Comparative analysis of the trends in thyroid cancer burden in China and worldwide from 1990 to 2021

doi:10.21203/rs.3.rs-4991591/v1

In recent years, the incidence of thyroid cancer has been increasing, posing a significant public health problem. This study aims to assess the burden of thyroid cancer in China and globally between 1990 and 2021. It seeks to elucidate trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs), while also identifying variations across different age groups and genders. Data were extracted from the Global Burden of Disease (GBD) database from 1990 to 2021, focusing on thyroid cancer indicators in China and globally. We calculated age-standardised incidence (ASIR), age-standardised prevalence (ASPR), age-standardised mortality (ASMR), and age-standardised DALY rate (ASDR) for each age group, and analyzed the annual percentage change (APC) in trends over the study period using Joinpoint regression models. In China, the incidence of thyroid cancer increased by 295.70% between 1990 and 2021, with a significant annual increase of 2.242%. The global incidence increased by 177.62% and the APC was 1.139%. While ASMR declined slightly both in China and globally, ASPR showed a substantial increase. It is worth noting that the burden of thyroid cancer is higher in women, and the increased risk of developing the disease has been more pronounced in men in recent years. The findings highlight the need for targeted prevention strategies, improved diagnostics to avoid overdiagnosis, and equitable allocation of public health resources to address the growing thyroid cancer challenge.

Earth and environmental sciences/Environmental sciences

Health sciences/Risk factors

Thyroid cancer is one of the most common endocrine malignancies and its incidence has been growing over the past few decades, ranking ninth globally in cancer incidence and mortality according to the GLOBOCAN2020 Cancer incidence and Mortality database of the World Health Organization's International Agency for Research on Cancer^1,2, rising to seventh globally in 2022³. In China, with rapid economic development and an aging population, the incidence of thyroid cancer is also on the rise, posing a major challenge to the public health system. Studies have found that the development of thyroid cancer is influenced by a number of factors, including childhood exposure to ionizing radiation, genetic factors, gender, age, and racial or ethnic background⁴ Although the treatment and prognosis of thyroid cancer is usually superior to that of other malignancies and patient survival is high, early diagnosis and treatment of the disease is essential to improve the quality of life of patients and reduce mortality.

In recent years, due to the widespread use of imaging technology, there has been a significant increase in the detection rate of thyroid cancer. This has contributed to a rise in the incidence of thyroid cancer to some extent, while also raising concerns about overdiagnosis. Studies have shown an increase in the incidence and mortality of thyroid cancer in both China and G20 countries from 1990 to 2019, highlighting the need to strengthen prevention, control, and treatment strategies, and the importance of international cooperation in addressing the global challenge posed by thyroid cancer⁵. Emerging strategies for targeted treatment of thyroid cancer, such as neoadjuvant kinase inhibitors and the derivation of redifferentiation therapies for differentiated thyroid cancer, have helped to improve the disease burden of thyroid cancer⁶. However, previous studies on the burden of thyroid cancer have been limited by sociological factors such as sample size, demographics, and regional economic development, which have hindered our multi-faceted understanding of the global burden of disease.

Current reports on the burden of thyroid cancer in global disease studies have focused on regional projections globally and for selected countries⁷, with existing studies making future projections of the burden of thyroid cancer based on thyroid cancer cases available in the GBD database from 1990 to 2019^8,9. As the most populous country in the world, China has placed a serious burden on the health care system due to the increasing incidence of thyroid cancer. Although there are some relevant studies on the burden of the disease in China¹⁰, these analyses mainly focus on the incidence and spatial distribution characteristics of women, and do not provide an in-depth understanding of the progression of thyroid cancer disease in China. Therefore, based on the latest GBD database, this study conducted a comprehensive analysis and comparison of the burden of disease in China and the world from 1990 to 2021, aiming to provide customized insights for the reduction of the global burden of thyroid cancer, promote the formulation of prevention strategies and the fair allocation of public health resources, and provide scientific basis for the effective management of thyroid cancer in China and globally.

