Burden and trends of biliary tract cancer in five Northeast Asian countries, 1990-2021

doi:10.3969/j.issn.1674-8115.2026.09.011

Abstract

Abstract:

Objective ·To evaluate the epidemiological characteristics and health inequalities of biliary tract cancer in five Northeast Asian countries (China, Japan, Republic of Korea, Democratic People′s Republic of Korea, and Mongolia) from 1990 to 2021, and to project disease burden trends through 2035, providing evidence for regional prevention and control strategies. Methods ·Data were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Incidence, mortality, disability-adjusted life years (DALYs), sociodemographic index (SDI), and estimated annual percentage change (EAPC) for biliary tract cancer from 1990 to 2021 were analyzed. A Bayesian age-period-cohort (BAPC) model was applied to predict changes in disease burden from 2022 to 2035. Results ·In 2021, there were 88 861 new cases, 66 107 deaths, and 1 292 121 person-year (DALYs) attributable to biliary tract cancer in the five countries. From 1990 to 2021, the age-standardized incidence rate (ASIR) increased in China but declined in the other four countries, while the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) declined in all five countries; the Republic of Korea showed EAPCs of -2.18% for ASMR and -2.71% for ASDR. Nevertheless, the absolute burden in the 5 countries continued to rise, with China showing the most pronounced increase. Males and older adults were the main high-burden groups, with incidence and mortality peaking in the 70‒74 and 75‒79 age groups, respectively. The burden of BTC remained heterogeneous across countries with different SDI levels, while between-country disparities narrowed over time and health inequalities decreased. Population aging was the dominant driver of burden growth, and in China, it contributed 53.21% of the increase in incidence, 81.31% in mortality, and 82.32% in DALYs. The BAPC model projected that by 2035, new cases, deaths, and DALYs would reach 133 706, 89 852, and 1 586 879, respectively, representing increases of 50.5%, 35.9%, and 22.8% compared with 2021. Conclusion ·From 1990 to 2021, the burden of biliary tract cancer in five Northeast Asian countries generally increased, with a heavier burden in males and older age groups. Projections suggest that the numbers of incident cases, deaths, and DALYs will continue to rise through 2035. Population aging is the primary driver of this growth, with China contributing the most. Tailored, SDI-stratified prevention and control strategies, including strengthening high-risk screening, early diagnosis, standardized treatment, and surveillance/registry quality, are needed to reduce the future burden.

Key words: biliary tract cancer, disease burden, population aging, Bayesian age-period-cohort (BAPC) model

CLC Number:

R735.72

Dong Wenjun, Zhao Jingwei, Zhu Jiayun, Gong Wei, Yang Ziyi. Burden and trends of biliary tract cancer in five Northeast Asian countries, 1990-2021[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(9): 1260-1271.

Figures/Tables 8

TrendMD

References 21

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Country	Indicator	1990		2021		1990-2021
Country	Indicator	Number	ASIR/ASMR/ASDR (95%UI)/(×10^-5)	Number	ASIR/ASMR/ASDR(95%UI)/(×10^-5)	EAPC(95%CI)/%
China	Incidence	17 077 (13 003‒21 744)	2.19 (1.68‒2.79)	51 720 (35 618‒66 848)	2.49 (1.71‒3.21)	0.50 (0.40‒0.60)
	Death	17 251 (13 213‒22 143)	2.32 (1.78‒2.97)	37 833 (26 653‒49 262)	1.85 (1.29‒2.40)	-0.75 (-0.86‒-0.65)
	DALY	452 349 (341 842‒581 398)	52.61 (39.99‒67.15)	857 504 (601 927‒1 121 113)	40.38 (28.21‒52.61)	-0.87 (-0.96‒-0.78)
Japan	Incidence	15 703 (14 504‒16 419)	9.37 (8.60‒9.82)	28 939 (23 552‒32 108)	6.26 (5.34‒6.79)	-1.35 (-1.42‒-1.29)
	Death	13 406 (12 384‒13 953)	8.05 (7.39‒8.41)	22 132 (18 034‒24 522)	4.57 (3.90‒4.96)	-1.95 (-2.00‒-1.91)
	DALY	276 961 (261 454‒285 666)	162.13 (152.67‒167.42)	317 770 (271 464‒344 318)	81.20 (72.71‒86.20)	-2.35 (-2.40‒-2.31)
Republic of Korea	Incidence	2 782 (1 848‒3 459)	10.51 (7.16‒13.14)	7 661 (4 783‒9 725)	8.12 (5.06‒10.31)	-0.80 (-0.88‒-0.73)
	Death	2 828 (1 886‒3 546)	11.18 (7.73‒13.90)	5 615 (3 526‒7 089)	5.97 (3.73‒7.55)	-2.18 (-2.28‒-2.07)
	DALY	70 622 (45 474‒88 384)	237.21 (156.74‒295.81)	103 165 (66 117‒130 309)	109.19 (70.36‒137.25)	-2.71 (-2.81‒-2.61)
Democratic People′s Republic of Korea	Incidence	268 (184‒450)	1.73 (1.19‒2.88)	481 (324‒853)	1.46 (0.98‒2.60)	-0.45 (-0.52‒-0.38)
	Death	271 (187‒451)	1.82 (1.25‒3.00)	466 (316‒834)	1.44 (0.97‒2.57)	-0.68 (-0.75‒-0.62)
	DALY	7 461 (5 056‒12 317)	43.9 (30.33‒72.86)	11 973 (7 927‒20 589)	35.43 (23.53‒61.23)	-0.62 (-0.67‒-0.57)
Mongolia	Incidence	36 (24‒53)	3.40 (2.27‒5.03)	60 (44‒88)	2.69 (1.95‒4.01)	-0.99 (-1.21‒-0.78)
	Death	37 (25‒55)	3.57 (2.38‒5.29)	61 (45‒91)	2.85 (2.06‒4.27)	-0.97 (-1.17‒-0.77)
	DALY	1 070 (671‒1 567)	95.80 (61.34‒140.90)	1 709 (1 242‒2 486)	68.43 (49.82‒101.33)	-1.37 (-1.61‒-1.12)

