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. 2026 May 24;152(7):146. doi: 10.1007/s00432-026-06514-9

The burden of nasopharyngeal carcinoma in countries of the Association of Southeast Asian Nations (ASEAN), 1990–2023: findings from the Global Burden of Disease Study 2023

Lijun Cheng 1, Jianxin Dong 1, Jun Li 1,✉
PMCID: PMC13388621  PMID: 42177696

Abstract

Background

Nasopharyngeal carcinoma (NPC) remains a major cancer burden in parts of Asia, particularly in the Association of Southeast Asian Nations (ASEAN). However, the burden and trends within ASEAN have not been comprehensively explored.

Methods

We extracted data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of NPC in ASEAN from the Global Burden of Disease Study (GBD) 2023. We summarized absolute counts, crude rates, and age-standardized rates, and quantified temporal trends using estimated annual percentage changes (EAPCs). Analyses were stratified by sex, age group, and Sociodemographic Index (SDI). Associations between SDI and age-standardized rates were examined using Spearman correlation and smoothing spline models.

Results

In 2023, NPC in ASEAN accounted for 17,077 (95% UI: 12,742–22,109) incident cases, 65,845 (95% UI: 46,258–90,557) prevalent cases, 12,422 (95% UI: 9,657–15,413) deaths, and 435,087 (95% UI: 335,841–542,950) DALYs. Compared with 1990, the corresponding counts increased by 189%, 222%, 155%, and 141%, respectively. From 1990 to 2023, the age-standardized incidence and prevalence rate increased; whereas the age-standardized mortality rate declined slightly, and the age-standardized DALY rate remained stable. The burden was higher in males than in females and was concentrated in adults aged 45–59 years. Clear heterogeneity was observed across member states and SDI levels.

Conclusions

NPC remains a major public health challenge in ASEAN. The overall burden continues to rise, with clear disparities between countries and higher impact among males and middle-aged adults. ASEAN countries should work together to reduce the regional burden of NPC.

Keywords: Nasopharyngeal carcinoma, ASEAN, Global Burden of Disease Study, Epidemiology, Disability-adjusted life years, Sociodemographic index

Introduction

Nasopharyngeal carcinoma (NPC) is a distinctive malignancy with a pronounced geographic concentration (Su et al. 2024). Although relatively uncommon worldwide, it occurs disproportionately in Asia, particularly in East and Southeast Asia (Zhou et al. 2025). According to GLOBOCAN 2022, there were an estimated 120,434 new NPC cases and 73,482 related deaths worldwide in 2022, with more than 83% of both occurring in Asia (Global Cancer Observatory 2024). Because early symptoms are often non-specific and the primary tumour is located in a relatively inaccessible anatomical site, many patients are diagnosed with locoregionally advanced disease, contributing substantially to mortality, disability, and treatment burden in endemic areas (Su et al. 2024, King et al. 2024). Accordingly, the public health impact of NPC is best assessed not only by incidence but also by indicators such as mortality and disability-adjusted life years (DALYs).

Within the global landscape of NPC, the member states of the Association of Southeast Asian Nations (ASEAN) represent a particularly important high-burden region for NPC surveillance. Several countries in Southeast Asia, including Indonesia, Malaysia, Singapore, Viet Nam, the Philippines, and Thailand, continue to report relatively high incidence rates (Chan et al. 2025). At the same time, the regional burden is not uniform. Population-based studies from Sarawak, Malaysia, have shown marked ethnic variation, with the Bidayuh population having one of the highest reported incidence rates worldwide (Wong et al. 2023). Similar ethnic heterogeneity, together with a clear male predominance, has also been reported in Sabah (Wong et al. 2021). Clinical outcomes likewise vary across the region. For example, a hospital-based cohort from Indonesia reported poor overall survival, particularly among patients diagnosed at an advanced stage (Hutajulu et al. 2021). Together, these observations indicate that ASEAN should not be considered a single epidemiological entity.

Previous burden studies, including those based on the Global Burden of Disease Study (GBD) 2021, have primarily focused on global, continental, or national estimates (Wu et al. 2025, Cui et al. 2025). ASEAN-specific patterns have received less attention, despite the region’s wide variation in sociodemographic development, population ageing, cancer registration, diagnostic capacity, and cancer care infrastructure. GBD 2023 provides updated estimates derived from cancer registries, vital registration systems, and other sources, allowing a more current comparison of NPC burden across time and place (Collaborators 2025).

