Trends and projections of the global disease burden of thyroid cancer attributable to high body mass index in China, 1990-2021_Chinese Journal of Evidence-Based Medicine

Authors：

FENG Xue ¹ , FU Shufan ² , LU Yueyang ³ , GAO Anran ¹ ,  GAO Rui ¹

1. Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, P. R. China;
2. Nanjing University of Chinese Medicine, Nanjing 210023, P. R. China;
3. Beijing University of Chinese Medicine, Beijing 100029, P. R. China;

Corresponding?author：

GAO Rui, Email: xyyygr@126.com

Keywords：

High body mass index; Thyroid cancer; Burden of disease; China; Joinpoint regression; Forecast

DOI：

10.7507/1672-2531.202509162

Video：

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Objective To assess the burden of thyroid cancer (TC) attributable to high body mass index (BMI) in China from 1990 to 2021. In addition, we analyzed the effects of age, period, and cohort on the trends in TC burden and projected the disease burden from 2022 to 2050. Methods Data derived from the Global Burden of Disease (GBD) 2021 database were employed. Temporal trends were analyzed using Joinpoint regression to calculate the average annual percentage change (AAPC). To elucidate the independent effects of age, period, and cohort, we employed an APC model. In addition, a Bayesian age-period-cohort (BAPC) model was applied to project the future burden of TC associated with high BMI in China during 2022-2050. Results From 1990 to 2021 in China, mortality from TC attributable to high BMI increased, with stable age-standardized mortality rates (ASMR) but rising age-standardized DALY rates (ASDR). APC model analysis revealed that the age effect indicated a gradual increase in disease burden with advancing age. The time effect showed a decline in mortality risk from 1999 to 2004, followed by a rise in disease burden over time thereafter. The cohort effect demonstrated a persistent increase in disease risk, suggesting a growing disease burden among younger cohorts. Conclusion Between 1990 and 2021, China’s TC burden attributable to high BMI increased, with projections indicating further rises among males but declines among females, highlighting the need for targeted obesity prevention.

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12.	Clayton D, Schifflers E. Models for temporal variation in cancer rates. I: age-period and age-cohort models. Stat Med, 1987, 6(4): 449-467.
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26.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
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28.	Jia MJ, Wang S, Li Y, et al. Global burden of thyroid cancer among adolescents and young adults, 1990-2021, and projections to 2050: an analysis based on the GBD 2021. Front Endocrinol (Lausanne), 2025, 16: 1503144.
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30.	Gu X, Zhu P, Zhang H, et al. A qualitative thematic analysis exploring chinese young adults' experiences in decision making on the management of low-risk papillary thyroid cancer. Thyroid, 2024, 34(12): 1486-1494.
31.	Pappa T, Alevizaki M. Obesity and thyroid cancer: a clinical update. Thyroid, 2014, 24(2): 190-199.
32.	Chen LH, Xie T, Lei Q, et al. A review of complex hormone regulation in thyroid cancer: novel insights beyond the hypothalamus-pituitary-thyroid axis. Front Endocrinol (Lausanne), 2024, 15: 1419913.
33.	Qiao X, Cui Y, Ma C, et al. Incidence trends and spatial distribution of thyroid cancer in the Chinese female population from 1990 to 2019. Asia Pac J Oncol Nurs, 2024, 11(7): 100529.
34.	Papantoniou P, Maniadakis N. The economic cost of obesity: a cost-of-illness study in Greece. Appl Health Econ Health Policy, 2025.
35.	Huang K, Huang X, Qian S, et al. Temporal trends of thyroid cancer in China and globally from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021. Sci Rep, 2024, 14(1): 25538.

