Global, regional, and national burden of brain and other CNS cancer, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Brain and Other CNS Cancer Collaborators, Anoop P Patel, James L Fisher, Emma Nichols, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Haftom Niguse Abraha, Dominic Agius, Fares Alahdab, Tahiya Alam, Christine A Allen, Nahla Hamed Anber, Ashish Awasthi, Hamid Badali, Abate Bekele Belachew, Ali Bijani, Tone Bjørge, Félix Carvalho, Ferrán Catalá-López, Jee-Young J Choi, Ahmad Daryani, Meaza Girma Degefa, Gebre Teklemariam Demoz, Huyen Phuc Do, Manisha Dubey, Eduarda Fernandes, Irina Filip, Kyle J Foreman, Abadi Kahsu Gebre, Yilma Chisha Dea Geramo, Nima Hafezi-Nejad, Samer Hamidi, James D Harvey, Hamid Yimam Hassen, Simon I Hay, Seyed Sina Naghibi Irvani, Mihajlo Jakovljevic, Ravi Prakash Jha, Amir Kasaeian, Ibrahim A Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Yun Jin Kim, Getnet Mengistu, Karzan Abdulmuhsin Mohammad, Ali H Mokdad, Gabriele Nagel, Mohsen Naghavi, Gurudatta Naik, Huong Lan Thi Nguyen, Long Hoang Nguyen, Trang Huyen Nguyen, Molly R Nixon, Andrew T Olagunju, David M Pereira, Gabriel David Pinilla-Monsalve, Hossein Poustchi, Mostafa Qorbani, Amir Radfar, Robert C Reiner, Gholamreza Roshandel, Hosein Safari, Saeid Safiri, Abdallah M Samy, Shahabeddin Sarvi, Masood Ali Shaikh, Mehdi Sharif, Rajesh Sharma, Sara Sheikhbahaei, Reza Shirkoohi, Jasvinder A Singh, Mari Smith, Rafael Tabarés-Seisdedos, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Elisabete Weiderpass, Kidu Gidey Weldegwergs, Ebrahim M Yimer, Vesna Zadnik, Zoubida Zaidi, Richard G Ellenbogen, Theo Vos, Valery L Feigin, Christopher J L Murray, Christina Fitzmaurice, GBD 2016 Brain and Other CNS Cancer Collaborators, Anoop P Patel, James L Fisher, Emma Nichols, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Haftom Niguse Abraha, Dominic Agius, Fares Alahdab, Tahiya Alam, Christine A Allen, Nahla Hamed Anber, Ashish Awasthi, Hamid Badali, Abate Bekele Belachew, Ali Bijani, Tone Bjørge, Félix Carvalho, Ferrán Catalá-López, Jee-Young J Choi, Ahmad Daryani, Meaza Girma Degefa, Gebre Teklemariam Demoz, Huyen Phuc Do, Manisha Dubey, Eduarda Fernandes, Irina Filip, Kyle J Foreman, Abadi Kahsu Gebre, Yilma Chisha Dea Geramo, Nima Hafezi-Nejad, Samer Hamidi, James D Harvey, Hamid Yimam Hassen, Simon I Hay, Seyed Sina Naghibi Irvani, Mihajlo Jakovljevic, Ravi Prakash Jha, Amir Kasaeian, Ibrahim A Khalil, Ejaz Ahmad Khan, Young-Ho Khang, Yun Jin Kim, Getnet Mengistu, Karzan Abdulmuhsin Mohammad, Ali H Mokdad, Gabriele Nagel, Mohsen Naghavi, Gurudatta Naik, Huong Lan Thi Nguyen, Long Hoang Nguyen, Trang Huyen Nguyen, Molly R Nixon, Andrew T Olagunju, David M Pereira, Gabriel David Pinilla-Monsalve, Hossein Poustchi, Mostafa Qorbani, Amir Radfar, Robert C Reiner, Gholamreza Roshandel, Hosein Safari, Saeid Safiri, Abdallah M Samy, Shahabeddin Sarvi, Masood Ali Shaikh, Mehdi Sharif, Rajesh Sharma, Sara Sheikhbahaei, Reza Shirkoohi, Jasvinder A Singh, Mari Smith, Rafael Tabarés-Seisdedos, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Elisabete Weiderpass, Kidu Gidey Weldegwergs, Ebrahim M Yimer, Vesna Zadnik, Zoubida Zaidi, Richard G Ellenbogen, Theo Vos, Valery L Feigin, Christopher J L Murray, Christina Fitzmaurice