In this study, we used GBD 2023 estimates to describe the spatiotemporal patterns of NPC incidence, prevalence, mortality, and DALYs across ASEAN member states from 1990 to 2023. We also examined variation by sex, age, and sociodemographic development. Our aim was to provide updated epidemiological evidence to support more targeted approaches to NPC prevention and control in ASEAN.

Methods

Data source

Data were obtained from the GBD 2023 Results Tool (vizhub.healthdata.org/gbd-results/), released by the Institute for Health Metrics and Evaluation (IHME) in 2025. GBD 2023 synthesized information from more than 300,000 data sources, including vital registration systems, surveys, disease registries, and published studies, to estimate the burden of 375 diseases and injuries across 204 countries and territories. The database provides disease-specific estimates of incidence, prevalence, mortality, and DALYs by age, sex, year, and location (Collaborators 2025).

DALYs were defined as the sum of years lived with disability (YLDs) and years of life lost (YLLs). YLDs were estimated by multiplying the prevalence of each sequela, or the duration and nature of injury, for each cause–age–sex–location–year combination by the corresponding disability weight. YLLs were calculated by multiplying the number of deaths for each cause–age–sex–location–year combination by the standard life expectancy at the age of death (Collaborators 2025, Collaborators and GDaIaRF 2025).

Data collection

We extracted data on nasopharyngeal carcinoma for ASEAN and its 11 member states from 1990 to 2023. Outcomes of interest included incidence, prevalence, mortality, and DALYs. Measures included absolute counts, crude rates, and age-standardized rates (ASRs): the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR). Analyses were stratified by sex and by 20 age groups, from younger than 5 years to 95 years and older in 5-year intervals. To minimize the effects of population growth and population ageing, temporal comparisons were based primarily on ASRs per 100,000 population. All estimates were reported with 95% uncertainty intervals (UIs).

Statistical analysis

Temporal trends in ASRs were assessed using the estimated annual percentage change (EAPC). Assuming a log-linear relationship between the ASR and calendar year, we fitted the following model:

graphic file with name d33e346.gif

where ln(ASR) denotes the natural logarithm of the ASR, α is the intercept, β is the regression coefficient representing the annual change in ln(ASR), X denotes calendar year, and ε is the random error term. The EAPC was calculated as:

graphic file with name d33e352.gif

ASR was considered to be increasing when both the EAPC and the lower bound of its 95% confidence interval (CI) were greater than 0, and decreasing when both the EAPC and the upper bound of its 95% CI were less than 0.

We further examined the association between ASRs and the Sociodemographic Index (SDI) across the 11 ASEAN member states from 1990 to 2023 using Spearman’s rank correlation analysis. To explore potential non-linear relationships, smoothing spline models were fitted to visualize the association between SDI and NPC burden.

All analyses were conducted using R software (version 4.5.3). P < 0.05 was considered statistically significant.

Results

Overall burden and temporal trends in ASEAN

In 2023, ASEAN recorded 17,077 (95% UI: 12,742–22,109) incident cases, 65,845 (95% UI: 46,258–90,557) prevalent cases, 12,422 (95% UI: 9657–15,413) deaths, and 435,087 (95% UI: 335,841–542,950) DALYs attributable to NPC. Compared with 1990, the corresponding counts increased by 189%, 222%, 155%, and 141%, respectively. At the regional level, the ASIR and ASPR increased from 1990 to 2023, whereas the ASMR declined slightly and the ASDR remained stable (Table 1). The corresponding EAPCs were 0.4 (95% CI 0.3 to 0.4) for ASIR, 0.9 (95% CI 0.8 to 0.9) for ASPR, − 0.2 (95% CI −0.2 to − 0.1) for ASMR, and − 0.0 (95% CI −0.1 to 0.0) for ASDR.

Table 1.