Data source

The data utilized in this study were obtained from the 2021 Global Burden of Disease dataset. We examined the incidence, prevalence, mortality, DALYs, and corresponding ASIR, ASPR, ASMR, and ASDR of thyroid cancer in China and globally. Additionally, we have calculated the Crude Incidence Rates (CIR), Crude Prevalence Rates (CPR), Crude Mortality Rates (CMR), and Crude DALY Rates (CDR), stratified by age groups, to provide a nuanced understanding of the disease's impact across different demographic segments.

The thyroid cancer-related data in this study came from the Global Health Data Exchange (GHDx) and its ancillary tools (http://ghdx.healthdata.org/gbd-results-tool). In this paper, the GBD tool was used to extract the incidence, prevalence, mortality and DALYs data in China and the world from 1990 to 2021 as indicators to assess the burden of thyroid cancer. Given that GBD's data is publicly available, the Institutional Ethics Committee granted an exemption for this study because it did not require approval. The study complied with guidelines for accurate and transparent health assessment reporting.

Statistical analysis

The Joinpoint regression model was used to calculate the annual mean percentage change (AAPC) and the corresponding 95% confidence interval (95%CI) to determine disease burden trends^11,12-. Logarithmic age normalized metrics can be fitted into a regression model, i.e. ln (y) =α + βx + ε, where y represents the respective age normalized metrics and x represents the calendar year. AAPC is calculated as 100 × (exp (β) − 1) and 95% CI can also be calculated from the model. If 95%CI of the estimated AAPC was > 0, the age-standardized index showed an upward trend. If < 0, it shows a decreasing trend; If it contains 0, the trend is stable. This study data using R statistical software, statistical analysis and visualization program version (4.3.2) and Joinpoint software program (the national cancer institute development, https://surveillance.cancer.gov/joinpoint) The version used in this article is 4.9.1.0. A P value < 0.05 was considered statistically significant.

1. Description of thyroid cancer burden in China and globally

1.1 Incidence of thyroid cancer in China and globally

The number of thyroid cancer cases in China increased from 12,157 (95%CI: 9714–14406) in 1990 to 48,105 (95%CI: 38,695-60068) in 2021, an increase of 295.70%. Globally, however, the incidence increased from 89,885 cases (95%CI: 84681–96999) in 1990 to 249,538 (223290–274638), a cumulative increase of 177.62%. In China, ASIR increased from 1.249(95%CI: 1.009–1.473) per 100,000 people in 1990 to 2.473 (95%CI: 1.993–3.008) per 100,000 people in 2021, a year-on-year increase of approximately 98%.From 1990 to 2021, the incidence of AAPC in China increased by 2.242% (95%CI: 2.112–2.371) and the global AAPC increased by 1.139 (95%CI: 1.037–1.24) (Table 1).

Table 1

All-age cases and age-standardized incidence, prevalence, mortality, and DALYs rates and corresponding AAPC of thyroid cancer in china and globally in 1990 and 2021
Location	Measure	1990		2021		1990–2021 AAPC
		All-ages cases	Age-standardized rates per 100,000 people	All-ages cases	Age-standardized rates per 100,000 people	1990–2021 AAPC
		n (95% CI)	n (95% CI)	n (95% CI)	n (95% CI)	n (95% CI)
China	Incidence	12157(9714–14406)	1.249(1.009–1.473)	48105(38695–60068)	2.473(1.993–3.088)	2.242 (2.112–2.371)
	Prevalence	87082(68622–104169)	8.098(6.410–9.660)	388411(311967–488388)	20.012(16.135–25.228)	2.975 (2.833–3.117)
	Deaths	3599(3038–4182)	0.473(0.403–0.550)	7692(6123–9429)	0.387(0.307–0.472)	-0.651 (-0.824 - -0.479)
	DALYs	110736(92143–130509)	12.086(10.142–14.080)	203325(163131–251789)	10.105(8.139–12.447)	-0.59 (-0.787 - -0.392)
Global	Incidence	89885(84681–96999)	2.062(1.951–2.224)	249538(223290–274638)	2.914(2.607–3.213)	1.139 (1.037–1.24)
	Prevalence	676649(636789–727723)	14.931(14.124–16.029)	1987148(1776275–2198245)	23.143(20.663–25.647)	1.418 (1.312–1.525)
	Deaths	21893(20437–24108)	0.570(0.530–0.628)	44799(39925–48541)	0.530(0.470–0.575)	-0.23 (-0.289 - -0.171)
	DALYs	646741(599119–717357)	15.206(14.184–16.830)	1246485(1094416–1375853)	14.571(12.783–16.115)	-0.131 (-0.241 - -0.021)

