Unequal Progress in Early-Onset Bladder Cancer Control: Global Trends, Socioeconomic Disparities, and Policy Efficiency from 1990 to 2021

TL;DR

This study shows that early-onset bladder cancer is increasing globally, especially in middle-income countries, with significant disparities and the need for better prevention and resource allocation.

Contribution

The study introduces decomposition and SDI-efficiency frontier analyses to assess EOBC trends and policy performance.

Findings

EOBC incidence, prevalence, and DALYs increased significantly from 1990 to 2021, with the highest burden in middle-SDI regions.

Males had over twice the burden of females, with the highest rates in the 45–49 age group.

Smoking was the leading risk factor, while hyperglycemia burdens rose in high-income areas.

Abstract

Background: This study investigates the global burden of early-onset bladder cancer (EOBC) from 1990 to 2021, highlighting regional disparities and the growing role of metabolic risk factors. Early-onset bladder cancer (EOBC), diagnosed before age 50, is an emerging global health concern. While less common than kidney cancer, EOBC contributes substantially to mortality and disability-adjusted life years (DALYs), with marked sex disparities. Its global epidemiology remains unassessed systematically. Methods: Using GBD 1990–2021 data, we analyzed EOBC incidence, prevalence, mortality, and DALYs across 204 countries in individuals aged 15–49. Trends were examined via segmented regression, EAPC, and Bayesian age-period-cohort modeling. Inequality was quantified using SII and CI. Decomposition and SDI-efficiency frontier analyses were introduced. Results: From 1990 to 2021, EOBC incidence rose 62.2%, prevalence 73.1%, deaths 15.3%, and DALYs 15.8%. Middle-SDI regions bore the highest burden. Aging drove trends in high-SDI areas and population growth in low-SDI regions. Over 25% of high-SDI countries underperformed in incidence/prevalence control. Smoking remained the leading risk factor, with rising hyperglycemia burdens in high-income areas. Males carried over twice the female burden, peaking at age 45–49. Conclusions: EOBC shows sustained global growth with middle-aged concentration and significant regional disparities. Structural inefficiencies highlight the need for enhanced screening, early warning, and tailored resource allocation.

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