Incidence, prevalence, mortality, and DALYs of nasopharyngeal carcinoma in ASEAN countries, and their EAPCs from 1990 to 2023

Location Incidence Prevalence Mortality DALYs
Number of cases, 2023 ASR, 2023 EAPC, 1990–2023 Number of cases, 2023 ASR, 2023 EAPC, 1990–2023 Number of cases, 2023 ASR, 2023 EAPC, 1990–2023 Number of cases, 2023 ASR, 2023 EAPC, 1990–2023
ASEAN 17,077 (12742, 22109) 2.3 (1.7, 2.9) 0.4 (0.3,0.4) 65,845 (46258, 90557) 8.7 (6.1, 12.0) 0.9 (0.8,0.9) 12,422 (9657, 15413) 1.7 (1.3, 2.1) − 0.2 (− 0.2, − 0.1) 435,087 (335841, 542950) 56.8 (43.8, 70.8) − 0.0 (− 0.1,0.0)
Male 11,816 (8601, 16074) 3.3 (2.4, 4.4) 0.4 (0.4,0.5) 44,717 (30849, 64709) 12.2 (8.4, 17.5) 1.0 (0.9,1.0) 8738 (6380, 11228) 2.5 (1.8, 3.2) − 0.1 (− 0.1, − 0.0) 305,774 (219680, 395291) 81.7 (58.7, 105.3) 0.0 (− 0.0,0.1)
Female 5261 (3489, 7559) 1.4 (0.9, 2.0) 0.1 (0.1,0.2) 21,128 (13256, 31939) 5.5 (3.5, 8.4) 0.7 (0.6,0.7) 3685 (2543, 5200) 1.0 (0.7, 1.4) − 0.4 (− 0.5, − 0.4) 129,313 (87657, 183548) 33.3 (22.6, 47.2) − 0.3 (− 0.4,-0.2)
Brunei Darussalam 19 (13, 26) 3.9 (2.6, 5.5) − 0.2 (− 0.3,− 0.2) 92 (58, 147) 18.3 (11.4, 29.3) 0.3 (0.2,0.4) 10 (7, 12) 2.1 (1.6, 2.6) − 1.1 (− 1.1, − 1.0) 336 (261, 417) 65.3 (51.0, 80.9) − 0.9 (− 1.0,− 0.9)
Cambodia 210 (145, 297) 1.3 (0.9, 1.9) − 0.7 (− 0.8,− 0.5) 685 (458, 1020) 4.2 (2.8, 6.2) − 0.7 (− 0.9, − 0.5) 180 (124, 254) 1.2 (0.8, 1.7) − 0.6 (− 0.7, − 0.5) 6429 (4375, 9014) 39.8 (27.1, 56.1) − 1.2 (− 1.3,− 1.0)
Indonesia 5163 (3563, 7124) 1.7 (1.2, 2.3) 0.8 (0.6,0.9) 17,157 (11782, 25263) 5.4 (3.7, 7.9) 1.0 (0.9,1.2) 4306 (3045, 5878) 1.4 (1.0, 2.0) 0.5 (0.3,0.6) 155,927 (110007, 212137) 48.9 (34.6, 66.3) 0.7 (0.6,0.9)
Lao People’s Democratic Republic 125 (85, 173) 2.0 (1.4, 2.8) 0.7 (0.5,0.9) 399 (264, 585) 6.1 (4.1, 8.8) 0.9 (0.6,1.1) 107 (72, 145) 1.8 (1.2, 2.5) 0.5 (0.4,0.7) 3940 (2663, 5369) 60.9 (41.1, 83.2) 0.5 (0.3,0.7)
Malaysia 1094 (849, 1363) 3.2 (2.5, 3.9) − 1.0 (− 1.2,− 0.8) 3849 (2794, 5225) 10.7 (7.8, 14.5) − 0.5 (− 0.6,− 0.3) 870 (697, 1028) 2.6 (2.1, 3.1) − 1.4 (− 1.6,− 1.2) 27,794 (22054, 33568) 79.0 (63.0, 95.1) − 1.3 (− 1.5,− 1.1)
