Global burden of head and neck cancers including thyroid cancer in older adults (≥ 60 years old) and projections to 2050: a systematic and comprehensive analysis of the global burden of disease study 2021

Abstract

Background

Head and neck cancers (HNC), including laryngeal cancer (LC), lip and oral cavity cancer (LOC), nasopharyngeal cancer (NPC), thyroid cancer (TC), and various other oropharyngeal cancers (OPC), significantly impact the physical and mental health of older adults. This study seeks to comprehensively assess the burden of HNC among older adults (≥ 60 years old) in various regions and countries worldwide, covering the time frame from 1990 to 2021.

Methods

Data regarding the incidence, mortality rates, and disability-adjusted life years (DALYs) were gathered from the Global Burden of Disease (GBD) 2021 to assess the impact of female cancers—specifically LC, LOC, NPC, TC and OPC—among older adults worldwide. A trend analysis was performed by employing the joinpoint regression to evaluate temporal changes, and the average annual percentage change (AAPC) was computed to measure these trends. Moreover, the Age-Period-Cohort (APC) model was applied to examine the influences of age, time, and birth cohort on incidence, mortality, and DALYs. Additionally, to predict the impact of HNC over the forthcoming 30 years, the Bayesian Age-Period-Cohort (BAPC) model was utilized.

Results

In 2021, the global incidence of HNC was reported as 612,067.03 cases (95% uncertainty interval [UI]: 555,776.85–662,604.36), resulting in an age-standardized incidence rate (ASIR) of 56.27 (95% UI: 51–60.93). The number of recorded deaths was 348,000.2 (95% UI: 313,328.89–378,923.15), leading to an age-standardized death rate (ASDR) of 32.34 (95% UI: 29.06–35.22). The total number DALYs was 7,330,871.21 (95% UI: 6,641,999.58–7,977,099.69), with an age-standardized DALY rate of 669.03 (95% UI: 605.54–728.07). An analysis of age-standardized trends indicates a gradual upward trend in ASIR, with an estimated annual percentage change (EAPC) of 0.15 (95% confidence interval [CI]: 0.07–0.22). In contrast, the ASDR and age-standardized DALYs have shown a decreasing trend, with EAPC of -0.57 (95% CI: [-0.65] - [-0.5]) and − 0.66 (95% CI: [-0.74] - [-0.58]), respectively. Notably, a significant increase in female patients has been observed. The age distribution profile indicates that the highest incidence of HNC occurs in the 60–64 age group for both sexes. Mortality rates peak in the 65–69 age group, also affecting both sexes, while the burden of DALYs is most significant in the 60–64 age group. Among the various subtypes of HNC, cancers of the LOC represent the most substantial disease burden.

Conclusions

The global incidence of HNC continues to rise, despite a decline in mortality rates, highlighting significant regional disparities. This discrepancy is particularly evident in South Asia, where a high disease burden is attributed to tobacco use, HPV infections, and limitations in healthcare access. Although targeted interventions have improved outcomes for male populations, regions with low Socio-demographic Index (SDI) are now experiencing an increase in incidence among women. The disease predominantly affects adults aged 60 to 69, emphasizing the necessity for focused screening, especially for older women. Key risk factors include tobacco and alcohol use, elevated Body Mass Index (BMI), and occupational exposures. Current projections suggest that these factors will continue to drive an increase in global HNC cases in the coming years.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-025-06753-4.

Introduction

Head and neck cancers (HNC) are anatomically defined as a collection of malignant tumors located above the clavicle, beneath the cranial base, and in front of the cervical spine. This classification encompasses laryngeal cancer (LC), cancer of the lip and oral cavity (LOC), nasopharyngeal cancer (NPC), thyroid cancer (TC), and several other oropharyngeal cancers (OPC). Each of these cancer types poses considerable difficulties in terms of prevention, accurate clinical diagnosis, and effective treatment strategies. As reported in the global cancer statistics for 2022, HNC is the fourth most prevalent cancer type worldwide, with a total of 1,712,626 new diagnoses and 505,592 fatalities. This accounts for 8.5% of all cancer cases and 5.2% of cancer-related deaths, imposing a substantial economic and health burden on humanity globally [1, 2].

As the global population continues to age, health concerns related to older adults have garnered heightened focus. Elderly patients with cancer are typically defined as individuals diagnosed with cancer at the age of 60 or 65 and above [3]. Notably, elderly patients with HNC account for more than 50% of all HNC cases. It is projected that by 2030, the rate of newly diagnosed HNC cases in this age group will increase by more than 60% [4, 5]. Furthermore, by 2050, the global population aged 60 and above is projected to reach approximately 1.6 billion [6]. This demographic shift indicates that the burden of HNC is likely to increase, resulting in a continuous rise in the demand for medical resources. Compared to other diseases, the diagnosis and effective treatment of HNC typically necessitate a multidisciplinary and multimodal approach [7]. However, access to these resources is unevenly distributed on a global scale. Previous studies have indicated that elderly patients with HNC exhibit a significantly higher mortality rate compared to their younger counterparts [8]. Additionally, elderly HNC patients encounter numerous challenges, including less prominent early symptoms, multiple comorbidities, declined nutritional and immune functions, significant psychological and emotional stress, and poor treatment tolerance [9–11]. These factors adversely impact the diagnosis, treatment, and prognosis of elderly HNC patients.

Despite continuous shifts in population demographics, most of the existing research focuses on the disease burden associated with HNC across all age groups. However, there is insufficient documentation regarding the burden of HNC in individuals aged 60 and older, resulting in a lack of comprehensive analysis on how HNC affects the older population. Therefore, it is crucial for nations and health organizations worldwide to conduct an extensive examination of the effects of HNC on the elderly to develop targeted public health strategies and achieve health objectives.

This study is the first to utilize Global Burden of Disease (GBD) data, specifically targeting the population aged 60 and above, encompassing all 204 countries and regions, to comprehensively analyze the disease burden of HNC, including TC. The primary objectives of this study are: (1) to quantify and compare the incidence, mortality, and disability-adjusted life year (DALY) burden of different HNC subtypes including TC and their changing trends among the global, regional, and national populations aged 60 years and above from 1990 to 2021; (2) to explore the socio-demographic index (SDI) correlations with HNC burden in the elderly population; (3) to identify the specific cancer sites and countries/regions with the heaviest burden, thereby providing an evidence base for optimizing the allocation of HNC prevention and control resources for the elderly population.

