Global to local burdens, inequalities, and achievable frontiers of child and adolescent malignant neoplasm of bone and articular cartilage across 953 countries and sublocations, 1980-2040, with deep learning-based forecasts

Wenxiang Cai; Yaling Wu; Mingyang Xue; Yihang Chu; GBD 2021 Global to Local Child and Adolescent MNBAC Collaborators; Salman Rawaf; Marilyn M Bui; Javier Martín Broto; Heping Zhang; Lukasz Szarpak; Liming Pan; Baozhen Huang; Yiming Xiong; Fei Li; You Zeng; Kai Chen; Claire Chenwen Zhong; Hao Peng; Pengpeng Ye; João Conde; Fei Peng; Queran Lin; Wenyi Jin

doi:10.1016/j.jot.2025.101042

Global to local burdens, inequalities, and achievable frontiers of child and adolescent malignant neoplasm of bone and articular cartilage across 953 countries and sublocations, 1980-2040, with deep learning-based forecasts

J Orthop Translat. 2026 Feb 2:56:101042. doi: 10.1016/j.jot.2025.101042. eCollection 2026 Jan.

Authors

Wenxiang Cai¹, Yaling Wu², Mingyang Xue³, Yihang Chu^{4

5}; GBD 2021 Global to Local Child and Adolescent MNBAC Collaborators; Salman Rawaf⁶, Marilyn M Bui⁷, Javier Martín Broto⁸, Heping Zhang⁹, Lukasz Szarpak^{10

11}, Liming Pan¹², Baozhen Huang¹, Yiming Xiong¹³, Fei Li¹⁴, You Zeng¹⁵, Kai Chen^{16

17}, Claire Chenwen Zhong¹⁸, Hao Peng¹, Pengpeng Ye¹⁹, João Conde²⁰, Fei Peng¹, Queran Lin⁶, Wenyi Jin^{1

21}

Affiliations

¹ Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China.
² Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ School of Medicine, Kunming University of Science and Technology, Kunming, 650500, China.
⁴ Department of Information, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.
⁵ Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China.
⁶ WHO Collaborating Centre for Public Health Education and Training, Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
⁷ Departments of Pathology and Machine Learning, Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
⁸ Medical Oncology Department, Fundación Jimenez Diaz University Hospital, University Hospital General de Villalba, and Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain.
⁹ Department of Biostatistics, Yale University School of Public Health, New Haven, CT, 06520, USA.
¹⁰ Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland.
¹¹ Institute of Medical Science, Collegium Medicum, The John Paul II Catholic University of Lublin, Lubin, Poland.
¹² School of Cyber Science and Technology, University of Science and Technology of China, Hefei, 230026, China.
¹³ College of Integrated Traditional Chinese and Western Medicine, Anhui University of Chinese Medicine, 350 Longzihu Road, Xinzhan District, (shaoquanhu Campus), Hefei, China.
¹⁴ Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China.
¹⁵ Department of Women and Children Health Care, Guangzhou Baiyun District Maternal and Child Health Hospital, Guangzhou, 510400, China.
¹⁶ Guangdong Provincial Key Laboratory of Malignant Tumour Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Artifical Intelligence Lab, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
¹⁷ Guangdong Provincial Clinical Research Center for Breast Diseases, China.
¹⁸ JC School of Public Health & Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, China.
¹⁹ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
²⁰ ToxOmics, NOVA Medical School, Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisboa, Portugal.
²¹ Department of Biomedical Sciences, City University of Hong Kong, 999077, Hong Kong, China.

Abstract

Background: Malignant neoplasm of bone and articular cartilage (MNBAC), a major cause of cancer-related mortality, disproportionately impacts children and adolescents. However, comprehensive and future-oriented studies are still lacking.

Methods: We systematically analyzed global-to-subnational MNBAC burdens, inequalities, and ideal achievable frontiers among those under 20 years old across 953 locations from 1980 to 2021. An advanced attention-based deep-learning pipeline was created for precise forecasting.

Results: From 1990 to 2021, the global prevalence and incidence rate of MNBAC among those aged <20 years increased by 14.7 % and 14.3 %, respectively, leading to 139,154 prevalent cases by 2021. This disproportionately affected males and increased progressively with age, peaking in adolescents aged 15-19 years. Despite a slight global decline in MNBAC mortality, notable increases were observed in low-middle SDI region. 87.3 % of countries and 93.8 % of subnational locations experiencing increased mortality were situated in low to middle SDI regions, exemplified by Tokelau (377.8 %) and Indonesia's West Papua (148.6 %). Concurrently, the global YLD/YLL ratio for those <20 years increased, reflecting the ongoing transition from fatal to non-fatal burdens. This shift mainly impacted socio-economically advantaged settings, as 61 % of the top 100 countries were categorized as high and high-middle SDI. However, substantial gaps remain globally, with at least 94.1 % of countries and 81.4 % of subnational locations failing to meet achievable frontiers by 2021. Forecasts to 2040 anticipate further increases in incidence and stagnation in mortality, alongside widening disparities. Approximately 60.0 % of 672 subnational locations are forecasted to exhibit rising prevalence, with 41.2 % in the UK. By 2040, 30.0 % of the top 100 high-prevalence subnational locations will likely be in Sub-Saharan Africa, including 56 % in the UK. Mortality rates are forecasted to remain highest in low SDI region, especially in Eastern Sub-Saharan Africa, accounting for 47.7 % in Kenya alone.

Conclusion: The MNBAC burden remains high, especially among adolescents, with anticipated increases in lower-income areas, necessitating targeted healthcare policies and increased investment.

The translational potential of this article: This study highlights the growing global burden of MNBAC and the urgent need for age-specific prevention, early detection, and equitable access to healthcare. Enhancing cancer registries, expanding financial protection, and integrating MNBAC management into national cancer control strategies could help reduce disparities and improve outcomes for affected children and adolescents.

Keywords: Death rate; Disability-adjusted life-years; Forecast; Incidence; Malignant neoplasm of bone and articular cartilage; Prevalence.