Myanmar 1104 (760, 1484) 2.0 (1.4, 2.7) − 0.4 (− 0.5,− 0.2) 3400 (2244, 4966) 6.0 (3.9, 8.7) − 0.3 (− 0.5,− 0.1) 968 (666, 1287) 1.8 (1.3, 2.4) − 0.5 (− 0.6,− 0.3) 33,065 (22869, 44858) 58.3 (40.3, 79.0) − 0.6 (− 0.8,− 0.4)
Philippines 1582 (1267, 1922) 1.6 (1.3, 1.9) − 0.0 (− 0.2,0.1) 5347 (4106, 6903) 5.1 (4.0, 6.5) − 0.0 (− 0.1,0.1) 1313 (1048, 1564) 1.4 (1.1, 1.7) − 0.1 (− 0.2,0.1) 46,175 (36734, 54957) 44.8 (35.7, 53.3) − 0.1 (− 0.2,0.0)
Singapore 1212 (763, 1653) 14.2 (9.0, 19.3) 0.2 (− 0.0,0.5) 7888 (4995, 11021) 93.5 (60.4, 129.3) 1.1 (0.8,1.4) 206 (180, 235) 2.3 (2.0, 2.6) − 3.4 (− 3.6,− 3.1) 6000 (5231, 6922) 69.5 (60.8, 79.3) − 3.6 (− 3.8,− 3.4)
Thailand 1944 (1575, 2490) 2.1 (1.6, 2.7) 0.0 (− 0.2,0.3) 7642 (5541, 10780) 8.9 (6.3, 13.0) 1.0 (0.8,1.3) 1404 (1159, 1686) 1.3 (1.1, 1.6) − 0.9 (− 1.1,− 0.6) 44,428 (36060, 54221) 45.2 (37.9, 55.3) − 0.7 (− 1.0,− 0.4)
Timor-Leste 17 (11, 25) 1.6 (1.1, 2.4) − 0.1 (− 0.3,0.1) 58 (37, 89) 5.2 (3.3, 7.8) 0.2 (− 0.0,0.5) 14 (10, 20) 1.4 (1.0, 2.0) − 0.3 (− 0.5,− 0.1) 506 (350, 699) 46.8 (32.2, 65.2) − 0.1 (− 0.4,0.1)
Viet Nam 4607 (3057, 6555) 3.9 (2.6, 5.6) 0.6 (0.4,0.8) 19,328 (11998, 30242) 16.5 (10.2, 25.8) 1.2 (1.0,1.5) 3046 (2081, 4152) 2.6 (1.8, 3.5) − 0.1 (− 0.2,0.1) 110,487 (76351, 150495) 92.4 (63.7, 125.8) − 0.1 (− 0.2,0.1)
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In ASEAN, males had a higher NPC burden than females in 2023 (Table 1). Males accounted for 11,816 incident cases, 44,717 prevalent cases, 8,738 deaths, and 305,774 DALYs, compared with 5,261 incident cases, 21,128 prevalent cases, 3,685 deaths, and 129,313 DALYs in females. ASRs were also higher in males than in females for incidence (3.3 vs. 1.4 per 100,000), prevalence (12.2 vs. 5.5), mortality (2.5 vs. 1.0), and DALYs (81.7 vs. 33.3). From 1990 to 2023, the incidence and prevalence of NPC increased more rapidly among males than among females in ASEAN, while deaths and DALYs attributable to NPC declined more sharply among females than among males (Table 1).

