Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region,1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Abstract

Importance

Nasopharyngeal cancer (NPC) is a strikingly age-specific and region-specific malignancy whose disproportionate and changing burden among younger people in the Western Pacific Region (WPR) has yet to be comprehensively quantified.

Objective

This study aimed to evaluate the burden and trends of NPC in individuals under 55 years in the WPR from 1990 to 2021 and project future trends up to 2035.

Design

Population-based study.

Population

Individuals under 55 years in the WPR, as part of the Global Burden of Disease Study 2021, spanning from 1990 to 2021.

Main Outcome Measures

Age-standardized rates of incidence, mortality, prevalence, disability-adjusted life years (DALYs), and average annual percentage change (AAPC) of nasopharyngeal cancer among people younger than 55 analyzed by regions and countries in the WPR from 1990 to 2021.

Results

Between 1990 and 2021, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDLR) of NPC in individuals under 55 years in the WPR significantly decreased (all P < .001), whereas the age-standardized prevalence rate (ASPR) increased (P < .001). The NPC burden increased with age, peaking in the 50 to 54 age group, and was higher in males. Singapore exhibited the highest age-standardized incidence rate (ASIR) but low ASMR and ASDLR and China showed a decline in the ASIR and the ASMR, though the ASPR increased (all P < .001). Aging and population growth contributed to the rising NPC burden in the region. From 2022 to 2035, the ASIR is projected to rise to 2.85 per 100,000 [AAPC 95% CI = 2.04% (1.97%, 2.09%), P < .001], and the ASPR is expected to increase to 18.54 per 100,000 [AAPC 95% CI = 2.36% (2.24%, 2.44%), P < .001].

Conclusion

The growing NPC burden among young populations in the WPR underscores the need for countries to adopt effective prevention strategies based on the experiences of peers with similar demographic profiles.

Graphical Abstract

Keywords

nasopharyngeal cancer burden of disease epidemiology disability-adjusted life years trends

Introduction

Nasopharyngeal cancer (NPC), primarily driven by Epstein-Barr virus (EBV) infection, genetic factors, and environmental exposures, represents a significant global health threat.¹ The Western Pacific Region (WPR) accounts for over 70% of NPC cases, with approximately 133,000 new diagnoses and 80,000 deaths annually, 40% of which occur in individuals under 55 years, particularly in regions like Southern China and Southeast Asia.^2
-4 The aggressive nature of NPC, which includes symptoms such as nasal obstruction and cranial nerve damage, leads to high treatment costs, long-term disabilities (eg, hearing loss), and loss of productivity, placing considerable strain on families and health care systems.⁵ Young patients face unique challenges, including delayed diagnosis due to nonspecific symptoms (eg, tinnitus) and career or family disruptions, which exacerbate socioeconomic and psychological impacts.⁶ Regional disparities further complicate this issue, with rural populations in the WPR experiencing higher mortality due to limited access to screening and advanced treatment options. The region’s genetic factors (eg, HLA polymorphisms), high EBV prevalence (over 90% seropositivity in high-risk groups), and environmental exposures (eg, preserved foods, smoking) necessitate targeted interventions to address the growing burden on younger populations.^3,7

The Global Burden of Disease (GBD) study, which provides valuable metrics like disability-adjusted life years (DALYs), is crucial for informing global health policies, yet it inadequately represents younger NPC populations.⁸ While GBD data inform WHO guidelines and national initiatives (eg, Singapore’s endoscopy training programs), its focus on older cohorts obscures trends within younger age groups, such as the rising incidence among Southeast Asian women.^9,10 Risk attribution remains imprecise; although smoking and dietary nitrosamines are known risk factors, there are insufficient data on the impact of urbanization and air pollution on specific populations.⁴ Methodological limitations, such as extrapolated mortality estimates in data-scarce regions (eg, Papua New Guinea), further hinder accuracy.¹¹ Addressing these challenges requires age-stratified analyses (eg, 15-34, 35-54 years), incorporation of geospatial data on dietary and occupational exposures, and the use of advanced screening technologies (eg, plasma EBV DNA testing) to refine risk models.^5,12 Such advancements could strengthen regional efforts, such as ASEAN’s unified cancer registries or China’s pollution control measures, to mitigate the disproportionate impact of NPC on younger populations in rapidly-changing environments.^13,14

This study evaluated the NPC burden among populations under 55 in 31 countries and regions of the WPR using 2021 GBD data (1990-2021), thereby identifying temporal trends (eg, the increasing burden in Vietnam) and projecting future scenarios using Bayesian modeling. The findings guide equitable resource allocation, with a focus on high-burden areas like Malaysia, and inform policies targeting occupational hazards or preserved food consumption. By highlighting disparities and evaluating the effectiveness of interventions, this research supports the WHO’s cancer control objectives, promoting integrated strategies to reduce the long-term socioeconomic and health impacts of NPC in the WPR.