1.2 Thyroid cancer prevalence in China and globally

From the prevalence point of view, the number of thyroid cancer cases in China increased from 87082 (95%CI: 68622-104,169) in 1990 to 388411 (95%CI: 311967–488388), an increase of about 346.03%. However, worldwide prevalence increased from 676,649 (95%CI: 636789–727723) in 1990 to 1987,148 (95%CI: 1776275–2198245) in 2021, a cumulative increase of approximately 193.67%.In 1990, the ASPR in China rose from 8.098 (95%CI: 6.410–9.660) per 100,000 people to 20.012 (95%CI: 16.135–25.228) per 100,000 people in 2021, a year-on-year increase of 147.12%. AAPC values for the standardized prevalence of thyroid cancer in China and the world from 1990 to 2021 are 2.975 and 1.418, respectively. This signifies that the prevalence of thyroid cancer in China has experienced an average annual increase of 2.975% over the past three decades, whereas the global prevalence has seen a comparatively moderate average annual growth of 1.418%(Table 1).

1.3 Thyroid cancer mortality in China and globally

Globally, thyroid cancer will cause 44,799 deaths in 2021 (95%CI: 39,925 − 48,541), an increase of 104.63% compared to 1990. In China, the death rate increased by 113.73% between 1990 and 2021. Global ASMR declined from 0.570 per 100,000 population in 1990 (95%CI: 0.530–0.628) to 0.530 per 100,000 population in 2021 (95%CI: 0.470–0.575). In China, ASMR declined from 0.473 (95%CI: 0.403–0.550) per 100,000 people in 1990 to 0.387 (95%CI: 0.307–0.472) per 100,000 people in 2021. From 1990 to 2021, the mortality AAPC in China decreased by 0.651% (95%CI: [-0.824]-[-0.479]), while the global mortality AAPC decreased by 0.23% (95%CI: [-0.289]-[-0.171]) (Table 1).

1.4 Thyroid cancer in DALYs in China and globally

In China, the DALYs of thyroid cancer increased from 110736 (95%CI: 92143–130509) in 1990 to 203325 (95%CI: 163131–251789) in 2021, with a cumulative increase of 83.61%. Globally, DALYs increased by approximately 92.73% between 1990 and 2019. Global ASDR declined from 15.206 per 100,000 population in 1990 (95%CI: 14.184–16.830) to 14.571 per 100,000 population in 2021 (95%CI: 12.783–16.115). In China, ASDR declined from 12.086 (95%CI: 10.142–14.080) per 100,000 people in 1990 to 10.105 (95%CI: 8.139–12.447) per 100,000 people in 2021. From 1990 to 2021, AAPC in DALYs decreased by 0.131% (95%CI: [-0.241]-[-0.021]) globally, and by 0.59% (95%CI: [-0.787]-[-0.392]) in China(Table 1).

2. Joinpoint regression model analysis

The APC of ASIR and ASPR for thyroid cancer in China and the world from 1990 to 2021 showed an increasing trend (Fig. 1 and Fig. 2). It should be noted that the annual percentage changes (APC) of ASMR and ASDR in thyroid cancer in China during 1990–2017 first leveled off and then significantly decreased (ASMR:1990–1996 APC = 0.04; 1996–2003 APC=-1.61,P < 0.05; 2003–2007 APC=-1.18,P < 0.05; ASDR:1990–1996 APC=-0.19; 1996–2003 APC=-1.68,P < 0.05; 2003–2007 APC=-0.94,P < 0.05), but increased after Joinpoint 2007, and showed a downward trend again after Joinpoint 2011. Globally, ASMR and ASDR in thyroid cancer increased from 1990 to 1995 (P < 0.05), but decreased from 1995 to 2004. However, for the global ASMR, it was found to be stable from 2004 to 2013 and then showed a significant decline (P < 0.05); ASDR showed an upward inflection point from 2004 to 2010 (P < 0.05) and then showed a downward trend again (P < 0.05) (Fig. 1 and Fig. 2).