Cross-country and sex-specific comparison of burden

From 1990 to 2023, among the 11 member countries, Singapore consistently had the highest ASIR and ASPR for NPC, both of which showed an upward trend. However, Singapore’s ASMR and ASDR for NPC continued to decline significantly. Although Malaysia and Vietnam had ASIR and ASPR for NPC that were far lower than Singapore’s, they had the highest ASMR and ASDR (Fig. 1). Among the 11 member countries, Thailand, Vietnam, Timor-Leste, and Brunei exhibited trends in NPC burden similar to those of Singapore, namely, rising ASIR and ASPR, and declining ASMR and ASDR. Meanwhile, all four metrics showed a downward trend in Cambodia, Malaysia, and Myanmar. In contrast, the NPC burden showed an upward trend in Indonesia and the Lao People’s Democratic Republic (Fig. 1).

Fig. 1.

Fig. 1

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Age-standardized incidence, prevalence, mortality, and DALY rates for NPC in ASEAN countries from 1990 to 2023, and their EAPCs

In all ASEAN member states, males had higher ASIR, ASPR, ASMR, and ASDR of NPC than females in 2023 (Fig. 2). The magnitude of this sex disparity varied across countries. The disparity in the burden of NPC between males and females was substantial in Malaysia, Singapore, and Thailand, whereas it was smaller in Timor-Leste, the Lao People’s Democratic Republic, and Cambodia. In most member states, the trends in the burden of NPC were consistent between males and females. Notably, in the Philippines, the burden of NPC increased among males but decreased among females. Conversely, in Timor-Leste, the burden increased among females but decreased among males.

Fig. 2.

Fig. 2

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Sex-specific age-standardized incidence, prevalence, mortality, and DALY rates for NPC across ASEAN countries from 1990 to 2023, and their EAPCs

Age-specific burden of NPC in ASEAN

Age-specific analyses showed that the absolute burden of NPC was concentrated in adults aged 45–64 years, and the male-female disparity in burden was most pronounced in this age range (Fig. 3). Across all four indicators, counts increased from early adulthood, peaked in middle age or early older age, and then declined in the oldest age groups. Age-specific rates remained relatively high into older age groups, particularly among males. For incidence, prevalence, and DALYs, the peak age occurred approximately 5–10 years earlier in females than in males.

Fig. 3.

Fig. 3

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Incidence, prevalence, mortality, and DALYs of NPC by sex and age group in ASEAN countries, 2023. Error bars and shaded areas represent 95% uncertainty intervals

Age-specific temporal trends showed distinct patterns across indicators and countries (Fig. 4). In the ASEAN region, the incidence of NPC declined among children younger than 15 years and older adults aged 65–84 years, whereas it increased among adults aged 15–64 years and those aged 85 years and above. The prevalence has decreased among children under 10 years, remained stable among those aged 10–14 years, but increased in all other age groups, with the largest increase observed among those aged over 80 years (Fig. 4A, B). In contrast, at the regional level, the EAPCs for mortality and DALYs were negative for most age groups except for those aged 25–59 years (Fig. 4C, D).

Fig. 4.

Fig. 4

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Age-specific EAPC in incidence, prevalence, mortality, and DALY rates for ASEAN countries from 1990 to 2023. A Age-specific EAPC in incidence rates. B Age-specific EAPC in prevalence rates. C Age-specific EAPC in death rates. D Age-specific EAPC in DALY rates

At the national level, the incidence and prevalence of NPC in Indonesia, Thailand, Timor-Leste, and Viet Nam generally showed an upward trend among young and middle-aged adults, particularly those aged 20–59 years, while a downward trend was generally observed among those aged 65 years and older. In contrast, Cambodia, Malaysia, and Myanmar showed declining or only slightly rising trends across most age groups (Fig. 4A, B). In terms of mortality and DALYs, the upward trends in Indonesia, the Lao People’s Democratic Republic, Timor-Leste, and Viet Nam are primarily concentrated among people aged 25–64 years. In contrast, mortality and DALYs decreased across most age groups in Brunei Darussalam, Malaysia, Myanmar, Thailand, and the Philippines (Fig. 4C, D). All indicators in Cambodia showed a downward trend among people under 49 years, but generally showed an upward trend among middle-aged and older adults aged 50 years and above.

Notably, Singapore showed a distinct age-specific pattern (Fig. 4). Decreasing trends in incidence and prevalence were observed only among adults aged 30–59 years, whereas increasing trends were found among younger and older age groups, particularly among those aged 70 years and above. Meanwhile, the decreasing trends in mortality and DALYs were especially pronounced among adults aged 30–59 years.

SDI-specific burden

In 2023, Timor-Leste, Cambodia, and the Lao People’s Democratic Republic were in the low-SDI range (0.48–0.52). Malaysia, Brunei Darussalam, and Singapore were in the high-SDI range (0.77–0.87). The remaining member states were in the middle-SDI range (0.53–0.69). Incidence and prevalence burden were highest in the high-SDI group, while mortality and DALY burden showed a less uniform distribution across SDI categories (Fig. 5B). The burden of NPC varied across levels of sociodemographic development (Fig. 5). Across member states from 1990 to 2023, ASRs were positively correlated with SDI (Spearman r = 0.508–0.779; all P < 0.001). ASIR and ASPR increased with SDI, whereas ASMR and ASDR showed non-linear associations, with downward trends at higher SDI levels.