Materials and Methods

Data Sources

Data were sourced from the GBD 2021 study,¹⁵ which provides a comprehensive set of statistics on 369 diseases and injuries, 88 potential causes, and various groupings across 204 countries and territories, including NPC. The detailed methodology of the GBD 2021 study is outlined elsewhere.¹⁵ To ensure transparency, reproducibility, and adherence to best practices, this research follows the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER; Supplemental Table S1).¹⁶ Data for this study were exclusively retrieved from the publicly-accessible Institute for Health Metrics and Evaluation website, negating the need for ethics approval or informed consent.

Definitions of Variables

Age, gender, sociodemographic index (SDI), and national-specific temporal changes were directly obtained for the years 1990 to 2021. Incidence, prevalence, mortality, and DALYs associated with NPC in individuals under 55 years old were recorded per 100,000 population. The 95% uncertainty intervals (UIs) were calculated by determining the 25th and 975th percentiles of the 1,000 estimates, following the GBD algorithm.¹⁷ For age-specific analyses, age groups were categorized into 10 intervals, spanning from 5 to 55 years in 5 year increments. The SDI is a composite measure that assesses a country’s or territory’s developmental status based on 3 key indicators: per capita income distribution, average years of education, and fertility rate among women under 25 years of age. Based on 2021 SDI values, countries were stratified into 5 development categories: high SDI (>0.81), high-middle SDI (0.70-0.81), middle SDI (0.61-0.70), low-middle SDI (0.46-0.60), and low SDI (<0.46). The GBD categorizes countries and territories into 21 regions, with the WPR encompassing 31 countries and territories, including China, Japan, the Republic of Korea, Australia, Singapore, and Vietnam.¹⁸

Statistical Analysis

Key measures were analyzed using both absolute numbers and age-standardized rates (ASRs) per 100,000 population, with 95% UIs, including age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), age-standardized prevalence rates (ASPRs), and age-standardized disability-adjusted life years rates (ASDLRs). Age standardization was based on the 2021 GBD world population standard age structure. The data were stratified by age, sex, year, and country within the WPR, encompassing its 31 nations and territories.¹⁹ To determine the 95% UIs, 500 iterations were generated from the model’s posterior distribution for each estimate, with the 12.5th and 487.5th ordered values used.²⁰ Temporal changes were considered statistically significant if the 95% UIs excluded zero. The relative percentage change for both absolute case numbers and ASR per 100,000 population was calculated to assess temporal changes from 1990 to 2021.¹⁵

For temporal trend analysis, the average annual percentage change (AAPC) was computed.²¹ The AAPC was derived by fitting the natural logarithm of ASR against calendar year: ln(ASR) = α + β × (calendar year) + ε, with AAPC calculated as 100 × (exp(β) − 1), and the 95% confidence interval (CI) reported.

To examine the relationship between epilepsy burden and SDI, smoothing splines models and locally-weighted scatterplot smoothing (LOESS) were employed. Spearman’s correlation analysis was conducted to estimate the ρ (rho) values and P-values for the association between ASRs and SDI.²²

To identify the drivers of change in NPC indicators from 1990 to 2021, decomposition analyses using the age-period-cohort model were performed, quantifying contributions from age distribution, population size, and epidemiological factors of NPC.²³ For projections from 2022 to 2035, a Bayesian age-period-cohort (BAPC) model with integrated nested Laplace approximations was utilized, providing superior predictive coverage for disease rates and future burden compared with alternative models.²⁴ All analyses were conducted using the BAPC package in R software, following validated methodological protocols from previous research.²⁴ Statistical significance was set at a 2-sided P-value <.05, with all analyses performed in the R software (version 4.3.2).

Results

Baselines

In 2021, the number of incidences, deaths, prevalence, and DALYs for NPC in the WPR among individuals under 55 years were 40,912, 12,637, 249,608, and 591,554.17, respectively. The corresponding ASRs were 2.15 per 100,000 for incidence, 0.62 per 100,000 for mortality, 13.35 per 100,000 for prevalence, and 30.24 per 100,000 for DALYs (Table 1 and Supplemental Table S2).