3、Comparison of disease burden trends of thyroid cancer in China and globally

From 1990 to 2021, ASIR of thyroid cancer in China and the world showed a slight upward trend, while ASMR showed a slight downward trend. At the same time, the ASPR of thyroid cancer is on the rise in both China and the world, and as can be seen from Fig. 3, the growth rate in China is significantly greater. On the contrary, the ASDR of thyroid cancer in China and the world as a whole showed a downward trend between 1990 and 2021, but in China, it showed a slight upward trend from 2007 to 2011 and then a slight decline(Fig. 3).

4、Thyroid cancer disease burden in different age groups in China

Figure 4 shows the incidence, prevalence, mortality, and DALYs of thyroid cancer in different age groups in China in 1990 and 2021, as well as the corresponding coarse rates. From the incidence point of view, thyroid cancer occurs at all ages, mainly in the 50–59 age group; In 1990 and 2021, the crude incidence of thyroid cancer (CIR) in China began to increase from the 0–14 age group, began to slightly after an inflection point in the 40–44 age group, and then continued to increase. This indicates that the incidence of thyroid cancer is the peak in the middle-aged and elderly groups. The peak incidence of thyroid cancer in China in 1990 was in the 40–44 age group, while in 2021 it was in the 55–59 age group, which may reflect the long-term nature of thyroid cancer and changes in disease patterns over time. In terms of the number of deaths, the age group with the highest number of deaths in 1990 and 2021 was 75–79, and the CMR of thyroid cancer showed an increasing trend with increasing age. A similar trend was observed in CDR, and the peak DALYs in 1990 and 2021 were in the 55–59 age group.

5. Gender-specific disease burden of thyroid cancer in China

Figures 5 and 6 show a comparison of thyroid cancer incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in men and women of different age groups in China in 1990 and 2021. Figure 5A shows the number of new cases of thyroid cancer in men and women in different age groups in 1990. The results show that in all age groups, the number of thyroid cancer patients in women is higher than that in men, which is consistent with the global trend. However, the peak age of the incidence of thyroid cancer in Chinese women is 40–44 years old, while the peak age of the incidence of thyroid cancer in men is 55–59 years old. This suggests that women are more susceptible to the disease burden of thyroid cancer(Fig. 5A and Supplementary Fig. 1A). In 2021, the incidence peaks in both men and women at 55–59 years of age, and the number of thyroid cancer cases in men has increased significantly compared to 1990 (Fig. 6A). From the perspective of prevalence results, the peak stage of prevalence of both male and female in China in 1990 and 2021 was consistent with the incidence results, and the number of male thyroid cancer cases gradually increased with the passage of time(Fig. 5B and Fig. 6B). When comparing the number of deaths of men and women in 1990, it is found that the number of deaths of women is higher than that of men in all age groups in China and globally, but the peak of death of Chinese women occurs at 70–74 years old, while the peak of death of men is 75–79 years old. In 2021, the number of male deaths in China is approaching the number of female deaths, but the peak of male deaths occurs at the age of 75–79, and the peak of female thyroid cancer deaths occurs at the age of 70–74(Fig. 5C and Fig. 6C). At the global level of change, women have a higher risk of thyroid cancer and death than men (Supplementary Fig. 1 and Supplementary Fig. 2). In 1990 and 2021, the peak age of female DALYs in China was 65–69 years old, while the peak age of male DALYs was 55–59 years old(Fig. 5D and Fig. 6D). These results indicate that the burden of thyroid cancer increases in the middle-aged and elderly population, and the trend changes in China and the world are slightly skewed, suggesting that we need to develop targeted prevention and treatment strategies.

