Association between the Human Development Index and the burden of major gastrointestinal cancers: results from Global Burden of Disease 2021.

Abstract

Aim: To assess the longitudinal association between the Human Development Index (HDI) and the global burden of major gastrointestinal (GI) cancers from 1990 to 2021.

Background: GI cancers contribute substantially to global incidence, mortality, and disability-adjusted life years (DALYs), with wide variation across HDI levels.

Methods: Using Global Burden of Disease 2021 data, we analyzed age-standardized incidence (ASIR), mortality (ASMR), disability-adjusted life-year (ASDR), and tobacco-attributable mortality for colorectal, liver, pancreatic, and stomach cancers (1990-2021). Countries were classified as more developed (HDI ≥0.700) or less developed (HDI <0.700), and associations were assessed using longitudinal multilevel mixed-effects models and Spearman correlations.

Results: In 2021, HDI was positively correlated with colorectal and pancreatic cancer burden, while liver cancer showed inverse associations only in less developed countries and stomach cancer only in more developed settings. For tobacco-attributable ASMR, associations were positive for colorectal and pancreatic cancers, non-significant for liver, and opposite for stomach (positive in less vs. inverse in more developed countries). Longitudinally (1990-2021), colorectal cancer showed a rising ASIR in both groups, but significantly divergent slopes for ASMR and ASDR, with declining rates in more developed countries and increasing rates in less developed countries. Liver cancer had significantly unfavorable slopes, with ASIR, ASMR, and ASDR increasing in more developed but declining in less developed settings. Pancreatic cancer exhibited increases in all measures, with significantly slower growth in more developed countries. Stomach cancer showed consistent declines across all measures, with considerably steeper reductions in more developed regions.

Conclusion: Human development strongly shapes GI cancer burden, with divergent high- and low-HDI trends evident only in longitudinal analyses.