Table 1.

Absolute Numbers for Incidence, Mortality, Prevalence, and DALYs for NPC in Individuals Under 55 Years in the Western Pacific Countries in 1990 and 2021.

Incidence				Mortality				Prevalence				DALYs
In 1990		In 2021		In 1990		In 2021		In 1990		In 2021		In 1990		In 2021
Number	95%UI	Number	95%UI	Number	95%UI	Number	95%UI	Number	95%UI	Number	95%UI	Number	95%UI	Number	95%UI
26301.57	22061.61, 31062.41	40912.05	31888.87, 52235.00	18361.92	15445.94, 21539.98	12637.26	10164.29, 15609.82	107341.86	90103.38, 127400.25	249608.12	192188.42, 320983.47	900684.40	757467.03, 1057132.34	591554.17	475543.27, 729446.19
0.20	0.12, 0.33	0.38	0.24, 0.57	0.16	0.10, 0.26	0.29	0.18, 0.42	0.73	0.44, 1.19	1.43	0.89, 2.17	7.15	4.38, 11.58	12.52	7.91, 18.64
121.71	89.83, 160.04	130.50	93.89, 175.37	27.58	22.15, 33.76	24.06	17.68, 31.85	794.13	582.60, 1051.31	881.26	633.11, 1187.40	1356.15	1081.45, 1675.63	1160.86	844.44, 1549.33
2.58	1.69, 3.74	5.88	3.97, 8.44	2.18	1.42, 3.13	4.57	3.12, 6.55	8.72	5.70, 12.67	21.77	14.64, 31.31	112.18	72.99, 162.81	213.91	145.32, 307.01
56.72	35.35, 84.85	130.32	78.97, 205.45	49.53	30.91, 73.90	99.16	60.28, 156.01	181.14	112.45, 270.38	489.91	295.69, 779.17	2469.49	1529.22, 3701.17	4731.06	2854.95, 7471.73
24204.90	19979.33, 28971.17	36393.21	27525.40, 47582.36	16857.56	13936.35, 20049.24	10019.12	7707.04, 12851.23	98974.80	81735.60, 119067.42	228405.32	171705.55, 299434.34	826502.74	683360.68, 982456.04	468423.63	360027.36, 599298.80
0.01	0.01, 0.02	0.02	0.01, 0.03	0.01	0.01, 0.01	0.01	0.01, 0.02	0.05	0.03, 0.08	0.10	0.06, 0.16	0.42	0.26, 0.64	0.46	0.28, 0.71
0.95	0.62, 1.43	1.22	0.74, 1.90	0.78	0.51, 1.17	0.97	0.60, 1.48	3.29	2.14, 4.98	4.35	2.64, 6.93	35.84	23.32, 54.18	43.21	26.38, 66.81
1.24	0.92, 1.64	1.60	1.18, 2.15	0.80	0.62, 1.03	1.03	0.78, 1.33	5.34	3.96, 7.19	6.91	5.07, 9.43	36.71	28.37, 47.53	45.10	34.19, 58.95
178.46	164.32, 195.33	171.93	146.25, 204.82	110.12	105.27, 115.56	75.21	71.29, 79.74	804.94	728.20, 892.42	935.78	777.75, 1138.35	5092.16	4860.82, 5353.85	3424.05	3241.87, 3633.71
0.18	0.10, 0.28	0.34	0.18, 0.58	0.16	0.09, 0.26	0.30	0.17, 0.50	0.53	0.31, 0.85	1.06	0.57, 1.80	7.28	4.23, 11.72	13.73	7.56, 23.04
26.78	15.31, 41.85	43.76	26.30, 69.78	23.91	13.84, 37.77	34.97	20.92, 55.98	82.71	47.02, 129.62	156.75	93.23, 250.05	1175.90	673.75, 1869.00	1692.00	1009.56, 2718.01
488.51	327.42, 700.57	1115.91	729.70, 1636.58	368.93	246.91, 528.81	629.88	415.45, 912.95	1858.26	1239.39, 2665.68	5323.82	3458.82, 7815.07	17916.59	11952.37, 25723.29	29895.31	19662.92, 43353.91
0.12	0.07, 0.19	0.26	0.14, 0.41	0.10	0.06, 0.16	0.21	0.12, 0.34	0.38	0.23, 0.61	0.85	0.47, 1.40	4.77	2.81, 7.63	9.72	5.40, 15.75
