Burden and temporal trends of cervical cancer in reproductive-age females from 1990 to 2021 and projections to 2035 in G20 countries: a systematic analysis of the Global Burden of Disease Study 2021

OBJECTIVE: Cervical cancer remains a critical global health threat. Despite its member states accounting for more than 85% of global gross domestic product (GDP), no comprehensive assessment of cervical cancer burden exists across the diverse Group of Twenty (G20) economies. This study aimed to characterize long-term cervical cancer burden trends and project future epidemiological trajectories among G20 reproductive-age females. METHODS: Using Global Burden of Disease 2021 data, we analyzed cervical cancer disability-adjusted life years (DALYs) among females aged 15-49 years in G20 countries (1990-2021) via Joinpoint regression, health inequality indices, Das Gupta decomposition, and Bayesian age-period-cohort projection to 2035. RESULTS: In 2021, cervical cancer generated 2.27 million DALYs among G20 reproductive-age females, with age-standardized rates ranging from 24.89 (Saudi Arabia) to 667.65 (South Africa) per 100,000. Overall rates declined (annual average percent change [AAPC]=-1.40%) (1990-2021), with China achieving a notable reduction (AAPC=-1.51%), but increased in Russia (AAPC=1.70%), Japan (AAPC=0.65%), Italy (AAPC=0.33%), and South Africa (AAPC=0.14%). Sociodemographic Index (SDI)-related inequality narrowed (1990: Slope Index of Inequality [SII]=-349.58, Concentration Index=-0.21; 2021: SII=-261.82, Concentration Index=-0.18), but persisted. Population growth (+23.99%) and age structure changes (+20.92%) drove DALY increases in the G20, offset by epidemiological improvements (-43.92%). Most G20 countries will see declining burden by 2035, while South Africa faces the largest increase. CONCLUSION: Differentiated, evidence-based strategies tailored to national burden characteristics, addressing demographic shifts, key health system gaps, and human papillomavirus genotype disparities, are critically needed to successfully achieve the World Health Organization 2030 global cervical cancer elimination targets.