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

Abstract

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 modeled 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-standardized incidence rates of CNS cancer increased globally by 17.3% (95% UI 11.4 to 26.9) between 1990 and 2016 (2016 age-standardized incidence rate 4.63 per 100,000 person-years [4.17 to 4.90]). The highest age-standardized incidence rate was in the highest quintile of SDI (6.91 [5.71 to 7.53]). Age-standardized 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-standardized DALY rate of −10.0% (−16.4 to 2.6) between 1990 and 2016. The age-standardized 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 analyze CNS cancer burden by subtype.