Age-sex-specific burden of urological cancers attributable to risk factors in China and its provinces, 1990–2021, and forecasts with scenarios simulation: a systematic analysis for the Global Burden of Disease Study 2021

Background: As global aging intensifies, urological cancers pose increasing health and economic burdens. In China, home to one-fifth of the world's population, monitoring the distribution and determinants of these cancers and simulating the effects of health interventions are crucial for global and national health. Methods: With Global Burden of Disease (GBD) China database, the present study analyzed age-sex-specific patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in China and its 34 provinces as well as the association between gross domestic product per capita (GDPPC) and these patterns. Importantly, a multi-attentive deep learning pipeline (iTransformer) was pioneered to model the spatiotemporal patterns of urological cancers, risk factors, GDPPC, and population, to provide age-sex-location-specific long-term forecasts of urological cancer burdens, and to investigate the impacts of risk-factor-directed interventions on their future burdens. Findings: From 1990 to 2021, the incidence and prevalence of urological cancers in China has increased, leading to 266,887 new cases (95% confidence interval: 205,304-346,033) and 159,506,067 (12,236,0000-207,447,070) cases in 2021, driven primarily by males aged 55+ years. In 2021, Taiwan, Beijing, and Zhejiang had the highest age-standardized incidence rate (ASIR) and age-standardized prevalence rates of urological cancer in China, highlighting significant regional disparities in the disease burden. Conversely, the national age-standardized mortality rate (ASMR) has declined from 6.5 (5.1-7.8) per 100,000 population in 1990 to 5.6 (4.4-7.2) in 2021, notably in Jilin [-166.7% (-237 to -64.6)], Tibet [-135.4% (-229.1 to 4.4)], and Heilongjiang [-118.5% (-206.5 to -4.6)]. Specifically, the national ASMR for bladder and testicular cancers reduced by -32.1% (-47.9 to 1.9) and -31.1% (-50.2 to 7.2), respectively, whereas prostate and kidney cancers rose by 7.9% (-18.4 to 43.6) and 9.2% (-12.2 to 36.5). Age-standardized DALYs, YLDs, and YLLs for urological cancers were consistent with ASMR. Males suffered higher burdens of urological cancers than females in all populations, except those aged <5 years. Regionally and provincially, high GDPPC provinces have the highest burden of prostate cancer, while the main burden in other provinces is bladder cancer. The main risk factors for urological cancers in 2021 are smoking [accounting for 55.1% (42.7-67.4)], high body mass index [13.9% (5.3-22.4)], and high fasting glycemic index [5.9% (-0.8 to 13.4)] for both males and females, with smoking remarkably affecting males and high body mass index affecting females. Between 2022 and 2040, the ASIR of urological cancers increased from 10.09 (9.19-10.99) to 14.42 (14.30-14.54), despite their ASMR decreasing. Notably, prostate cancer surpassed bladder cancer as the primary subcategory, with those aged 55+ years showing the highest increase in ASIR, highlighting the aging-related transformation of the urological cancer burden. Following the implementation of targeted interventions, smoking control achieved the greatest reduction in urological cancer burden, mainly affecting male bladder cancer (-45.8% decline). In females, controlling smoking and high fasting plasma glucose reduced by 5.3% and 5.8% ASMR in urological cancers. Finally, the averaged mean-square-Percentage-Error, absolute-Percentage-Error, and root-mean-square Logarithmic-Error of the forecasting model are 0.54 ± 0.22, 1.51 ± 1.26, and 0.15 ± 0.07, respectively, indicating that the model performs well. Interpretation: Urological cancers exhibit an aging trend, with increased incidence rates among the population aged 55+ years, making prostate cancer the most burdensome subcategory. Moreover, urological cancer burden is imbalanced by age, sex, and province. Based on our findings, authorities and policymakers could refine or tailor population-specific health strategies, including promoting smoking cessation, weight reduction, and blood sugar control. Funding: Bill & Melinda Gates Foundation.