Materials and methods

Data collection, study population, and selection criteria

The data for this study were sourced from the GBD 2021 database (https://ghdx.healthdata.org/gbd-2021). This comprehensive database encompasses evaluation data for 204 countries and regions, covering 371 types of diseases and injuries, as well as 88 risk factors [12]. Our data includes information on gender, age, incidence, mortality, and DALY related to HNC across 21 GBD regions and 204 different countries/regions. Our study is a secondary ecological analysis of GBD 2021 estimates, which are generated through model-based methods incorporating various data sources and assumptions. Utilizing the Global Health Data Exchange (GHDx) query tool (https://vizhub.healthdata.org/gbd-results/), we extracted epidemiological indicators for HNC (including LC, OPC, NPC, TC, and OPC) among individuals aged 60 and above from 1990 to 2021. This included prevalence, incidence, mortality, and DALY rates, as well as DALYs data related to risk factors. The types of cancers included strictly adhere to the ‘Head and Neck Cancer’ classification criteria of GBD 2021; the thyroid gland is categorized as a head and neck organ, and its clinical management (surgery and radiotherapy) overlaps with that of head and neck squamous cell carcinoma (HNSCC). Inclusion in global data comparability, the inclusion of TC follows the GBD standard classification. Furthermore, although TC is highly prevalent among young women, its absolute disease burden in the population aged ≥ 60 years (particularly the mortality rate of advanced cases) remains a significant public health concern [13]. We excluded non-epithelial tumors of the head and neck, metastatic HNC, and recurrent HNC, as these were not included in the GBD study. The 95% uncertainty interval (UI) for every indicator was established by identifying the 2.5th and 97.5th percentiles, which relate to the arranged 1,000 values derived from the posterior distribution [14]. The GBD 2021 report calculated the SDI for each nation, serving as an indicator of the social and economic factors that influence health outcomes. This index is assessed as a composite metric that includes per capita income, average educational attainment, and the birth rate of women aged 25 and younger. The 204 countries and regions were categorized into five tiers based on their SDI: high, upper middle, middle, lower middle, and low SDI. Scores on the SDI scale range from 0 to 100, with 0 representing the lowest income levels, least years of education, and highest fertility rates, while a score of 100 signifies the highest income, most years of education, and lowest fertility rates [15]. We used estimates produced by the GBD 2021 study (which derives cause-specific mortality using methods such as CODEm). For non-fatal estimates, the GBD DisMod-MR 2.1 framework was used. We did not independently re-run CODEm; rather, we used the GBD outputs. DisMod-MR 2.1 is a Bayesian meta-regression tool developed for the GBD study, specifically designed to estimate non-fatal health outcomes using sparse and heterogeneous epidemiological data. It generates internally consistent estimates of incidence, prevalence, remission, and mortality rates for various diseases and conditions. The tool is based on a Bayesian compartmental model framework, which solves differential equations to regulate the relationships between different epidemiological parameters. Furthermore, it employs a negative binomial rate model to effectively manage overdispersion and zero-inflation in the data. Additionally, the Bayesian Age-Period-Cohort (BAPC) model is utilized to predict the future burden of HNC among the elderly [16].

Definition of statistical indicators

The Age-Standardized Incidence Rate (ASIR) represents the rate of new cases of a specific disease within a defined population, adjusted for age structure, typically utilizing a standard population age distribution. This adjustment aims to mitigate the influence of variations in age composition across different populations, thereby facilitating the comparison of incidence rates across diverse regions or time periods. Similarly, the Age-Standardized Death Rate (ASDR) indicates the rate of deaths attributable to a specific disease in a particular population, also adjusted for age structure. This adjustment enables a fair comparison of mortality risk among different populations. DALY refers to all the years of healthy life lost from disease onset to death, including years of life lost due to premature death (YLL) and years of healthy life lost due to disability (YLD). DALY integrates the loss of life expectancy and the decline in quality of life due to health issues, thereby reflecting the overall impact of a specific disease or injury on population health [17].

Statistical analysis

In this study, we used the Joinpoint software (version 4.9.1.0, https://surveillance.cancer.gov/joinpoint/) developed by the National Cancer Institute Division of Cancer Control & Population Sciences. The Monte Carlo permutation test, the default model optimization method of the Joinpoint software, was used to select the optimal number of joinpoints. All models were fitted with a maximum of 5 joinpoints, corresponding to 6-line segments. This parameter was selected to balance model flexibility and parsimony while effectively capturing meaningful trend transitions. The same maximum joinpoint limit (5 joinpoints) and permutation test criteria were uniformly applied across all stratification levels, including global, regional, anatomical subsite, and sex-specific analyses. For data series with fewer than eight observed data points, the software’s internal algorithm automatically constrained the maximum number of joinpoints to prevent overfitting. This constraint impacted a limited number of sub-analyses in regions or subsites with sparse data. Annual percent change (APC) and average annual percent change (AAPC) were calculated with 95% confidence intervals, and a p-value below 0.05 was deemed statistically significant [18, 19].

The Age-Period-Cohort (APC) model stands out as a sophisticated research approach that goes beyond conventional analyses in studies of health and socio-economic development. Grounded in the Poisson distribution, it improves the typical descriptive analysis technique by breaking down the variables of interest into three dimensions: age, period, and cohort. This decomposition facilitates a thorough investigation of long-term trends in the evolution of diseases over time [20, 21]. The age effect indicates how the likelihood of a particular outcome varies with changes in age, illustrating the impact of demographic changes on that outcome. Period effects refer to shifts in disease incidence and DALY rates among different populations, shaped by human factors like improvements in diagnostic methods, screening processes, and early detection techniques. The cohort effect refers to the variations in characteristics among groups born in the same year. Typically, the APC model is represented by the equation: Y = log(M) = µ + α(age)i + β(period)j + γ(cohort)k + ε. Furthermore, we assessed the significance of trends in annual percentage changes using a Wald χ² test [22].

In this research, a BAPC model was employed, which included integrated nested Laplace approximations to predict upcoming trends in disease burden. Compared to the APC model, the BAPC model, which employs integrated nested Laplace approximation (INLA), exhibited enhanced coverage and precision, and it was used to predict disease burden on a global level through the year 2050 [23]. In this study, all statistical analyses and their corresponding visual representations were conducted using R statistical software, specifically version 4.3.3. A significance threshold of P < 0.05 was established to ensure that the findings could be interpreted appropriately within the context of statistical significance.

Results

Global burden of older adults with HNC, 1990–2021

According to global HNC statistics published by the GBD Collaboration in 2021, there has been an increase in the ASIR of HNC, while the ASDR and DALYs have shown a decline. As indicated in Table 1, the global incidence of HNC in 2021 was 612,067.03 cases (95% uncertainty interval [UI]: 555,776.85–662,604.36), resulting in an ASIR of 56.27 (95% UI: 51–60.93). The number of deaths was recorded at 348,000.2 (95% UI: 313,328.89–378,923.15), leading to an ASDR of 32.34 (95% UI: 29.06–35.22). The total number of DALYs was 7,330,871.21 (95% UI: 6,641,999.58–7,977,099.69), with an age-standardized DALY rate of 669.03 (95% UI: 605.54–728.07). An analysis of age-standardized trends reveals a gradual upward trend in ASIR, with an estimated annual percentage change (EAPC) of 0.15 (95% confidence interval [CI]: 0.07–0.22). Meanwhile, the ASDR and age-standardized DALYs have demonstrated a decreasing trend, with EAPC of −0.57 (95% CI: [−0.65] - [−0.5]) and − 0.66 (95% CI: [−0.74] - [−0.58]), respectively. Among the 21 regions reported by GBD, Central Europe exhibited the most rapid increase in ASIR, with an EAPC of 0.91 (95% CI: 0.83–1). Conversely, in Western Sub-Saharan Africa, both ASDR and age-standardized DALYs displayed the highest growth rates, with EAPCs of 0.24 (95% CI: 0.18–0.31) and 0.11 (95% CI: 0.05–0.17), respectively. In contrast, East Asia experienced the most significant declines in ASDR and age-standardized DALYs, with EAPCs of −1.72 (95% CI: [−1.88]- [−1.56]) and − 1.79 (95% CI: [−1.96] - [−1.62]). Figure 1 and Supplementary Tables 1–3 provide a visual representation of the global ASIR, ASDR, age-standardized DALYs, and their corresponding EAPC across 204 regions.