0.34	0.19, 0.56	0.44	0.26, 0.70	0.30	0.16, 0.48	0.36	0.22, 0.57	1.09	0.60, 1.78	1.49	0.88, 2.40	13.91	7.68, 22.74	16.09	9.57, 25.63
2.88	1.71, 4.69	6.49	4.03, 9.76	2.64	1.57, 4.27	5.46	3.42, 8.10	8.70	5.15, 14.18	21.83	13.49, 33.23	148.86	87.15, 243.33	273.46	169.90, 410.44
0.05	0.02, 0.08	0.05	0.02, 0.09	0.04	0.02, 0.07	0.04	0.02, 0.07	0.15	0.08, 0.26	0.17	0.08, 0.31	1.79	0.93, 3.17	1.76	0.87, 3.19
16.69	11.95, 23.16	16.46	12.24, 21.34	4.45	3.49, 5.63	3.50	2.64, 4.49	105.49	74.49, 147.41	108.85	80.79, 141.19	222.29	174.07, 283.32	168.65	126.04, 217.08
0.01	0.00, 0.01	0.01	0.00, 0.01	0.01	0.00, 0.01	0.01	0.00, 0.01	0.03	0.02, 0.05	0.03	0.02, 0.05	0.30	0.18, 0.49	0.23	0.14, 0.37
0.32	0.19, 0.52	0.45	0.29, 0.69	0.21	0.13, 0.34	0.30	0.20, 0.45	1.39	0.80, 2.25	1.90	1.22, 2.93	9.79	5.84, 15.58	13.02	8.53, 19.17
0.00	0.00, 0.01	0.00	0.00, 0.01	0.00	0.00, 0.00	0.00	0.00, 0.01	0.01	0.01, 0.03	0.02	0.01, 0.04	0.12	0.06, 0.22	0.15	0.08, 0.26
10.56	5.04, 18.61	26.35	12.98, 48.37	9.09	4.35, 15.94	22.32	10.98, 40.88	34.38	16.25, 60.70	88.35	43.39, 160.95	423.25	199.93, 748.61	1025.78	504.58, 1882.26
371.95	317.49, 437.24	802.02	654.25, 970.56	280.46	242.38, 325.60	578.69	473.31, 697.94	1407.53	1188.35, 1663.62	3174.52	2559.68, 3883.22	14154.25	12217.02, 16417.66	27664.51	22700.19, 33243.67
84.28	56.55, 119.97	100.82	68.13, 143.68	68.66	46.10, 97.23	45.85	32.78, 63.31	295.50	195.62, 422.18	540.35	363.83, 775.99	3344.58	2232.66, 4757.06	2073.95	1474.42, 2875.14
1.01	0.60, 1.63	1.64	0.96, 2.68	0.79	0.48, 1.28	1.16	0.70, 1.89	3.65	2.15, 5.94	6.61	3.80, 10.98	40.34	23.79, 65.71	56.68	33.19, 93.65
104.20	84.53, 126.29	85.76	61.48, 116.85	77.19	63.82, 92.72	39.08	29.43, 50.90	405.38	324.93, 496.55	459.72	324.87, 632.68	3660.98	3011.84, 4422.86	1800.53	1349.23, 2358.47
0.95	0.43, 1.63	2.56	1.49, 4.13	0.84	0.38, 1.44	2.18	1.28, 3.50	2.92	1.33, 5.05	8.38	4.86, 13.62	38.41	17.43, 66.46	98.97	57.48, 159.56
0.00	0.00, 0.01	0.01	0.00, 0.01	0.00	0.00, 0.01	0.00	0.00, 0.01	0.02	0.01, 0.03	0.02	0.01, 0.04	0.19	0.11, 0.31	0.18	0.10, 0.30
0.21	0.12, 0.34	0.27	0.15, 0.45	0.17	0.10, 0.27	0.20	0.11, 0.33	0.74	0.44, 1.20	1.03	0.58, 1.75	7.47	4.40, 12.22	8.77	4.96, 14.65
0.04	0.02, 0.06	0.05	0.03, 0.07	0.03	0.02, 0.05	0.04	0.02, 0.06	0.12	0.07, 0.18	0.16	0.10, 0.25	1.48	0.86, 2.33	1.63	1.01, 2.55
0.39	0.21, 0.66	0.94	0.57, 1.49	0.34	0.19, 0.58	0.80	0.49, 1.26	1.27	0.69, 2.14	3.11	1.85, 4.95	15.72	8.56, 26.89	36.29	21.81, 57.78
627.12	402.63, 936.40	1874.82	1110.51, 2947.26	476.05	309.27, 710.90	1049.11	628.84, 1649.30	2365.96	1507.26, 3534.20	8972.54	5326.35, 14170.11	23937.13	15446.76, 35874.39	48718.79	29198.51, 76823.33

Abbreviations: DALYs, disability-adjusted life years. UI, uncertainty interval.

