Comparative trends in oral cancer burden across the globe, China, Europe, the US, Southeast Asia, and Africa (1990-2021): a GBD 2021 analysis.

backgroundOral cancer including lip, oral cavity cancer contributes to cancer burden importantly in the world. It is crucial for effective policy planning to comprehensively evaluate oral cancer burden regionally.

methodsThe incidence, mortality, and disability-adjusted life years (DALYs) due to oral cancer from 1990 to 2021 were estimated according to Global Burden of Disease (GBD) 2021 methods. The GBD comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for oral cancer attributable to smoking, tobacco, and alcohol consumption in 2021.

resultsThe male-to-female ratio of age-standardized incidence rate (ASIR) for oral cancer was 2.99 in China, 2.7 in Europe, 2.24 in the United States, 1.73 in Southeast Asia, and 1.51 in Africa. The corresponding ratios of age-standardized mortality rate (ASMR) for oral cancer were 3.82, 3.16, 2.45, 1.89, and 1.60 respectively. Key risk factors for oral cancer-related deaths and DALYs varied by region and showed distinct age- and sex-stratified patterns. In China, tobacco was the primary contributor, accounting for 51.4% of oral cancer deaths in men, with a higher impact among older males aged ≥ 55 years. In Europe and the United States (US), alcohol consumption dominated, contributing a larger proportion of deaths in younger men (20-54 years) and showing higher attributable fractions than smoking in these age groups. In Southeast Asia, chewing tobacco was the major driver, responsible for 48.79% of oral cancer deaths in women, with this proportion exceeding 50% in females aged ≥ 55 years. Among men in Southeast Asia, smoking was the predominant risk factor for oral cancer mortality.

conclusionsThe burden of oral cancer exhibits distinct temporal and regional variations, with significant differences in incidence, mortality, and DALYs across global regions. Such differences are strongly associated with region-specific risk factor patterns, and these patterns also vary by age and sex. These insights highlight the need for targeted prevention strategies tailored to regional, age, and sex characteristics, including anti-smoking interventions in older Chinese men, alcohol control measures in younger European and American men, and efforts to reduce chewing tobacco use among older Southeast Asian women, to effectively mitigate the global burden of oral cancer.