Table 1.

Global burden of head and neck cancer and trends in older adults (≥ 60 years old) from 1990 to 2021 by 21 GBD regions, 5 SDI regions and gender

	1990		2021			1990		2021			1990		2021
Characteristics (95%Ul)	Incidence cases	ASIR	Incidence cases	ASIR	EAPC	Death cases	ASMR	Death cases	ASMR	EAPC	DALYs cases	ASDR	DALYs cases	ASDR	EAPC
	(95%UI)	Pre 100,000 (95%UI)	(95%UI)	Pre 100,000 (95%UI)	(95%CI)	(95%UI)	Pre 100,000 (95%UI)	(95%UI)	Pre 100,000 (95%UI)	(95%CI)	(95%UI)	Pre 100,000 (95%UI)	(95%UI)	Pre 100,000 (95%UI)	(95%CI)
Global	256817.54 (239914.37 ~ 273503.11)	52.98 (49.32 ~ 56.47)	612067.03 (555776.85 ~ 662604.36)	56.27 (51 ~ 60.93)	0.15 (0.07 to 0.22)	176246.17 (162471.18 ~ 190201.85)	37.22 (34.2 ~ 40.2)	348000.2 (313328.89 ~ 378923.15)	32.34 (29.06 ~ 35.22)	−0.57 (−0.65 to −0.5)	3905763.05 (3612630.51 ~ 4213171.21)	786.56 (726.33 ~ 848.66)	7330871.21 (6641999.58 ~ 7977099.69)	669.03 (605.54 ~ 728.07)	−0.66 (−0.74 to −0.58)
Gender
Female	80612.93 (72252.05 ~ 88301.22)	30.38 (27.15 ~ 33.3)	201,305 (173791.1 ~ 227211.08)	34.31 (29.63 ~ 38.73)	0.36 (0.31 to 0.41)	50623.35 (44028.44 ~ 56741.68)	19.48 (16.9 ~ 21.83)	103784.3 (88174.23 ~ 118907.92)	17.65 (15 ~ 20.21)	−0.43 (−0.49 to −0.36)	1053384.75 (917999.66 ~ 1182673.19)	392.84 (341.96 ~ 441.02)	2051195.06 (1767704.41 ~ 2350318.6)	349.98 (301.7 ~ 400.99)	−0.5 (−0.57 to −0.43)
Male	176204.61 (163550.87 ~ 189789.03)	81.45 (75.39 ~ 87.78)	410762.02 (371111.27 ~ 448913.46)	82.03 (73.94 ~ 89.64)	−0.03 (−0.12 to 0.06)	125622.82 (114804.6 ~ 137587.61)	60.14 (54.84 ~ 65.87)	244215.9 (218331.56 ~ 269260.04)	49.87 (44.5 ~ 54.96)	−0.72 (−0.81 to −0.64)	2852378.3 (2610855.61 ~ 3127201.02)	1264.56 (1156.2 ~ 1386.01)	5279676.15 (4726305.97 ~ 5830790.8)	1033.79 (924.64 ~ 1141.23)	−0.79 (−0.88 to −0.7)
SDI
High SDI	91706.83 (86058.21 ~ 96459.56)	63.63 (59.67 ~ 66.96)	187053.84 (168862.01 ~ 200610.69)	68.07 (61.87 ~ 72.83)	0.27 (0.21 to 0.33)	40891.96 (38234.27 ~ 42993.77)	28.4 (26.5 ~ 29.88)	65190.31 (57947.18 ~ 70129.17)	22.68 (20.37 ~ 24.31)	−0.78 (−0.87 to −0.68)	865722.83 (816244.03 ~ 910428.31)	602.86 (568.01 ~ 634.2)	1274326.63 (1160312.36 ~ 1365331.22)	467.67 (428.51 ~ 500.12)	−0.88 (−0.97 to −0.78)
High-middle SDI	65389.69 (60146.54 ~ 70885.72)	51.71 (47.41 ~ 56.11)	131242.19 (115146.31 ~ 147960.58)	51.08 (44.78 ~ 57.57)	−0.14 (−0.23 to −0.06)	45862.58 (41939.58 ~ 50005.56)	37.4 (34.06 ~ 40.81)	67095.54 (59036.52 ~ 75447.27)	26.38 (23.18 ~ 29.66)	−1.34 (−1.44 to −1.25)	1025768.9 (940792.1 ~ 1118386.52)	794.01 (726.55 ~ 866.28)	1418504.02 (1253784.11 ~ 1596502.33)	550.5 (486.32 ~ 619.45)	−1.42 (−1.53 to −1.32)
Middle SDI	11075.5 (8936.62 ~ 13471.88)	43.35 (34.98 ~ 52.74)	26868.03 (22028.22 ~ 32356.45)	48.41 (39.71 ~ 58.19)	0.28 (0.18 to 0.39)	10349.87 (8368.56 ~ 12635.07)	41.9 (33.85 ~ 51.15)	23151.76 (19013.88 ~ 27834.38)	43.24 (35.54 ~ 51.9)	0.05 (−0.03 to 0.13)	238173.2 (192485.04 ~ 290608.62)	886.7 (716.6 ~ 1081.82)	510423.34 (418501.86 ~ 615014.48)	883.08 (724.63 ~ 1062.66)	−0.84 (−0.94 to −0.74)
Low-middle SDI	37680.74 (31845.8 ~ 44316.51)	54.28 (45.74 ~ 63.93)	108099.66 (93643.16 ~ 123588.95)	63.67 (55.11 ~ 72.82)	0.46 (0.39 to 0.54)	34571.4 (29089.35 ~ 40825.06)	51.3 (43.04 ~ 60.69)	88555.76 (76758.32 ~ 101428.58)	53.62 (46.41 ~ 61.45)	0.1 (0.04 to 0.16)	786296.71 (663268.22 ~ 927884.54)	1084.44 (913.08 ~ 1280.86)	1929261.5 (1671522.54 ~ 2209584.41)	1104.4 (956.42 ~ 1265.14)	0.02 (−0.04 to 0.08)
Low SDI	50663.79 (45475.57 ~ 56289.37)	43.24 (38.75 ~ 48.05)	158208.34 (138283.56 ~ 179258.8)	48.19 (42.05 ~ 54.58)	0.23 (0.11 to 0.35)	44351.68 (39714.47 ~ 49225.77)	39.36 (35.19 ~ 43.73)	103651.51 (91064.1 ~ 116559.66)	32.53 (28.5 ~ 36.57)	−0.78 (−0.87 to −0.69)	985057.01 (881966.64 ~ 1093070.62)	802.58 (718.21 ~ 890.87)	2190857.7 (1929870.09 ~ 2463656.61)	656.46 (577.51 ~ 738)	−0.09 (−0.17 to −0.02)
GBD region
Andean Latin America	554.9 (446.9 ~ 684.97)	23.93 (19.27 ~ 29.52)	2029.07 (1519.25 ~ 2673.26)	28.34 (21.23 ~ 37.31)	0.56 (0.41 to 0.72)	498.66 (403.55 ~ 613.52)	21.92 (17.73 ~ 26.98)	1310.57 (990.56 ~ 1695.33)	18.53 (14.01 ~ 23.96)	−0.54 (−0.67 to −0.41)	9972.52 (8067.27 ~ 12275.3)	423.11 (342.3 ~ 520.81)	25236.66 (19007.56 ~ 32775.73)	351.91 (265.15 ~ 456.84)	−0.63 (−0.78 to −0.49)