Fig. 5.

Fig. 5

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SDI-based age-standardized incidence, prevalence, mortality, and DALY rates for NPC in ASEAN countries. A SDI-based age-standardized rates in ASEAN countries from 1990 to 2023. B Age-standardized rates of ASEAN countries by SDI in 2023

Discussion

This study provides an updated regional assessment of the burden of NPC in ASEAN based on GBD 2023 estimates. Three findings deserve particular emphasis. First, from 1990 to 2023, the absolute burden of NPC in ASEAN increased markedly, whereas the ASIR and ASPR rose modestly, the ASMR declined slightly, and the ASDR remained stable. Second, the burden remained concentrated in males and middle-aged adults, particularly among those aged 45–59 years. Third, substantial heterogeneity was observed across member states and levels of sociodemographic development. Taken together, these findings indicate that ASEAN should not be regarded as a homogeneous high-burden region, but rather as a region comprising countries at different stages of NPC epidemiological transition and control. To our knowledge, this is the first study to characterize ASEAN-wide NPC burden patterns using GBD 2023 estimates.

A prominent finding of this study was the persistent inequality in NPC burden across sex and age groups. Males consistently had a substantially higher NPC burden than females, and in most countries, the increases in incidence and prevalence were greater in males, whereas declines in deaths and DALYs were more pronounced in females. This pattern is consistent with previous reports from Southeast Asia, which have shown male predominance in NPC and substantially higher male ASIR in several endemic settings (Chan et al. 2025, Xiao et al. 2013, OuYang et al. 2015). Smoking, alcohol consumption, and certain occupational or environmental exposures remain more common among males in many Southeast Asian settings and may contribute to both increased NPC risk and poorer prognosis (Tian et al. 2025, Wang et al. 2025). Sex-related differences in hormonal milieu, immune regulation, comorbidity profiles, and healthcare-seeking behavior may also influence both disease occurrence and survival (OuYang et al. 2015).

Age-specific analyses further revealed that the absolute burden of NPC was concentrated among middle-aged adults, particularly those aged 45–59 years. This pattern is consistent with regional evidence indicating that NPC in Southeast Asia primarily affects working-age adults (Su et al. 2024, Chan et al. 2025, Nakanishi et al. 2017). This age distribution may partly reflect the cumulative effect of major regional risk exposures over the life course, particularly tobacco smoking and occupational inhalational exposures, which have been repeatedly linked to NPC in Southeast Asian populations (Romdhoni et al. 2023, Chen et al. 2021). Importantly, the overall regional pattern concealed substantial between-country variation, including marked differences in age-specific temporal trends. High-SDI settings, such as Singapore, were characterized by high incidence and prevalence but lower and declining mortality and disability burden, whereas several low- and middle-SDI countries showed a less favorable combination of rising occurrence and persistently heavy mortality-related burden. These differences probably reflect variation in case detection, registry completeness, diagnostic delay, treatment accessibility, and quality of care. All of these have been identified as major challenges in Southeast Asia (Chan et al. 2025, Cui et al. 2025).

Age-specific temporal patterns further underscored this heterogeneity. In several member states, increasing incidence and prevalence were concentrated in young and middle adulthood, whereas mortality- and DALY-related burden remained elevated among adults aged 25–64 years. By contrast, Singapore showed a distinctive age-specific pattern. Negative EAPCs for incidence and prevalence were observed mainly in adults aged 30–59 years, whereas positive trends persisted in younger age groups and re-emerged in older adults, particularly among those aged 70 years and above. This pattern is noteworthy because it suggests that the epidemiological transition of NPC in high-SDI settings may not occur uniformly across age groups. The decline in middle-aged adults may reflect improvements in risk control, earlier diagnosis, or cohort-related reductions in exposure among traditionally high-risk populations. In contrast, the persistence of positive trends in younger and older age groups may indicate that the burden of NPC is shifting beyond the conventional middle-aged high-risk profile (Luo et al. 2007, Mak et al. 2015). These observations suggest that even in higher-SDI settings with more favorable overall mortality outcomes, surveillance and early-detection strategies should not focus exclusively on middle-aged adults, but should remain responsive to burden emerging at both extremes of the age spectrum.

