Table 4_An analysis of the global burden of gallbladder and biliary tract cancer attributable to high BMI in 204 countries and territories: 1990–2021.xlsx

BackgroundGallbladder and biliary tract cancers (GBTCs) are aggressive with poor prognosis, often undetected until advanced stages. High Body Mass Index (BMI) is a significant risk factor, contributing substantially to GBTC mortality and Disability-Adjusted Life Years (DALYs). This study aimed to quantify the global burdens of GBTCs attributable to high BMI from 1990 to 2021, thereby developing more rational prevention and treatment strategies for GBTC.
MethodsData were extracted from the Global Burden of Disease (GBD) 2021. Age-standardized rates of mortality (ASMR), and DALYs (ASDR) for GBTCs due to high BMI were calculated by years, genders, ages, geographical locations, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) was calculated to evaluate the temporal trends from 1990 to 2021. Decomposition and frontier analyses were conducted to understand the driving forces behind burden changes and to identify top-performing countries. Inequality analysis was conducted to assess burden disparities across different SDI levels. The disease burden was forecasted through 2035 using the Bayesian age period cohort (BAPC) model.
ResultsGlobally, ASMR and ASDR for GBTCs related to high BMI decreased from 1990 to 2021; however, the absolute number of deaths and DALYs cases more than doubled, and similar patterns are projected to continue over the next 14 years in the absence of intervention. High SDI regions showed higher burdens due to higher obesity rates, population growth, and aging, while low SDI regions faced higher EAPCs due to limited resources. Moreover, this inequality has become more significant. Females were more susceptible across all age groups. Notable variations in burden management were observed among countries, with some low SDI nations demonstrating superior performance to high SDI countries.
ConclusionDespite the decline in rates, the burden of GBTCs attributable to high BMI remains substantial, underscoring the need for targeted prevention strategies for high BMI, particularly in high SDI regions. Gender and age disparities necessitate tailored health interventions.

背景：胆囊及胆道恶性肿瘤（Gallbladder and biliary tract cancers, GBTCs）具有侵袭性强、预后不佳的特点，往往直至疾病晚期才得以确诊。高体质量指数（Body Mass Index, BMI）是其重要危险因素，对胆囊胆道癌的死亡率与伤残调整生命年（Disability-Adjusted Life Years, DALYs）贡献显著。本研究旨在量化1990年至2021年间由高体质量指数所致的胆囊胆道癌全球疾病负担，从而为胆囊胆道癌制定更合理的防治策略。
方法：数据源自2021年全球疾病负担研究（Global Burden of Disease, GBD）。按年份、性别、年龄、地域及社会人口学指数（sociodemographic index, SDI），计算由高体质量指数所致胆囊胆道癌的年龄标准化死亡率（age-standardized mortality rate, ASMR）与年龄标准化伤残调整生命年率（age-standardized DALY rate, ASDR）。通过估算年度变化百分比（estimated annual percentage change, EAPC）评估1990年至2021年的时间趋势。采用分解分析与前沿分析明确疾病负担变化的驱动因素，并识别表现最优的国家。开展不平等分析以评估不同社会人口学指数水平间的疾病负担差异。借助贝叶斯年龄-时期-队列（Bayesian age period cohort, BAPC）模型，对2035年的疾病负担进行预测。
结果：1990年至2021年，全球范围内与高体质量指数相关的胆囊胆道癌年龄标准化死亡率与年龄标准化伤残调整生命年率均有所下降，但死亡人数与伤残调整生命年病例数的绝对数值翻倍有余，且在无干预措施的情况下，未来14年这一趋势预计将持续。高社会人口学指数地区因肥胖率更高、人口增长与人口老龄化，疾病负担更重；而低社会人口学指数地区因资源有限，估算年度变化百分比更高。此外，这种疾病负担的不平等性愈发显著。各年龄组女性均更易罹患此类肿瘤。各国在疾病负担管理方面存在显著差异，部分低社会人口学指数国家的表现优于高社会人口学指数国家。
结论：尽管相关率有所下降，但由高体质量指数所致的胆囊胆道癌疾病负担仍十分沉重，这凸显了针对高体质量指数制定针对性预防策略的必要性，尤其在高社会人口学指数地区。性别与年龄方面的差异则要求制定个性化的健康干预措施。