Compared with those in 1990, the incidence and prevalence of NPC in 2021 among individuals under 55 years in the WPR increased by 55.55% and 132.54%, respectively. Conversely, mortality and DALYs decreased by 31.18% and 34.32%, respectively. The ASIR and the ASPR for 2021 increased by 0% and 54.51%, respectively, while the ASMR and ASDLR decreased by 59.48% and 58.63%, respectively (Table 1 and Supplemental Table S2).

National Burden and Comparison with Their SDI Levels

In 2021, the top 3 countries in terms of ASDLR in the WPR were Malaysia, Vietnam, and Brunei Darussalam, while the countries with the lowest ASDLR were Japan, the Cook Islands, and Palau. The top 3 countries in the ASIR were Malaysia, China, and Vietnam, with Japan, the Cook Islands, and Palau reporting the lowest ASIR. The highest ASPR was observed in Malaysia, China, and Vietnam, while the lowest ASPR was seen in the Cook Islands, Fiji, and Palau. Regarding the ASMR, Malaysia, Vietnam, and Brunei Darussalam had the highest rates, and Japan, the Cook Islands, and Palau had the lowest (Figure 1).

Figure 1.

Distribution of the ASIR, the ASMR, the ASPR, and ASDLR attributable to NPC in individuals aged under 55 years in the Western Pacific countries in 2021. ASIR in 2021 (A), ASMR (B), ASPR (C), ASDLR (D).

At the national level, both the ASMR and ASDLR exhibited a significant exponential decline as SDI levels increased (Figure 2B and D). Malaysia and Singapore showed higher-than-expected ASIR and ASDLR values according to their SDI levels between 1990 and 2021. The ASDLR was negatively correlated with SDI across all countries (ρ = −0.25, P < 0.001). The ASIR for Malaysia, Singapore, China, and Vietnam was higher than expected based on their SDI (Figure 2A). The ASPR of Malaysia, Singapore, China, and Vietnam also exceeded expectations according to their SDI, and ASPR values were positively correlated with SDI (ρ = .14, P < .001) across countries (Figure 2 and Supplemental Table S3).

Figure 2.

The ASIR, the ASMR, the ASPR, and ASDLR for NPC in individuals aged under 55 years in the Western Pacific countries by SDI, 1990 to 2021. ASIR (A), ASMR (B), ASPR (C), ASDLR (D).

From 1990 to 2021, the ASIR remained stable, but the ASMR and ASDLR decreased, while the ASPR increased (all P < .001). In the last decade, from 2012 to 2021, the ASDLR remained stable (P > .05), while the ASIR and the ASPR increased, and the ASMR decreased (all P < .001; Figure 3 and Supplemental Figure S1 and Supplemental Table S3).

Figure 3.

Forest plot of AAPC in ASDLR of NPC in the Western Pacific countries for individuals aged under 55 years from 1990 to 2021 and 2012 to 2021. ASIR (A), ASMR (B), ASPR (C), ASDLR (D).

From 1990 to 2021, the ASDLR for NPC in individuals under 55 decreased in 30 of the 31 countries and territories in the WPR. The fastest declines were observed in Singapore (AAPC = −4.62%), China (AAPC = −3.31%), and the Republic of Korea (AAPC = −2.83%). In contrast, American Samoa was the only territory that experienced an increase in the ASDLR (AAPC = 0.23%), as well as in incidence rate (ASIR, AAPC = 0.54%), mortality rate (ASMR, AAPC = 0.17%), and prevalence rate (ASPR, AAPC = 0.82%). Among the 24 countries with the decreasing ASIR, the most significant drops were in Singapore (AAPC = −2.99%), New Zealand (AAPC = −1.52%), and Australia (AAPC = −1.17%). On the other hand, 6 countries saw increases in incidence rates, with the sharpest rises in Vietnam (AAPC = 0.70%), the Cook Islands (AAPC = 0.65%), Japan (AAPC = 0.23%), Samoa (AAPC = 0.17%), and Mongolia (AAPC = 0.16%). For the ASMR, 30 countries observed declines, with the largest reductions in Singapore (AAPC = −4.75%), China (AAPC = −3.38%), and the Republic of Korea (AAPC = −2.81%). The ASPR decreased in 13 countries, with notable drops in Singapore (AAPC = −1.84%), New Zealand (AAPC = −1.32%), and Australia (AAPC = −1.03%). Meanwhile, 16 countries experienced increases in the ASPR, with significant rises in Vietnam (AAPC = 1.62%), the Cook Islands (AAPC = 1.53%), and China (AAPC = 1.38%; all P < .05; Figure 3 and Supplemental Figure S1 and Supplemental Table S3).

