Changing Trends In The Disease Burden Of Non-melanoma Skin Cancer Globally And Its Prediction

Objective: This study described the global disease burden attributable to non-melanoma skin cancer(NMSC)in 2019,assessed the changing trends in NMSC-related disease burden from 1990 to 2019,and predicted the disease burden over the next 25 years.The aim was to provide an evidence-based assessment of the current control strategies’ effectiveness and to make recommendations for future prevention and control policies.Methods: The data on NMSC-related disease burden from 1990 to 2019 were extracted from the Global Disease Burden Study 2019(GBD 2019).The indicators of disease burden included the number of incidence cases,the number of death cases,the number of disability-adjusted life years(DALY),and the corresponding age-standardized rate.In addition,the population forecast data,the standardization demographic data,and some national indicators data were collected during the same period.The national indicators included vegetation indicators,urban characteristic indicators,demographic indicators,and socioeconomic indicators.This study conducted a three-stage analysis.First,we reported the NMSC-related disease burden globally and for different subgroups(like gender,age,socio-demographic index(SDI)regions,subtype,GBD regions,countries and regions)in 2019.Second,we examined the temporal trend of the disease burden attributable to NMSC worldwide from 1990 to 2019.In this part of the analysis,the linear regression analysis was used to estimate the estimated annual percentage change(EAPC)in the global age standardization rate at all levels from 1990 to 2019.Subgroup analysis was performed using nonparametric rank sum tests and machine learning methods(K mean cluster analysis).To explore the risk factors associated with NMSC,panel model analysis was used to explore the relationship between some national indicators and the disease burden attributable to NMSC.Finally,we used the age-period-cohort(APC)models to predict the disease burden from 2020 to2044.The APC models were fitted within the Bayesian frameworks and the framework of maximum likelihood(ML)or restricted estimation maximum likelihood(REML),respectively.The sensitivity analysis was performed with the auto-regressive integrated moving average(ARIMA)model and the exponential smoothing(ES)model in the time series model to verify the stability of the results.Results:(1)In 2019,the number of incidence cases attributable to NMSC was6,353,687(95% uncertainty intervals(UI): 5,805,441,6,952,145)globally.The number of death cases was 56,054(95% UI: 50,415,59,792).And the number of DALY cases was 1,183,233(95% UI: 1,085,365,1,264,545).The ASIR was 79.10/100,000(95% UI:72.29/100,000,86.63/100,000),the ASMR was 0.73/100,000(95% UI: 0.65/100,000,0.78/100,000),and the age-standardized DALY rate was 14.67/100,000(95% UI:13.45/100,000,15.67/100,000).There were significant differences in the disease burden attributable to NMSC by gender,age groups,SDI regions,subtype,GBD regions,and countries and regions.(2)From 1990 to 2019,the number of incidence cases,the number of death cases,the number of DALY cases,and the corresponding age-standardized rate attributable to NMSC all showed upward trends.In subgroup analyses,the EAPC values for agestandardized rates from 1990 to 2019 differed significantly between sexes,with a more significant increase in the NMSC-related disease burden in males than in females.There were statistically significant differences in the disease burden changes associated with NMSC in different age groups,different SDI regions,different types,and different geographic regions.The results of the panel model showed that some national indicators were significantly associated with NMSC-related disease burden,including national income,average national income,forest area,annual GDP growth,annual GDP per capita growth,population density,the population aged 65 and above(percentage of the total population),female population(percentage of the total population)and urban population(percentage of the total population).(3)The prediction results of the Bayesian age-period-cohort(BAPC)model showed that the age-standardized rate attributable to NMSC globally would remain stable or decline slightly between 2020 to 2044.However,it was expected that the number of incidence cases,death,and DALY attributable to NMSC in the next 25 years would continue to increase.The results of the APC model were consistent with it.The results of the sensitivity analysis were also consistent,validating the robustness of the predicted results in this study.Conclusion: The disease burden attributable to NMSC contributed significantly to the global disease burden over the past 30 years.Moreover,the global NMSC-related disease burden would continue to increase in the next 25 years.To halt the growth in the number of incidence cases,death,and DALY attributable to NMSC and reduce the global burden of NMSC,health policymakers should take action to intervene.