Australasia	2165.7 (1813.75 ~ 2571.87)	69.77 (58.37 ~ 82.87)	4985.79 (3931.28 ~ 6198.23)	70.75 (55.84 ~ 88)	0.09 (−0.07 to 0.26)	820.62 (699.63 ~ 951.93)	26.75 (22.76 ~ 31.04)	1337.73 (1080.05 ~ 1609.25)	18.23 (14.76 ~ 21.93)	−1.26 (−1.46 to −1.05)	17763.21 (15131.74 ~ 20695.13)	572.57 (487.26 ~ 667.21)	26234.41 (21345.05 ~ 31689.24)	373.3 (304.3 ~ 450.92)	−1.42 (−1.63 to −1.2)
Caribbean	1837.93 (1615.69 ~ 2087.09)	57.91 (50.86 ~ 65.76)	3940.02 (3237.72 ~ 4742.54)	58.67 (48.22 ~ 70.62)	0.24 (0.13 to 0.36)	1438.07 (1269.87 ~ 1633)	46.15 (40.7 ~ 52.42)	2699.14 (2224.84 ~ 3234.71)	40.01 (32.99 ~ 47.95)	−0.28 (−0.39 to −0.17)	28994.13 (25603.85 ~ 32987.18)	904.44 (798.15 ~ 1029.08)	54153.53 (44600.81 ~ 65083.7)	807.31 (664.94 ~ 970.28)	−0.17 (−0.29 to −0.05)
Central Asia	2096.13 (1906.71 ~ 2312.78)	36.48 (33.08 ~ 40.38)	2948.99 (2574.34 ~ 3354.47)	30.06 (26.25 ~ 34.15)	−0.55 (−0.73 to −0.38)	1725.39 (1571.28 ~ 1904.58)	30.68 (27.81 ~ 34.02)	2086.43 (1828.79 ~ 2374.67)	22.17 (19.43 ~ 25.19)	−1.01 (−1.13 to −0.9)	39706.67 (36445.65 ~ 43471.82)	674.31 (617.2 ~ 740.62)	47488.96 (41617.78 ~ 54148.87)	468.37 (410.67 ~ 533.15)	−1.17 (−1.29 to −1.06)
Central Europe	10521.15 (9774.81 ~ 11288.23)	53.28 (49.42 ~ 57.2)	20943.47 (18753.79 ~ 23190.46)	70.49 (63.14 ~ 78.08)	0.91 (0.83 to 1)	7809.14 (7286.94 ~ 8349.31)	40.6 (37.78 ~ 43.45)	12281.3 (11062.89 ~ 13494.72)	40.98 (36.91 ~ 45.04)	0 (−0.1 to 0.1)	174629.68 (163205.62 ~ 186672.83)	869.21 (811.34 ~ 929.5)	267431.23 (241681.82 ~ 294152.16)	907.16 (819.81 ~ 998.07)	0.1 (0.01 to 0.19)
Central Latin America	3163.33 (2959.61 ~ 3357.47)	34.18 (31.87 ~ 36.29)	9004.14 (7854.81 ~ 10234.78)	29.48 (25.71 ~ 33.49)	−0.76 (−0.87 to −0.65)	2723.95 (2551.63 ~ 2881.95)	30.33 (28.29 ~ 32.13)	5992.71 (5224.43 ~ 6778.79)	20 (17.43 ~ 22.61)	−1.6 (−1.7 to −1.5)	54578.9 (51345.98 ~ 57705.85)	575.73 (540.28 ~ 609.03)	118008.65 (103270.76 ~ 133793.31)	384.26 (336.23 ~ 435.44)	−1.6 (−1.71 to −1.49)
Central Sub-Saharan Africa	581.49 (408.68 ~ 814.27)	24.36 (17.08 ~ 34.16)	1364.84 (955.22 ~ 1913.93)	24.5 (17.01 ~ 34.74)	0.01 (−0.15 to 0.17)	545.63 (382.96 ~ 759.78)	24.09 (16.83 ~ 33.76)	1200.73 (836.5 ~ 1684.44)	22.72 (15.62 ~ 32.43)	−0.18 (−0.31 to −0.06)	12680.72 (8867.77 ~ 17695.87)	492.71 (344.82 ~ 687.96)	27525.8 (19238.57 ~ 38392.94)	462.89 (321.82 ~ 651.28)	−0.19 (−0.32 to −0.07)
East Asia	40047.35 (33277.26 ~ 46895.64)	39.89 (33.23 ~ 46.62)	114365.31 (90663.73 ~ 142554.04)	41.29 (32.77 ~ 51.32)	0.09 (−0.11 to 0.3)	35802.1 (29785.69 ~ 41919.49)	37.36 (31.19 ~ 43.66)	62317.02 (49710 ~ 76889.03)	23.25 (18.56 ~ 28.58)	−1.72 (−1.88 to −1.56)	796973.1 (660328.17 ~ 935980.8)	754.38 (626.76 ~ 884.26)	1280819.89 (1016718.45 ~ 1591917.31)	458.92 (364.67 ~ 569.11)	−1.79 (−1.96 to −1.62)
Eastern Europe	17887.53 (16679.63 ~ 19322.83)	47.24 (43.99 ~ 51.04)	28283.32 (25157.6 ~ 31617.64)	57.75 (51.39 ~ 64.54)	0.4 (0.27 to 0.54)	12222.05 (11437.11 ~ 13111.86)	33.02 (30.83 ~ 35.42)	15040.79 (13366.27 ~ 16810.26)	31 (27.55 ~ 34.62)	−0.59 (−0.76 to −0.42)	288727.2 (270408.88 ~ 310148.87)	748.35 (700.3 ~ 803.78)	346660.66 (307805.58 ~ 388700.48)	704.08 (625.45 ~ 789.1)	−0.61 (−0.79 to −0.43)
Eastern Sub-Saharan Africa	3302.72 (2672.18 ~ 3978.33)	39.27 (31.77 ~ 47.3)	7027.25 (5497.95 ~ 8821.2)	38.77 (30.45 ~ 48.42)	−0.17 (−0.24 to −0.1)	3104.25 (2511.05 ~ 3746.65)	38.14 (30.84 ~ 46.04)	6124.49 (4786.98 ~ 7678.61)	35.07 (27.52 ~ 43.75)	−0.38 (−0.44 to −0.33)	71280.82 (57614.82 ~ 86087.54)	808.42 (653.66 ~ 976.08)	136965.09 (106418.41 ~ 172759.03)	724.13 (564.85 ~ 909.57)	−0.49 (−0.54 to −0.43)
High-income Asia Pacific	11207.59 (10001.33 ~ 12453.24)	44.49 (39.57 ~ 49.45)	36629.98 (30074.61 ~ 42747.43)	58.34 (48.56 ~ 67.98)	0.88 (0.64 to 1.11)	4636.14 (4179.62 ~ 5072.56)	19.1 (17.11 ~ 20.92)	13949.72 (11559.44 ~ 15593.96)	19.64 (16.72 ~ 21.81)	−0.11 (−0.3 to 0.08)	95584.09 (86742.49 ~ 104760.35)	378.08 (342 ~ 414.6)	229577.39 (196908.36 ~ 255164.27)	366.2 (319.91 ~ 405.71)	−0.28 (−0.48 to −0.09)