Abstract

Background: Brain and CNS cancers (collectively referred to as CNS cancers) are a source of mortality and morbidity for which diagnosis and treatment require extensive resource allocation and sophisticated diagnostic and therapeutic technology. Previous epidemiological studies are limited to specific geographical regions or time periods, making them difficult to compare on a global scale. In this analysis, we aimed to provide a comparable and comprehensive estimation of the global burden of brain cancer between 1990 and 2016.

Methods: We report means and 95% uncertainty intervals (UIs) for incidence, mortality, and disability-adjusted life-years (DALYs) estimates for CNS cancers (according to the International Classification of Diseases tenth revision: malignant neoplasm of meninges, malignant neoplasm of brain, and malignant neoplasm of spinal cord, cranial nerves, and other parts of CNS) from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. Data sources include vital registration and cancer registry data. Mortality was modelled using an ensemble model approach. Incidence was estimated by dividing the final mortality estimates by mortality to incidence ratios. DALYs were estimated by summing years of life lost and years lived with disability. Locations were grouped into quintiles based on the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate.

Findings: In 2016, there were 330 000 (95% UI 299 000 to 349 000) incident cases of CNS cancer and 227 000 (205 000 to 241 000) deaths globally, and age-standardised incidence rates of CNS cancer increased globally by 17·3% (95% UI 11·4 to 26·9) between 1990 and 2016 (2016 age-standardised incidence rate 4·63 per 100 000 person-years [4·17 to 4·90]). The highest age-standardised incidence rate was in the highest quintile of SDI (6·91 [5·71 to 7·53]). Age-standardised incidence rates increased with each SDI quintile. East Asia was the region with the most incident cases of CNS cancer for both sexes in 2016 (108 000 [95% UI 98 000 to 122 000]), followed by western Europe (49 000 [37 000 to 54 000]), and south Asia (31 000 [29 000 to 37 000]). The top three countries with the highest number of incident cases were China, the USA, and India. CNS cancer was responsible for 7·7 million (95% UI 6·9 to 8·3) DALYs globally, a non-significant change in age-standardised DALY rate of -10·0% (-16·4 to 2·6) between 1990 and 2016. The age-standardised DALY rate decreased in the high SDI quintile (-10·0% [-27·1 to -0·1]) and high-middle SDI quintile (-10·5% [-18·4 to -1·4]) over time but increased in the low SDI quintile (22·5% [11·2 to 50·5]).

Interpretation: CNS cancer is responsible for substantial morbidity and mortality worldwide, and incidence increased between 1990 and 2016. Significant geographical and regional variation in the incidence of CNS cancer might be reflective of differences in diagnoses and reporting practices or unknown environmental and genetic risk factors. Future efforts are needed to analyse CNS cancer burden by subtype.

Funding: Bill & Melinda Gates Foundation.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Age-standardised incidence of CNS cancer per 100 000 population for both sexes, 2016 ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Island. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.
Figure 2
Figure 2
Global age-standardised incidence rate per 100 000 population of CNS cancer by age and sex, 2016 Shaded areas show 95% uncertainty intervals.
Figure 3
Figure 3
Global age-specific years lived with disability (YLDs) and years of life lost (YLLs) rates per 100 000 population due to CNS cancer, 2016 Shaded areas show 95% uncertainty intervals.
Figure 4
Figure 4
Age-standardised disability-adjusted life-year (DALY) rates per 100 000 population for CNS cancer by 21 Global Burden of Disease regions and Socio-demographic Index (SDI), 1990–2016 In all regions, SDI has increased over time so progress in SDI is associated with points further to the right and later years for a given region. The black line represents expected values based on SDI.

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Source: PubMed

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