Over the past decade, the ASDLR for NPC in individuals under 55 in the WPR showed fluctuations. Among the 5 countries with an increase in DALY rates, the largest increases were in Malaysia (2.55%), Tokelau (0.88%), and Niue (0.69%). Among the 24 countries with a decline in DALY rates, the steepest declines occurred in Singapore (−5.01%), Guam (−3.31%), and New Zealand (−3.24%). For the incidence rate, the fastest declines were in Singapore (−3.87%), Guam (−3.33%), and New Zealand (−2.85%), among the 18 countries with a decreasing trend. Meanwhile, 9 countries saw an increase in incidence rates, with the highest increases in China (3.61%), Malaysia (3.60%), and Tokelau (1.50%). Regarding the mortality rate, among the 26 countries with decreasing trends, the most significant reductions were in Singapore (−5.67%), Guam (−3.46%), and the Republic of Korea (−3.17%). For the prevalence rate, 13 countries showed a decrease, with the largest reductions in Guam (−3.36%), Singapore (−3.16%), and New Zealand (−2.72%). Conversely, 15 countries saw an increase in prevalence rates, with the fastest increases in China (4.62%), Malaysia (4.36%), and Vietnam (2.56%; all P < .05; Figure 3 and Supplemental Figure S1 and Supplemental Table S3).

Disease Burden Stratified by Sex, Age Group

In 2021, the burden of NPC in the WPR among individuals under 55 years demonstrated a significant increase from the 5 to 9 age group to the 50 to 54 age group. Specifically, the mortality and DALY numbers and rates of NPC rose with age, peaking in the 50 to 54 age group (Figure 4B and D and Supplemental Tables S4 and S5). The corresponding incidence and prevalence rates also generally increased, except for a slight decrease in the 45 to 49 age group (Figure 4A and C and Supplemental Tables S4 and S5). Moreover, in every age group, males showed higher absolute numbers and rates for incidence, mortality, prevalence, and DALYs (Supplemental Table S6).

Figure 4.

Distribution of incidence, mortality, prevalence, and DALYs rate of NPC in individuals aged under 55 years by age and sex in the Western Pacific region in 2021. Incidence in 2021 (A), mortality (B), prevalence (C), DALYs rate (D).

Decomposition Analysis

In the WPR, both aging and population growth exerted upward pressure on all 4 metrics (value >0%). Epidemiological changes contributed to reductions in mortality and DALYs, whereas the effects of aging and population growth led to increases (value >0%). Notably, national patterns varied. For instance, in China, population growth contributed to a decrease in mortality and DALYs (value <0%). In regions such as East Asia, high-income Asia Pacific, Oceania, and Tropical Latin America, aging served to increase mortality and DALY rates. The impacts of aging, population dynamics, and epidemiological changes on incidence, mortality, prevalence, and DALYs are shown in Figure 5 and Supplemental Table S7.

Figure 5.

Decomposition of changes in the number of incidence, mortality, prevalence, and DALYs of NPC in individuals aged under 55 years in the Western Pacific countries from 1990 to 2021, based on population-level determinants of population aging, population growth, and epidemiological changes. Number of incidence (A), number of mortality (B), number of prevalence (C), number of DALYs (D).

Future Forecasts

The burden of NPC in individuals under 55 years in the WPR is projected to undergo significant changes from 2022 to 2035, with varying trends across different metrics. The ASIR is projected to rise from approximately 2.20 per 100,000 population in 2022 to around 2.85 per 100,000 by 2035 [AAPC 95% CI = 2.04% (1.97%, 2.09%), P < .001]. The ASMR is expected to increase slightly from about 0.63 per 100,000 in 2022 to 0.66 per 100,000 in 2035 [AAPC 95% CI = 0.47% (0.43%, 0.52%), P < .001]. The ASPR is anticipated to rise to 18.54 per 100,000 in 2035 [AAPC 95% CI = 2.36% (2.24%, 2.44%), P < .001], reflecting a roughly 40% increase. The ASDLR is expected to remain relatively stable, with a slight increase from 30.45 per 100,000 in 2022 to approximately 33.12 per 100,000 in 2035 [AAPC 95% CI = 0.65% (0.60%, 0.69%), P < .001; Figure 6 and Supplemental Table S8].