Country	Indicator	1990		2021		1990-2021
Country	Indicator	Number	ASIR/ASMR/ASDR (95%UI)/(×10^-5)	Number	ASIR/ASMR/ASDR(95%UI)/(×10^-5)	EAPC(95%CI)/%
China	Incidence	17 077 (13 003‒21 744)	2.19 (1.68‒2.79)	51 720 (35 618‒66 848)	2.49 (1.71‒3.21)	0.50 (0.40‒0.60)
	Death	17 251 (13 213‒22 143)	2.32 (1.78‒2.97)	37 833 (26 653‒49 262)	1.85 (1.29‒2.40)	-0.75 (-0.86‒-0.65)
	DALY	452 349 (341 842‒581 398)	52.61 (39.99‒67.15)	857 504 (601 927‒1 121 113)	40.38 (28.21‒52.61)	-0.87 (-0.96‒-0.78)
Japan	Incidence	15 703 (14 504‒16 419)	9.37 (8.60‒9.82)	28 939 (23 552‒32 108)	6.26 (5.34‒6.79)	-1.35 (-1.42‒-1.29)
	Death	13 406 (12 384‒13 953)	8.05 (7.39‒8.41)	22 132 (18 034‒24 522)	4.57 (3.90‒4.96)	-1.95 (-2.00‒-1.91)
	DALY	276 961 (261 454‒285 666)	162.13 (152.67‒167.42)	317 770 (271 464‒344 318)	81.20 (72.71‒86.20)	-2.35 (-2.40‒-2.31)
Republic of Korea	Incidence	2 782 (1 848‒3 459)	10.51 (7.16‒13.14)	7 661 (4 783‒9 725)	8.12 (5.06‒10.31)	-0.80 (-0.88‒-0.73)
	Death	2 828 (1 886‒3 546)	11.18 (7.73‒13.90)	5 615 (3 526‒7 089)	5.97 (3.73‒7.55)	-2.18 (-2.28‒-2.07)
	DALY	70 622 (45 474‒88 384)	237.21 (156.74‒295.81)	103 165 (66 117‒130 309)	109.19 (70.36‒137.25)	-2.71 (-2.81‒-2.61)
Democratic People′s Republic of Korea	Incidence	268 (184‒450)	1.73 (1.19‒2.88)	481 (324‒853)	1.46 (0.98‒2.60)	-0.45 (-0.52‒-0.38)
	Death	271 (187‒451)	1.82 (1.25‒3.00)	466 (316‒834)	1.44 (0.97‒2.57)	-0.68 (-0.75‒-0.62)
	DALY	7 461 (5 056‒12 317)	43.9 (30.33‒72.86)	11 973 (7 927‒20 589)	35.43 (23.53‒61.23)	-0.62 (-0.67‒-0.57)
Mongolia	Incidence	36 (24‒53)	3.40 (2.27‒5.03)	60 (44‒88)	2.69 (1.95‒4.01)	-0.99 (-1.21‒-0.78)
	Death	37 (25‒55)	3.57 (2.38‒5.29)	61 (45‒91)	2.85 (2.06‒4.27)	-0.97 (-1.17‒-0.77)
	DALY	1 070 (671‒1 567)	95.80 (61.34‒140.90)	1 709 (1 242‒2 486)	68.43 (49.82‒101.33)	-1.37 (-1.61‒-1.12)