The results in Fig. 7 show a comparison of all-age prevalence and age-standardized rates in Chinese men and women between 1990 and 2021. In 1990, the sex difference of ASIR between male and female thyroid cancer was the largest, and then ASIR showed an overall upward trend with the increase of years, and the gender difference also decreased. The trend of ASPR of thyroid cancer in men and women is similar to that of ASIR, showing an overall increasing trend from 1990 to 2021, and the ASPR and ASIR of women are always higher than that of men(Fig. 7A and Fig. 7B). However, in terms of ASMR and ASDR, we found that women's ASMR and ASDR decreased over time in all age groups, while men's ASMR and ASDR showed a first increase and then a slow decline. These results highlight how the disease burden of thyroid cancer in China has changed over time and varies across age and gender groups. In particular, it reveals that middle-aged and elderly people are at high risk of thyroid cancer, and face higher thyroid cancer mortality and DALYs burden. In addition, not only women need to pay attention to thyroid health, but also men's thyroid cancer patients are increasing year by year.

In this study, we evaluated the incidence, prevalence, mortality, and DALYs of thyroid cancer from a Chinese and global perspective over the past three decades based on the GBD2021 database, and revealed the differences in disease burden between genders and age groups in China and globally during 1990–2021. The results show that the incidence of thyroid cancer is on the rise in both China and the world, but the increase in China is more significant. This may be related to a number of factors, including the severe aging of the Chinese population, advances in medical imaging technology and lifestyle changes that have led to the detection of many asymptomatic cases, and low selenium levels in thyroid tissue¹³. However, there was a small decrease in mortality. This indicates that although the number of thyroid cancer cases has increased, the overall survival rate of thyroid cancer patients has improved.

The results of the study revealed that middle-aged and elderly people are at high risk of thyroid cancer under current social conditions, and face higher mortality and DALYs burden, which is consistent with recent research results¹⁴. In addition, although the incidence and prevalence of thyroid cancer in women is generally higher than that in men, the increasing number of male patients in recent years also needs our attention. This suggests that sex-specific biological differences and environmental risk factors may play a role in the development of thyroid cancer.

Although genetic factors play a role in the development of thyroid cancer, environmental and lifestyle factors, such as environmental pollution¹⁵, anxiety¹⁶, diet¹⁷, and obesity¹⁸, may also play an important role in thyroid risk. Future studies need to further explore how these factors interact with genetic factors and how to reduce the risk of thyroid cancer through lifestyle changes. In particular, with the wide application of imaging technology and the introduction of fine needle puncture pathological biopsy technology, the problem of thyroid cancer overdiagnosis needs to be paid more attention by researchers¹⁹. This suggests that we need to re-evaluate current thyroid cancer screening strategies to ensure that the benefits of screening outweigh the potential harms and reduce unnecessary treatment and patient anxiety. Given the increasing disease burden of thyroid cancer, it is important to develop scientific and effective public health policies and prevention strategies, including raising public awareness of thyroid health, improving control of environmental risk factors, and developing prevention programs for high-risk groups.

limitation

Although this study includes a comprehensive analysis of the thyroid cancer burden in China and globally, there are some shortcomings, such as the possibility of uncertainties in the GBD database and the inability to fully capture all socioeconomic and behavioral factors associated with thyroid cancer development²⁰. Future studies will need to use more diverse data sources and consider more risk factors to help provide deeper insights.

Competing interests

The authors declare no conflict of interest.

Funding

This work was funded by Wuhan Knowledge innovation special project (2023020201010161).

Author Contribution

HS conceived the study. Methodology, Data curation, Investigation, Software, Formal analysis, Visualization, Writing—original draft, YH(Yuhan zhang); Methodology, Investigation, Writing—review and editing, HY(Hanyu wang); XC , ZX and JQ contributed to the data collect, analysis, and interpretation.All authors read and approved the final manuscript.

Data Availability

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

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No competing interests reported.

Supplementaryinformation.pdf

Comparative analysis of the trends in thyroid cancer burden in China and worldwide from 1990 to 2021

Status:

Version 1

Abstract

Figures

Introduction

Methods

Statistical analysis

Results

Discussion

Declarations

Competing interests

Funding

Author Contribution

Data Availability

References

Additional Declarations

Supplementary Files

Status:

Version 1