High-income North America	36598.15 (34231.73 ~ 38401.36)	79.04 (73.99 ~ 82.91)	67909.9 (62066.85 ~ 72176.17)	76.78 (70.27 ~ 81.57)	−0.17 (−0.22 to −0.12)	12149.9 (11326.36 ~ 12688.3)	25.99 (24.23 ~ 27.14)	17749.21 (16032 ~ 18874.02)	19.78 (17.92 ~ 21.01)	−0.97 (−1.09 to −0.86)	259487.94 (244899.85 ~ 271182.44)	564.19 (532.87 ~ 589.45)	367313.24 (338510.8 ~ 390431.43)	415.6 (383.62 ~ 441.49)	−1.09 (−1.22 to −0.96)
North Africa and Middle East	5501.46 (4472.72 ~ 6895.02)	29.33 (23.73 ~ 36.93)	17573.14 (14624.88 ~ 20881.47)	34.51 (28.68 ~ 41)	0.59 (0.51 to 0.67)	4526.61 (3677.48 ~ 5639.39)	25.36 (20.46 ~ 31.84)	9809.17 (8228.83 ~ 11558.03)	20.53 (17.18 ~ 24.19)	−0.67 (−0.73 to −0.61)	98909.49 (80596.4 ~ 122917.31)	506.72 (411.44 ~ 632.24)	207569.32 (174191.38 ~ 244856.79)	401.77 (336.84 ~ 473.74)	−0.77 (−0.82 to −0.72)
Oceania	60.6 (43.14 ~ 83.13)	20.37 (14.63 ~ 27.8)	157.8 (111.75 ~ 217.57)	21.22 (15.15 ~ 29.15)	0.2 (0.15 to 0.25)	52 (36.72 ~ 71.97)	18.68 (13.33 ~ 25.69)	129.46 (91.17 ~ 180.76)	18.47 (13.1 ~ 25.68)	0.05 (0.01 to 0.1)	1169.31 (820.49 ~ 1627.22)	365.79 (259.04 ~ 505.55)	2819.5 (1972.62 ~ 3961.58)	360.13 (253.82 ~ 503.23)	0.04 (−0.01 to 0.09)
South Asia	47373.94 (40154.64 ~ 55355.05)	73.41 (61.92 ~ 85.94)	150218.61 (128735.32 ~ 171528.15)	84.9 (72.72 ~ 97)	0.32 (0.2 to 0.45)	43188.45 (36432.33 ~ 50711.12)	69.09 (57.97 ~ 81.32)	120454.37 (103532.21 ~ 137732.52)	70.05 (60.17 ~ 80.17)	−0.09 (−0.18 to 0.01)	995390.52 (843118.14 ~ 1166487.73)	1469.71 (1240.33 ~ 1724.96)	2641537.6 (2268810.99 ~ 3021088.47)	1450.69 (1245.88 ~ 1659.74)	−0.18 (−0.28 to −0.08)
Southeast Asia	12334.64 (10402.81 ~ 14594.6)	43.92 (36.99 ~ 52.09)	39246.18 (32475.69 ~ 47010.69)	51.21 (42.31 ~ 61.45)	0.37 (0.33 to 0.4)	10463.11 (8824.04 ~ 12378.7)	38.73 (32.6 ~ 45.99)	27091.08 (22501.29 ~ 32197.5)	37.15 (30.79 ~ 44.26)	−0.26 (−0.3 to −0.22)	228035.86 (192397.37 ~ 269229.94)	778.11 (656.34 ~ 920.4)	578207.07 (480719.5 ~ 686222.16)	731.16 (607.99 ~ 868.65)	−0.33 (−0.38 to −0.29)
Southern Latin America	2748.3 (2346.5 ~ 3192.05)	46.45 (39.62 ~ 53.95)	4044.9 (3379.47 ~ 4779.01)	35.94 (30.03 ~ 42.47)	−0.67 (−0.74 to −0.6)	2071.84 (1781.25 ~ 2394.54)	35.66 (30.61 ~ 41.22)	2448.79 (2052.14 ~ 2870.52)	21.55 (18.06 ~ 25.26)	−1.39 (−1.46 to −1.32)	44890.61 (38639.06 ~ 51926.21)	750.9 (645.93 ~ 868.68)	49149.64 (41506.07 ~ 57601.65)	438.32 (370.24 ~ 513.71)	−1.57 (−1.64 to −1.5)
Southern Sub-Saharan Africa	1053.38 (799.72 ~ 1351.24)	33.66 (25.59 ~ 43.13)	2530.32 (2178.54 ~ 2886.93)	37.16 (31.92 ~ 42.42)	0.22 (0.03 to 0.41)	906.51 (693.75 ~ 1160.38)	29.8 (22.84 ~ 38.1)	1999.47 (1729.52 ~ 2276.98)	30.49 (26.27 ~ 34.74)	−0.03 (−0.28 to 0.22)	19754.49 (15073.72 ~ 25355.4)	611.08 (466.91 ~ 783.57)	44792.44 (38810.99 ~ 51060.73)	634.61 (548.96 ~ 723.48)	0.03 (−0.23 to 0.29)
Tropical Latin America	4767.3 (4375.88 ~ 5159.54)	45.02 (41.11 ~ 48.78)	14834.94 (13282.36 ~ 16287.07)	46.02 (41.13 ~ 50.54)	0.06 (0 to 0.12)	4032.55 (3700.73 ~ 4355.67)	39.34 (35.84 ~ 42.56)	10739.58 (9603.5 ~ 11748.06)	33.69 (30.07 ~ 36.88)	−0.45 (−0.52 to −0.39)	87956.96 (81069.08 ~ 94938.76)	803.72 (738.11 ~ 868.22)	227768.05 (206019.35 ~ 248386.75)	699.92 (632.26 ~ 763.53)	−0.46 (−0.53 to −0.39)
Western Europe	51603.39 (47361.88 ~ 55898.5)	68.24 (62.62 ~ 73.97)	80796.12 (71200.4 ~ 89303.74)	68.86 (61.16 ~ 76)	0.14 (0.05 to 0.24)	26174.09 (24157.55 ~ 27988.01)	34.25 (31.58 ~ 36.65)	30319.43 (26483.6 ~ 33338.32)	24.06 (21.28 ~ 26.39)	−1.13 (−1.27 to −0.98)	549194.95 (509246.45 ~ 587828.37)	730.86 (677.62 ~ 782.54)	588009.93 (523265.2 ~ 645532.88)	506.97 (454.59 ~ 555.84)	−1.17 (−1.31 to −1.03)
Western Sub-Saharan Africa	1410.55 (1122.45 ~ 1723.18)	14.14 (11.29 ~ 17.23)	3232.91 (2585.71 ~ 3942.01)	15.65 (12.62 ~ 18.98)	0.4 (0.35 to 0.44)	1355.13 (1081.79 ~ 1655.15)	13.99 (11.21 ~ 17.03)	2919.02 (2350.36 ~ 3556.92)	14.7 (11.93 ~ 17.79)	0.24 (0.18 to 0.31)	30081.9 (23858.8 ~ 36892)	289.21 (230.13 ~ 353.74)	63602.18 (50761.85 ~ 78013.5)	293.41 (235.69 ~ 358.09)	0.11 (0.05 to 0.17)