The concentration of burden among males and middle-aged adults supports prioritizing adults aged 30–69 years, particularly males and individuals with a family history of NPC or other high-risk characteristics, for early-detection strategies (Lam et al. 2023, Chen et al. 2025). At the same time, the marked heterogeneity across countries suggests that a single regional strategy is unlikely to be sufficient. In countries with high occurrence but improving mortality, the priority may be to optimize risk stratification, recurrence surveillance, and survivorship care. In countries where mortality and DALY burden remain high, greater emphasis should be placed on strengthening referral pathways, improving access to nasopharyngeal endoscopy, imaging, pathology, and radiotherapy, and expanding multidisciplinary treatment capacity (Su et al. 2024, Chan et al. 2025). The SDI findings further suggest that sociodemographic development shapes the composition of NPC burden rather than simply indicating whether burden is high or low. Low- and middle-SDI countries are likely to benefit most from investment in early-detection infrastructure and standardized diagnostic and treatment pathways, whereas high-SDI countries may gain more from refining risk-stratified screening and follow-up strategies supported by EBV DNA, serological markers, and MRI (Lam et al. 2023, Lam et al. 2026, Ramsey et al. 2019).

Several limitations should be acknowledged. First, this study was based on modelled estimates from GBD 2023 rather than original individual-level data, and the results therefore depend on the completeness of cancer registration, the quality of underlying data sources, and modelling assumptions. This limitation may be particularly relevant in countries where population-based cancer registration systems remain underdeveloped (Zhang et al. 2023). Second, this was an ecological analysis and cannot support causal inference at the individual level. Accordingly, the mechanisms underlying the observed associations with sex, age, and SDI should be interpreted cautiously and will require confirmation in cohort-based and clinical studies. Third, GBD does not provide important clinical variables such as stage at diagnosis, histological subtype, EBV status, treatment modality, or long-term survival. As a result, our study could not determine whether a high burden in a given country primarily reflected higher underlying risk, improved case detection, better registration, or differences in treatment outcomes, nor could it quantify the contribution of delayed diagnosis or treatment disparities to mortality and DALYs (Chang et al. 2021). Finally, substantial ethnic and geographic heterogeneity exists within ASEAN countries, and national-level estimates may obscure important burden differences within specific high-risk subpopulations (Chan et al. 2025).

Conclusions

In summary, NPC remains a major public health challenge in ASEAN. From 1990 to 2023, the region experienced a marked increase in burden, with substantial heterogeneity across countries and persistent concentration in males and middle-aged adults. These findings support the need for stratified NPC control strategies tailored to country-specific epidemiological profiles and health-system capacity.

Acknowledgements

We truly appreciate the efforts of the Global Burden of Disease Study 2023 collaborators in delivering the most complete study of various diseases on a worldwide scale. We also express our sincere appreciation to the Institute for Health Metrics and Evaluation (IHME) for making the GBD data available for this research.

Abbreviations

NPC

Nasopharyngeal carcinoma

ASEAN

Association of Southeast Asian Nations

GBD

Global Burden of Disease

IHME

Health metrics and evaluation

DALYs

Disability-adjusted life years

YLDs

Years lived with disability

YLLs

Years of life lost

ASR

Age-standardized rate

ASIR

Age-standardized incidence rate

ASPR

Age-standardized prevalence rate

ASMR

Age-standardized mortality rate

ASDR

Age-standardized DALY rate

CI

Confidence interval

UI

Uncertainty interval

EAPC

Estimated annual percentage change

SDI

Socio-demographic index

Author contributions

L.C. and J.L. handled data processing and wrote the initial draft. L.C. and J.D. prepared the figures, validated the results, and revised the manuscript. L.C. and J.L. designed the study concept and critically revised the entire manuscript. All authors read and approved the final manuscript.

Funding

None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

Data used for the analyses are publicly available from the Institute of Health Metrics and Evaluation (http://ghdx.healthdata.org/gbd-results-tool).

Declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Clinical trial number

Not applicable.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Data used for the analyses are publicly available from the Institute of Health Metrics and Evaluation (http://ghdx.healthdata.org/gbd-results-tool).

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