ASMR (34.77) and ASDR (745.61). In females, breast cancer had the highest ASIR (97.00), while tracheal, bronchus, and lung cancer led in both ASMR (24.22) and ASDR (530.44). tobacco (20.87%), dietary risks (6.81%), and high BMI (6.72%) were the leading contributors to cancer DALYs in 2021.Projections from the Bayesian age-period-cohort (BAPC) model suggest significant reductions in ASMR and DALYs by 2036, although gender disparities will remain. Policymakers should focus on tobacco control and other carcinogenic risk factors to further reduce the cancer burden.

Conclusions: Cancer remains a major public health issue in the U.S. From 1990 to 2021, national cancer mortality and DALY rates decreased, but incidence increased, highlighting geographic, gender, and socioeconomic disparities. The focus should be on the top ten cancers contributing to DALYs, including ung, colorectal, breast, pancreatic, leukemia, prostate, non-Hodgkin lymphoma, brain, esophageal, and liver cancers, while addressing others as resources allow. Understanding shared etiologies is key for effective intervention strategies.

Keywords: DALYs (disability-adjusted life years); cancer burden; geographic disparities; risk factors.