Fig. 1.

Age-standardized disease burden and estimated annual percentage change of head and neck cancer across 204 countries and territories from 1990 to 2021. A ASIR of head and neck cancer across 204 countries and territories from 1990 to 2021. B EAPC in ASIR of head and neck cancer across 204 countries and territories from 1990 to 2021. C ASDR of head and neck cancer across 204 countries and territories from 1990 to 2021. D EAPC in ASDR of head and neck cancer across 204 countries and territories from 1990 to 2021. E Age-standardized DALYs of head and neck cancer across 204 countries and territories from 1990 to 2021. F EAPC in Age-standardized DALYs of head and neck cancer across 204 countries and territories from 1990 to 2021. ASIR, age-standardized incidence rate;ASIR, age-standardized incidence rate; ASIR of EAPC, age-standardized incidence rate of estimated annual percentage change; ASMR, age-standardized mortality rate; ASMR of EAPC, age-standardized mortality rate of estimated annual percentage change; ASDR, age-standardized death rate; ASDR of EAPC, age-standardized death rate of estimated annual percentage change

In addition, we conducted a sensitivity analysis on the key global EAPC of HNC excluding TC (Supplementary Table 4). Our findings revealed that the global trend of HNC, when excluding TC, did not significantly differ from the overall trend that includes TC. This suggests that, although TC is a distinct entity, its inclusion does not impact on our primary conclusions regarding the global burden of HNC research.

Global trends by SDI

Based on an analysis of data from 1990 to 2021, the overall incidence, deaths, and DALYs have shown year-on-year increases, irrespective of the district’s SDI level (Fig. 2A). However, the respective growth rates are characterized by variations across regions with different SDI levels. Specifically, regions with high SDI levels have maintained a higher growth rate compared to other regions, exhibiting fluctuations over time. In contrast, regions with low and middle SDI levels lag behind the high SDI regions in terms of growth rate, although their growth rates have significantly increased over the last decade. This upward trend in growth rates is also evident in both medium and low SDI regions. Notably, the growth rate in the high-middle SDI region has remained relatively stable. Conversely, ASDR and age-standardized DALYs exhibit similar trends, with stable growth patterns observed in low and medium SDI regions. In contrast, the growth trend for both metrics has decreased in the remaining SDI regions (Fig. 2B).

Fig. 2.

Trends in the disease burden of HNC from 1990 to 2021 by different SDI level regions. A Trends in incidence, deaths and DALYs of HNC from 1990 to 2021 by different SDI level regions. B Trends in ASIR, ASDR and age-standardized DALYs of HNC from 1990 to 2021 by different SDI level regions.ASIR, age-standardized incidence rate; ASR, Age-Standardized Rate; ASDR, age-standardized death rate; DALYs, disability-adjusted life years; SDI, socio-demographic index

Figure 3 presents a comprehensive analysis of the trends in ASIR, ASDR, and age-standardized DALYs in relation to SDI from 1990 to 2021, both globally and across the 21 GBD regions. The fitted curves derived from the data indicate that the relationship between the age-standardized indicators of disease burden and the SDI is not uniform and varies significantly by geographic region. Notably, the results reveal that South Asia exhibits markedly higher levels of SDI, ASDR, and age-standardized DALYs compared to other regions worldwide.

Fig. 3.

Trends in ASIR, ASDR, age-standardized DALYs for the burden of HNC across Global and 21 GBD regions by SDI from 1990 to 2021. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALYs, disability-adjusted life years; SDI, socio-demographic index

Burden trends on sex

Table 1 presents the differences in ASIR, ASDR, and age-standardized DALYs between males and females, indicating that males outnumber females in both 1990 and 2021. Concurrently, a more pronounced downward trend in ASDR and age-standardized DALYs was observed in men compared to women. The EAPC of ASDR was − 0.43 (95% CI: [−0.49, −0.36]) for females and − 0.72 (95% CI: [−0.81, −0.64]) for males. In terms of age-standardized DALYs, the EAPC was − 0.5 (95% CI: [−0.57, −0.43]) for females and − 0.79 (95% CI: [−0.88, −0.7]) for males. However, the EAPC of AISR exhibited a different trend between the sexes, with a value of 0.36 (95% CI: [0.31, 0.41]) for females and − 0.03 (95% CI: [−0.12, 0.06]) for males.

Burden trends by sex and SDI

Trends in the incidence, mortality, and DALYs for HNC among males and females across different SDI regions are depicted separately in Fig. 4A. The overall trends demonstrate a consistent increase from 1990 to 2021. Regions with high SDI exhibit a higher incidence of cases, while regions with intermediate SDI show elevated mortality risks and DALYs. In contrast, the low SDI region maintains relatively minimal levels of incidence, mortality, and DALYs. When examining ASIR, ASDR, and age-standardized DALYs, distinct gender differences emerge, as illustrated in Fig. 4B. The ASIR indicates a significant upward trend for females in both the low-middle and low SDI regions, whereas the male group in these regions exhibits relatively stable rates. Notably, the male group in the high-middle SDI region shows a significant downward trend in ASIR. Regarding ASDR, a marked decline is observed for females in the middle SDI region, while other regions remain relatively stable. Conversely, the high-middle SDI region for males demonstrates the most substantial downward trend. Regardless of gender, age-standardized DALYs reflect trends consistent with those observed in ASDR.

Fig. 4.

Trends in disease burden of HNC across SDI level regions by gender from 1990 to 2021. A The trends in incidence, death and DALYs of HNC across SDI level regions by gender from 1990 to 2021. B The trends in ASIR, ASDR and age-standardized DALYs of HNC across SDI level regions by gender from 1990 to 2021. ASIR, age-standardized incidence rate; ASR, age-standardized rate; ASDR, age-standardized death rate; DALYs, disability-adjusted life years; SDI, socio-demographic index

Burden trends by sex and age (≥ 60 years old)

Regardless of gender, both incidence rates and DALYs were higher in the 60 to 64-year-old subgroup compared to the other subgroups. For mortality rates, both sexes exhibited the highest figures in the 65 to 69-year-old subgroup. Figure 5 visualizes the rates of incidence, deaths, and DALYs. The ASIR shows a significant decrease in males from the 90 to 94-year-old subgroup to the 95 years and older subgroup, while it maintained an increasing trend prior to this age range. In contrast, the female group exhibited a gradual increase in ASIR with advancing age. Regarding the ASDR, there is a slight decline in males from the 90 to 94-year-old subgroup to the 95 + year-old subgroup, although an overall upward trend persists. In the female subgroup, ASDR continues to exhibit a slow increasing trend with age. Among age-standardized DALYs, males generally demonstrated a significant downward trend, while the female group remained relatively stable, with only a slight elevation observed in the older age subgroups.

Fig. 5.

Trends in ASIR, ASDR, age-standardized DALYs for the burden of HNC in different age groups (60 to 95+, 5-year interval) by gender in 2021. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALYs, disability-adjusted life years; SDI, socio-demographic index

Subtypes of HNC

Figure 6 illustrates the incidences of HNC subtypes alongside their respective ASIR, mortality rates, ASDR, DALYs, and age-standardized DALYs from 1990 to 2021. Notably, LOC consistently represented a larger proportion of cases during this period, with an ASIR of 19.66 (95% UI: [18.42, 20.69]) in 1990 and 23.13 (95% UI: [20.9, 24.86]) in 2021, remaining higher than that of other HNC subtypes. LC ranked second in incidence following the LOC; however, its ASIR exhibited a gradual decline, from 15.16 (95% UI: [14.24, 16.05]) in 1990 to 12.25 (95% UI: [11.27, 13.25]) in 2021. with a specific EAPC of −0.83 (95% CI: [−0.91, −0.75]).This trend is also observed in mortality rates and DALYs.