Figure 6.

Changing trends and projected rates of the ASIR, the ASMR, the ASPR, and ASDLR of NPC in individuals aged under 55 years in the Western Pacific countries from 1990 to 2035. ASIR (A), ASMR (B), ASPR (C), ASDLR (D).

Discussion

GBD studies provide a broad overview of the global distribution and impact of various diseases. However, more focused regional analyses of disease burden are essential for targeted control measures.¹⁵ NPC exhibits significant regional disparities,²⁵ with its incidence and mortality varying substantially worldwide, particularly in the WPR, a high-incidence area.^25,26 As a major country within the WPR, China presents unique characteristics in its NPC burden.⁴ These variations arise from a complex interplay of genetic factors, environmental exposures, lifestyle choices, and uneven distribution of health care resources.^4,11 For example, populations in regions with prolonged exposure to specific chemicals or viral infections face an elevated NPC risk.⁴ In areas with limited health care access, timely diagnosis and treatment may be inadequate, further skewing disease burden data.²⁷

The shifting burden of NPC among younger populations has profound implications for the overall disease burden across all age groups. Rising NPC incidence and mortality in younger individuals will likely lead to an increased number of cases and associated medical costs in the aging population.²⁸ While some collaboration exists among WPR countries in NPC control, these efforts need strengthening.²⁹ Sharing control experiences, technologies, and resources is essential to enhance overall NPC management across the region.³⁰ This study, which examines the NPC disease burden in the WPR, highlights the complex and evolving nature of the disease and offers valuable insights for regional public health decision-making and intervention strategies, with broad public health implications.³¹

From 1990 to 2021, the ASDLR for NPC among individuals under 55 years in the WPR showed a continuous decline, though a potential future increase remains plausible. Some countries, including Malaysia and Vietnam, have observed a decrease in NPC disease burden, but the reductions are modest, and the burden remains high. This slow progress complicates efforts to substantially lower the region’s overall disease burden.³² Conversely, in the past decade, some countries, notably China, have seen a rapid increase in the ASPR. Over the past 32 years, China’s ASMR and ASDLR for NPC in individuals under 55 have declined significantly, while the ASIR and the ASPR have increased notably in the last decade.

Compared with China, Singapore has experienced a more substantial decline in ASDLR, largely due to its effective NPC control strategies.³³ Singapore has implemented a comprehensive cancer screening and surveillance system that facilitates early detection of NPC, improving both cure and survival rates. Additionally, the country places a strong emphasis on health education to increase public awareness of NPC and reduce exposure to risk factors.³⁴ Japan also provides valuable insights into effective NPC control. The country has enforced stringent environmental regulations to reduce the emission of carcinogenic substances, thus lowering the incidence risks associated with NPC.³⁵ Japan’s continued investment in medical technology has also ensured advanced treatment options for patients with NPC.³⁶ South Korea, through enhanced collaboration among medical institutions, has optimized NPC treatment processes, improving both treatment efficiency and quality.³⁷

The reasons behind the significant decline in China’s ASMR and ASDLR, alongside the rapid rise in the ASIR and the ASPR over the past decade, are multifaceted. Economic development and lifestyle changes, including shifts in dietary habits and increasing environmental pollution, may contribute to higher incidence rates.^13,24 Additionally, advances in medical technology have prolonged the survival of patients with NPC, thereby increasing the prevalence of the disease.¹⁴ To mitigate this trend, several measures should be implemented to reduce the NPC disease burden. These include strengthening health education to raise public awareness of NPC risk factors and promote healthier lifestyles, enhancing cancer screening programs to expand coverage and improve early-detection rates, improving environmental pollution control to reduce carcinogen emissions, and increasing investment in NPC research to identify more effective treatment and prevention strategies.^11,27

