Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults.
Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults.
Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally.
Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.
Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.
Bibliographical noteFunding Information:
This study was funded by the Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the Cancer Center Support grant (number CA21765) from the National Cancer Institute through the US National Institutes of Health. We are very grateful for the contributions of cancer registries and vital registration systems around the world, and for all of the GBD study collaborators who contributed data and reviewed GBD 2019 cancer estimates. S Aljunid would like to acknowledge the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. H Ariffin acknowledges research funding from the Ministry of Science, Technology & Innovation, Malaysia. T Bärnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. N Bhakta acknowledges support from NCI Cancer Center Grant (CA21765), St. Baldricks Foundation (Award ID 586943) and ALSAC (American Lebanese Syrian Associated Charities). S Bhaskar acknowledges funding from the NSW Ministry of Health. J Conde acknowledges European Research Council Starting Grant (ERC-StG-2019-848325). V Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. J M Ferreira de Oliveira acknowledges funding from Fundação para a Ciência e a Tecnologia (FCT) and Ministério da Ciência, Tecnologia e Ensino Superior (MCTES) through national funds and “Programa Operacional Competitividade e Internacionalização” (COMPETE), grant number PTDC/MED-QUI/29243/2017-POCI-01-0145-FEDER-029243 and from PT national funds (FCT/MCTES) through grant UIDB/50006/2020. J M Ferreira de Oliveira also thanks FCT for funding through program DL 57/2016-Norma transitória (SFRH/BPD/74868/2010). J Glasbey acknowledges support from a doctoral research fellowship from the UK National Institute of Health Research (NIHR300175). A Guha acknowledges support from American Heart Association-Strategically Focused Research Network Grant in Disparities in Cardio-Oncology (#847740, #863620). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research council (NHMRC), Australia. S Haque acknowledges and is thankful to Jazan University, Saudi Arabia, for providing access to the Saudi Digital Library for this research study. Claudiu H and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. B-F Hwang acknowledges partial support from China Medical University (CMU110-MF-58), Taichung, Taiwan. K Innos and Keiu Paapsi acknowledge partial support from the Estonian Research Council (Grant No PRG722). S M S Islam acknowledges support from the NHMRC Emerging Leadership Fellowship. M Jakovljevic acknowledges the Serbian part of their contribution was co-funded through Grant OI 175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J Kauppila acknowledges research grants from Sigrid Jusélius Foundation, Finnish Cancer Foundation, and Päivikki and Sakari Sohlberg Foundation. M N Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh. Y J Kim acknowledges support from the Research Management Centre, Xiamen University Malaysia. [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional support provided by Manipal Academy of Higher Education. I Landires acknowledges support from Panama's Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), as member of the Sistema Nacional de Investigación (SNI). M-C Li acknowledges support from MOST 110-2314-B-003-001. J A Loureiro acknowledges support from Base Funding UIDB/00511/2020 of the LEPABE funded by national funds through the FCT/MCTES (PIDDAC) and Scientific Employment Stimulus (FCT) [CEECINST/00049/2018]. T Meretoja acknowledges support from a non-restricted grant from Cancer Foundation Finland. M Molokhia acknowledges support from the National Institute for Health Research Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London. M A Moni acknowledges support from the University of Queensland, Australia. O Odukoya acknowledges support from the Fogarty International Center of the National Institutes of Health under the Award Number K43TW010704. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R Radhakrishnan acknowledges IA/CPHI/18/1/503927/The Wellcome Trust DBT India Alliance. A Samy acknowledges support from the Egyptian Fulbright Mission Program. F Sha acknowledges Shenzhen Science and Technology Program (Grant No. KQTD20190929172835662). A Shetty acknowledges the support and cooperation of Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. B S Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for the encouragement and support provided. P Shetty acknowledges the Department of Forensic Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. D Silva acknowledges Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and Dr. Silva is supported in part by National Council for Scientific and Technological Development (CNPq), Brazil (302028/2018-8).
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© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
- Cause of Death
- Disability-Adjusted Life Years
- Global Burden of Disease
- Global Health
- Life Expectancy
- Risk Factors
- Socioeconomic Factors
- Young Adult