Fig. 6.

Trends in disease burden of HNC subtypes from 1990 to 2021. A Trends in incidence and ASIR of HNC across different age groups (5-year intervals) by gender in 2021. B Trends in deaths and ASDR of HNC across different age groups (5-year intervals) by gender in 2021. C Trends in DALYs and age-standardized DALYs of HNC across different age groups (5-year intervals) by gender in 2021. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALYs, disability-adjusted life years

The changes in ASR are as follows: the EAPC for NC and LC were − 1.31 (95% CI: [−1.51, −1.11]) and − 0.83 (95% CI: [−0.91, −0.75]), respectively, making them the only HNC showing a declining trend in ASIR. As for ASDR and age-standardized DALYs, only OPC exhibited an upward trend, with EAPC of 0.32 (95% CI: [0.24, 0.39]) and 0.41 (95% CI: [0.33, 0.48]), respectively.

Influence of risk factors on the burden of HNC

In our investigation of the risk factors for HNC, we focused on tobacco use, alcohol consumption, occupational exposures and high body mass index (BMI). Tobacco use and alcohol consumption are significant risk factors for HNC, particularly in regions including East Asia, South Asia, and Central Europe (Fig. 7). In South Asia, tobacco use is linked to a staggering increase of up to 350% in the risk of lip and oral cavity cancers, while alcohol consumption further contributes an additional 66.3% to this risk. This underscores the synergistic role of both substances in carcinogenesis. Furthermore, the relationship between high BMI and HNC, such as TC, is notably pronounced in high-income regions, including North America and high-income Asia-Pacific countries.

Fig. 7.

Proportion of global HNC attributable to tobacco use, alcohol intake , BMI, and occupational risk

BAPC prediction of the ASIR, ASDR and dalys

Figure 8A presents projections for 2050 regarding the incidence, DALYs, and mortality associated with HNC, along with the respective annual standardized rates stratified by gender. The total incidence, DALYs, and deaths are expected to rise significantly. In analyzing future trends for both males and females, the ASIRs are anticipated to remain stable, while the annual standardized DALYs and ASDR are projected to decline. However, a notable upward trend in ASIR, age-standardized DALYs, and ASDR for both sexes is expected post-2040, indicating that the burden of HNC will persist as a significant health concern in the future. Figure 8B provides detailed information on specific types of HNC, such as LC, which generally align with the overall trends observed in HNC.

Fig. 8.

Future GBD Projections of Morbidity, DALYs and Mortality for HNC. A Future GBD Projections of Morbidity, DALYs and Mortality for HNC B Future GBD Projections of Incidence, DALYs, and Mortality for different subtypes of HNC

Discussion

This research represents the first attempt to analyze the impact of HNC on individuals aged 60 and above, both globally and regionally, covering the period from 1990 to 2021, with a breakdown by age, sex, and SDI. The findings reveal a considerable rise in the occurrence of HNC among the elderly demographic worldwide, while death rates and DALYs have significantly declined, demonstrating marked differences based on age, gender, SDI, and geographical locations. These results underscore the critical necessity for enhanced awareness, prompt diagnosis, and effective intervention strategies to mitigate the effects of HNC on the aging global population.

Over the past 30 years, the ASIR of HNC among the elderly has shown a continuous global increase. Compared to 1990, the total number of cases has risen by 238%, while the ASIR has increased by 106%, reflecting the epidemiology of HNC. The observed trend indicates that various interventions undertaken by global health organizations over the last thirty years have not succeeded in reducing the disease burden experienced by elderly patients. Our projections indicate that the number of HNC cases in this demographic will increase by 1.15 times by 2050, posing a significant challenge for the formulation and adaptation of global health policies. Risk factor analysis reveals that the rise in ASIR is closely linked to exposure to smoking, alcohol consumption, occupational hazards, and high BMI. The escalation of risky behaviors, particularly smoking and alcohol consumption, significantly contributes to the increased incidence of HNC [24]. Previous studies have indicated that global per capita alcohol consumption among adults rose from 5.9 liters (95% CI: 5.8–6.1) in 1990 to 6.5 liters (95% CI: 6.6–6.9) in 2017, with projections suggesting a reach of 7.6 liters (95% CI: 6.5–10.5) by 2030 [25]. Additionally, the number of smokers in 2019 increased by 240 million compared to 1990 (900 million) [26]. Therefore, government agencies should implement appropriate public health policies and adopt targeted intervention measures, such as public health campaigns and restrictions on the supply of alcohol and tobacco, to mitigate these behaviors. It is noteworthy that over the past decade, the use of e-cigarettes has experienced explosive growth, particularly in European and American countries. E-cigarettes contain various potential carcinogens, including formaldehyde, acetaldehyde, heavy metals (such as nickel and lead), and nitrosamines, all of which can be considered potential risk factors for HNC. Furthermore, the duration of e-cigarette use is significantly longer than that of conventional cigarettes, which increases the dose of inhaled carcinogens and cytotoxins [27–29]. Although the risk of e-cigarettes for HNC has not yet been fully quantified, existing evidence has outlined a clear threat profile: the mechanisms of carcinogen release and tissue damage may elevate the incidence of HNC in the next 10 to 20 years. Public health policies must abandon the passive strategy of ‘harm reduction substitution’ and shift towards active control and cessation support to prevent new tobacco products from triggering a new wave of HNC. Human Papillomavirus (HPV) infection is one of the potential factors contributing to the rising prevalence of HNC [30]. Expanding vaccination efforts against HPV could effectively reduce the incidence of HNC, particularly in regions with low economic levels and poor sanitary conditions. Additionally, advances in screening technologies, such as endoscopy [31], narrow-band imaging [32], and imaging techniques like CT and MRI [33], have significantly contributed to the increase in ASIR. These advancements have led to an increase in diagnoses, resulting in the persistently high prevalence of HNC. However, regions with limited access to healthcare continue to exhibit high incidence rates. Therefore, future research should emphasize further innovation in screening technologies and enhance global accessibility to mitigate the growing incidence of HNC. The aging population has resulted in a rise in the diagnosis of HNC among elderly patients. Additionally, the prevalence of comorbidities, disabilities, geriatric syndromes, and social issues complicates treatment planning and management for this demographic [34].

Although the ASIR of HNC in the elderly is on the rise, both the ASDR and DALYs exhibit a downward trend. Currently, this trend is believed to be primarily attributed to two major factors. Firstly, the mortality rate of HNC is closely related to tumor stage as well as recurrence or metastasis [24]. Early screening and timely treatment of lesions can effectively reduce the mortality rate associated with HNC [35]. Secondly, This trend can largely be attributed to significant advancements in various anti-tumor treatment methods, including surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Each of these modalities has enhanced overall outcomes for patients suffering from HNC. As these innovative strategies have evolved, they have collectively transformed the landscape of care, resulting in better survival rates and improved quality of life for individuals affected by this disease [36]. In a phase 3 clinical trial involving 247 patients with advanced HNC, the majority of participants were over 60 years old. The median overall survival in the traditional chemotherapy group (methotrexate, docetaxel, or cetuximab) was 6.9 months, which was lower than that in the pembrolizumab treatment group (8.4 months) [37]. The combination of pembrolizumab and chemotherapy also yielded favorable outcomes. These advancements in treatment have effectively controlled tumor progression, reduced patient mortality, and enhanced quality of life. However, our projections indicate that by 2040, both the ASDR and DALYs for HNC in the elderly population are expected to trend upward. Therefore, continuous monitoring is essential to maintain the downward trend of ASDR and DALYs across various regions and populations. Furthermore, future studies should prioritize enhancing the accessibility of advanced treatment options in regions with inadequate healthcare infrastructure.