Significant gender disparities exist in the NPC burden among young individuals in the WPR, with males consistently exhibiting higher incidence rates than females. This disparity likely results from a multifactorial interplay. Biologically, sex-specific differences in hormonal profiles and physiological structures may influence susceptibility to NPC.¹¹ In addition, behavioral and occupational exposures contribute substantially.³⁸ Males are more frequently engaged in high-risk occupations involving carcinogen exposure and may adopt dietary patterns that elevate NPC risk.²⁸ Compared with those in other regions, young males in the WPR bear a disproportionately-higher NPC burden, potentially linked to regional environmental and lifestyle factors.³⁹ Sex-specific intervention strategies are warranted. For young males, emphasis should be placed on occupational health education to reduce exposure to high-risk environments, alongside the promotion of healthier dietary and lifestyle habits. Although incidence among young females is comparatively-lower, early-detection efforts remain critical.^40,41 Targeted health education is needed to improve symptom awareness and facilitate timely diagnosis. NPC control initiatives in youth populations must also ensure gender equity to prevent neglect of either group’s specific health needs.²⁸

The prevalence did not increase with age but instead decreased in the 45 to 49 age group. This may be attributable to factors such as lifestyle, immune status, and environmental exposure specific to this age cohort.⁴² Individuals in this age group often experience greater life stability, higher health literacy, and more consistent health behaviors. Their immune systems may also retain stronger capacity to counteract carcinogenic insults, and occupational exposures might be lower than those in younger working-age groups.^42,43

In developing effective NPC control measures for populations under 55, multiple contextual factors must be considered.^44,45 First, age-specific strategies are essential—focusing on health education and lifestyle interventions for adolescents and young adults, while enhancing occupational protection and routine screening for middle-aged groups. Second, optimal allocation of health care resources is necessary to ensure effective implementation. Sustainability and long-term impact must be prioritized, with continuous monitoring and evaluation mechanisms in place to iteratively refine control strategies.^14,46

Limitations

This study has several limitations. Potential biases in the data sources may affect accuracy, emphasizing the need for standardized data collection protocols. Moreover, the study did not account for all influencing factors, limiting the ability to fully explain the changes in disease burden. Future research should address these limitations by enhancing data quality control and broadening the scope of the analysis.

Conclusions

The study offers valuable insights into the trends of NPC disease burden in the WPR, highlighting the necessity for targeted control measures. The rising NPC burden among younger populations highlights the critical need for regional collaboration to ensure effective prevention strategies.

Supplemental Material

sj-docx-2-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-docx-2-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-tif-1-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-tif-1-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-3-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-3-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-4-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-4-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-5-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-5-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-6-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-6-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-7-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-7-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-8-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-8-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Supplemental Material

sj-xlsx-9-ohn-10.1177_19160216251411839 – Supplemental material for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study

Supplemental material, sj-xlsx-9-ohn-10.1177_19160216251411839 for Burden and Trends of Nasopharyngeal Cancer Among Younger People in the Western Pacific Region, 1990 to 2021: Findings from the 2021 Global Burden of Disease Study by Lei Zhou, Guifen Ma, Wenchang Jia, Yue Zhang, Lei Wu, Yan Ye, Danzheng Liu and Xiaopan Li in Journal of Otolaryngology - Head & Neck Surgery

Footnotes

Acknowledgements

We are grateful for the GBD study 2021 for providing the original data for this research.

Authors’ Contributions

L.Z. and X.L. wrote the main manuscript text. W.J., Y.Y., G.M., Y.Z., and L.W. analyzed the data, W.J., Y.Y., and X.L. created all the figures. Y.Y., D.L., and X.L. conceptualized the study. X.L. supervised the entire manuscript preparation process. All authors reviewed the manuscript and approved the final version.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the National Key Research and Development Program of China (2022YFC3600901), the National Natural Science Foundation of China (82000980), the Shanghai science and technology committee foundation (21Y31900500, 23SHS05000-01, 23SHS05000-03), Construction of Key Medical Disciplines in Xuhui District (SHXHZDXK202306) and the Interdisciplinary Medical and Engineering Research Projects at Fudan University (XM03241807). The funder did not participate in the study design, data collection, data collection, data analysis, data interpretation, or report writing. The corresponding author had full access to all study data and had the final decision-making authority for submission.

ORCID iDs

Lei Zhou

Wenchang Jiag

Yue Zhang

Danzheng Liu

Xiaopan Li

Data Availability

The data used in this research can be accessed on the Global Health Data Exchange (GHDX) website within the Global Burden of Disease (GBD) 2021 portal. Specific datasets and findings can be retrieved through this link: .

Supplemental Material

Additional supporting information is available in the online version of the article.

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