1. Deng T, Liu Q, Zi H, et al. Global trends in thyroid cancer 1990-2021: an analysis based on the GBD 2021. Endocr Relat Cancer, 2025, 32(3): e240297.
2. Chen DW, Haymart MR. Unravelling the rise in thyroid cancer incidence and addressing overdiagnosis. Nat Rev Endocrinol, 2026, 22(1): 10-20.
3. Shi X, Tang H, Zhang T, et al. Thyroid-stimulating hormone suppression in low-risk papillary thyroid cancer: a large-scale retrospective analysis of real-world data. EClinicalMedicine, 2024, 77: 102912.
4. Gong Y, Jiang Q, Zhai M, et al. Thyroid cancer trends in China and its comparative analysis with G20 countries: projections for 2020-2040. J Glob Health, 2024, 14: 04131.
5. Meng Z, Pan T, Yu J, et al. Burden of thyroid cancer in China and worldwide from 1990 to 2021: observation, comparison, and forecast from the Global Burden of Disease Study 2021. Front Endocrinol (Lausanne), 2024, 15: 1500926.
6. Cao W, Qin K, Li F, et al. Socioeconomic inequalities in cancer incidence and mortality: an analysis of GLOBOCAN 2022. Chin Med J (Engl), 2024, 137(12): 1407-1413.
7. Bao WQ, Zi H, Yuan QQ, et al. Global burden of thyroid cancer and its attributable risk factors in 204 countries and territories from 1990 to 2019. Thorac Cancer, 2021, 12(18): 2494-2503.
8. Chen YX, Hong HZ, Gao ZH, et al. Global trend and disparity in the burden of thyroid cancer attributable to high body-mass index from 1990 to 2021 and projection to 2049: a systematic analysis based on the Global Burden of Disease Study 2021. BMC Public Health, 2025, 25(1): 1051.
9. Shin A, Cho S, Jang D, et al. Body mass index and thyroid cancer risk: a pooled analysis of half a million men and women in the Asia cohort consortium. Thyroid, 2022, 32(3): 306-314.
10. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
11. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
12. Clayton D, Schifflers E. Models for temporal variation in cancer rates. I: age-period and age-cohort models. Stat Med, 1987, 6(4): 449-467.
13. Rosenberg PS, Anderson WF. Age-period-cohort models in cancer surveillance research: ready for prime time. Cancer Epidemiol Biomarkers Prev, 2011, 20(7): 1263-1268.
14. Rosenberg PS. A new age-period-cohort model for cancer surveillance research. Stat Methods Med Res, 2019, 28(10-11): 3363-3391.
15. Zhao Z, Fan Y, Sun P, et al. Temporal trends and geographic disparities in thyroid cancer burden: a global analysis from 1990 to 2021. Front Nutr, 2025, 12: 1613737.
16. Kim J, Gosnell JE, Roman SA. Geographic influences in the global rise of thyroid cancer. Nat Rev Endocrinol, 2020, 16(1): 17-29.
17. 滕熠, 張曉丹, 夏昌發, 等. 中國與全球癌癥發病、死亡和患病對比及其預測分析: GLOBOCAN2022數據解讀. 中華腫瘤防治雜志, 2024, 31(23): 1413-1420.
18. Ludgate ME, Masetti G, Soares P. The relationship between the gut microbiota and thyroid disorders. Nat Rev Endocrinol, 2024, 20(9): 511-525.
19. Kitahara CM, Sosa JA. Understanding the ever-changing incidence of thyroid cancer. Nat Rev Endocrinol, 2020, 16(11): 617-618.
20. Zhu X, Mi Y, Wang L, et al. Global burden of cancer attributable to high BMI (1990-2031): a multidimensional analysis based on GBD and Mendelian randomization. Front Nutr, 2025, 12: 1618799.
21. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body fatness and cancer-viewpoint of the IARC Working Group. N Engl J Med, 2016, 375(8): 794-798.
22. Zhao M, Zheng Y, Chen Z. Analysis of the burden of colorectal cancer attributable to high body mass index in 204 countries and regions worldwide from 1990 to 2021. Front Nutr, 2025, 12: 1589250.
23. Shi Z, Lin J, Wu Y, et al. Burden of cancer and changing cancer spectrum among older adults in China: trends and projections to 2030. Cancer Epidemiol, 2022, 76: 102068.
24. Handforth C, Clegg A, Young C, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol, 2015, 26(6): 1091-1101.
25. Yao K, Su H, Cui K, et al. Effectiveness of an intermittent fasting diet versus regular diet on fat loss in overweight and obese middle-aged and elderly people without metabolic disease: a systematic review and meta-analysis of randomized controlled trials. Journal of Nutrition, Health & Aging, 2024, 28(3): 100165.
26. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
27. Li M, Dal Maso L, Pizzato M, et al. Evolving epidemiological patterns of thyroid cancer and estimates of overdiagnosis in 2013-17 in 63 countries worldwide: a population-based study. Lancet Diabetes Endocrinol, 2024, 12(11): 824-836.
28. Jia MJ, Wang S, Li Y, et al. Global burden of thyroid cancer among adolescents and young adults, 1990-2021, and projections to 2050: an analysis based on the GBD 2021. Front Endocrinol (Lausanne), 2025, 16: 1503144.
29. Franchini F, Palatucci G, Colao A, et al. Obesity and thyroid cancer risk: an update. Int J Environ Res Public Health, 2022, 19(3): 1116.
30. Gu X, Zhu P, Zhang H, et al. A qualitative thematic analysis exploring chinese young adults' experiences in decision making on the management of low-risk papillary thyroid cancer. Thyroid, 2024, 34(12): 1486-1494.
31. Pappa T, Alevizaki M. Obesity and thyroid cancer: a clinical update. Thyroid, 2014, 24(2): 190-199.
32. Chen LH, Xie T, Lei Q, et al. A review of complex hormone regulation in thyroid cancer: novel insights beyond the hypothalamus-pituitary-thyroid axis. Front Endocrinol (Lausanne), 2024, 15: 1419913.
33. Qiao X, Cui Y, Ma C, et al. Incidence trends and spatial distribution of thyroid cancer in the Chinese female population from 1990 to 2019. Asia Pac J Oncol Nurs, 2024, 11(7): 100529.
34. Papantoniou P, Maniadakis N. The economic cost of obesity: a cost-of-illness study in Greece. Appl Health Econ Health Policy, 2025.
35. Huang K, Huang X, Qian S, et al. Temporal trends of thyroid cancer in China and globally from 1990 to 2021: an analysis of the Global Burden of Disease Study 2021. Sci Rep, 2024, 14(1): 25538.

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