The disease burden of HNC among the elderly exhibits significant regional disparities. Our research indicates that, compared to regions with low-middle SDI levels, the age-standardized incidence rate of HNC shows a more pronounced increase in high SDI regions. Various social factors, including economic status, educational attainment, and healthcare resources, collectively contribute to the emergence of these disparities. Specifically, lower economic levels are associated with reduced access to early screening and treatment, resulting in delayed diagnoses and poor prognoses. Populations in regions with low SDI levels often have lower educational attainment and insufficient awareness of risk factors such as HPV vaccination, alcohol consumption, and tobacco use, which further exacerbate the increased incidence and mortality rates of HNC. Therefore, it is imperative to implement targeted healthcare interventions in low to middle SDI regions to mitigate the incidence and mortality of HNC. Notably, we found that the ASIR, ASDR, and age-standardized DALYs in South Asia are significantly higher than in other regions. This disparity is attributed to high-risk behaviors prevalent in South Asia, such as tobacco chewing, smoking, and hookah use, along with genetic predisposition, dietary habits characterized by high consumption of salt and preserved foods, scarcity of medical resources, and inadequate public health policies [38–40]. Therefore, to effectively diminish the burden of HNC in this region, it is crucial to improve medical conditions, enhance early diagnosis, raise public health awareness, and strengthen preventive and control measures. It is crucial to consider these regional disparities when formulating health policies and interventions aimed at reducing disease burdens and improving overall public health.

Our research indicates that there are gender differences in the ASIR, ASDR, and DALYs of elderly HNC patients, with males consistently exhibiting higher rates than females. The age-standardized incidence rate peaks in the age group of 90 to 94 years. However, the incidence and mortality rates among elderly female HNC patients show an upward trend, with the annual increase in incidence rate for females (0.36; 95% CI: 0.31–0.41) surpassing that of males (0.03; 95% CI: −0.12–0.06), which aligns with previous research findings [41]. This phenomenon may be associated with factors such as differences in sex hormones, genetic susceptibility, environmental exposure, and lifestyle habits. Previous studies have suggested that estrogen may reduce the incidence of HNC [42]; however, the mere fact that women have higher estrogen levels than men cannot fully account for this phenomenon. Excessive alcohol consumption and Smoking are major risk factors for HNC [43, 44], particularly oral and laryngeal cancers, with men being more likely to engage in these habits compared to women. Although smoking rates among men have declined with increased public health awareness, smoking and drinking remain more prevalent among older men. Additionally, men have traditionally been more involved in occupations that expose them to harmful chemicals, such as construction, agriculture, and manufacturing. For instance, exposure to hazardous substances like asbestos is associated with an increased risk of HNC. Therefore, gender-specific interventions may be necessary to address these risks. Our findings indicate that the onset of HNC in elderly individuals predominantly occurs between the ages of 60 and 74. Therefore, it is crucial to enhance screening efforts targeted at this age group.

Among various types of HNC, LOC constitutes the largest proportion, and the ASIR exhibits an upward trend, aligning with findings from previous studies [8]. The incidence of LC ranks second to LOC, and over the past 30 years, the ASIR, ASDR, and DALYs associated with LC have all demonstrated a downward trend. Our predictions corroborate these findings. This trend is believed to be closely associated with several factors, including the implementation of early screening for LC, strategies aimed at larynx preservation, tobacco control policies, increased consumption of coffee and tea, HPV vaccination, and the introduction of novel anti-tumor therapies [45, 46]. In future screenings for HNC among elderly patients, it is imperative to enhance screening efforts specifically for LOC and LC.

While our study offers valuable insights into the global burden of HNC among the elderly, it has some limitations [12, 47, 48]. Firstly, the inadequacies of health information systems in low- and middle-income countries may compromise data accuracy, resulting in missing or erroneous key data, such as causes of death and disease incidence rates. In regions with limited diagnostic infrastructure, cancer subtypes may be misclassified, thereby obscuring true epidemiological patterns, particularly in cancers characterized by distinct molecular subtypes. This misclassification could lead to an underestimation of incidence and mortality trends. Secondly, the models employed in the GBD study rely on specific assumptions that may not accurately capture changes in public health interventions, overdiagnosis, and cohort effects. Furthermore, GBD primarily focuses on population-level data, making it challenging to adjust for individual-level confounding factors, such as comorbidities, treatment modalities, and tumor stages, which limit the accuracy of causal inferences. Lastly, although the SDI provides valuable stratification information, it does not fully encompass the social determinants of health, particularly among groups affected by systemic marginalization. Future research should aim to enhance data collection and modeling techniques to conduct in-depth analyses of risk factors, thereby improving the accuracy and efficacy of studies and providing stronger support for the prevention and treatment of HNC.

Conclusion

The increase in the global incidence of HNC contrasts with the overall decrease in mortality and disease burden, highlighting significant regional disparities. These variations may be attributed to differing levels of healthcare access, varying risk factors, and the effectiveness of public health policies. The elevated ASDR and DALYs in South Asia indicate that risk factors such as tobacco use, HPV infection, and healthcare accessibility significantly contribute to the burden of HNC, alongside economic considerations. While the incidence, mortality, and DALYs related with HNC are generally higher in men, recent interventions such as smoking cessation programs and HPV vaccination may have disproportionately benefited this demographic. Conversely, the rising incidence of HNC among women, particularly in low SDI regions, is concerning. Furthermore, the disease burden is predominantly observed in the 60–69 age group, underscoring the need for targeted screening efforts in this demographic, while also maintaining a focus on older female patients. Tobacco and alcohol consumption are major drivers of HNC, particularly in Asia and Europe. Additionally, a high BMI shows strong links to TC in high-income regions. The future global burden of disease from HNC should not be underestimated; thus, targeted interventions, improved public health measures, and enhanced data accuracy will be critical for effectively addressing this growing problem.

Authors’ contributions

Xianglong Li and Zhong Du: Conceptualization, Data curation, Formal analysis, Investigation, Visualization, Writing – original draft, and Writing – review & editing; Wen Tan, Shuang Wu and Chenxi Wang: Conceptualization, Data curation, Formal analysis, Investigation and Methodology; Yujie Pan, Fengnian Han and Guoxu Wang: Investigation, Methodology, Resources and Software; Wangying Xie, Man Zhu, and Ling Han: Conceptualization, Data curation, Formal analysis, Software and Validation; Xi Zhang and Qingyu Zhou: Funding acquisition, Supervision, Writing – original draft, and Writing – review & editing. All authors approved the final manuscript for submission.

Funding

Zhejiang Province Anti-Cancer Association-Qilu Cancer Prevention and Control Clinical Research Special Fund Project (zjskaxhqllckyxm202208).

Data availability

Data resources from the GBD study 2021 could be accessed online through the GHDx query tool (http://ghdx.healthdata.org/gbd-results-tool).

Declarations

Ethics approval and consent to participate

Not applicable, as this research is based on secondary data available in the public domain with no individual identifiers.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.