3.1 Overview
Table 1 showed the overall changes in the global burden of PC distribution between 1990 and 2019. There were 268434.51 (95% uncertainty interval, (UI) 229573.18, 329220.58) new PC cases, 2044006.62 (95% UI: 1749910.09, 2541958.35) PC patients, and 90275.23 (95% UI: 76005.63, 109056.31) deaths due to PC in 2019, with the age-standardized rates of incidence, prevalence, and mortality are 27.39 (95% UI: 23.42, 33.59), 208.56 (95% UI: 178.55, 259.37), 9.21 (95% UI: 7.76, 11.13) per 100,000 in 2019, respectively. The above values have also grown globally. Meanwhile, the age-standardized DALYs rate dropped from 147.74 (95% UI: 124.33, 169.92) per 100,000 in 1990 to 137.41 (95% UI: 116.86, 165.67) per 100,000 in the WPR in 2019.
The age-standardized rate, numbers, and percent change for PC in the WPR, the World, and China in 1990 and 2019 were detailed in Table 1.
Table1 Age-standardized rate, numbers, and percent change for PC in the WPR, the World, and China in 1990 and 2019
3.2 Trends for the DALYs rate of PC in the WPR from 1990 to 2019
As shown in Fig. 1, the trends for the DALYs rate of PC varied among the WHO Regional Committees. Overall, the DALYs rates of PC in the WPR, European Region, and the Region of Americas showed a decreased trend. In contrast, the trend in the Eastern Mediterranean Region and the African Region increased while it stayed stable in the South-East Asia Region.
In the WPR, the trends for the DALYs rate of PC existed regional variations from 1990 to 2019. Among the major countries, the trend for the DALYs rate in Australia (AAPC = -1.27 (95% CI =-1.45, -1.09) %, P < 0.001) showed the most rapid decline, while the trend for the DALYs rate in Viet Nam (AAPC = 0.78 (95% CI = 0.75, 0.81) %, P < 0.001) showed the fastest upward trend during 1990 to 2019, during the period from 1990 to 2019.
From 1990 to 2019, the age-standardized DALYs of PC in the WPR were below the global average; the age-standardized DALYs rate for low-Socio-Demographic-Index (SDI), middle-SDI, and high-SDI regions and the age-standardized DALYs rate for World Bank lower-income and World Bank high-income regions. The age-standardized DALYs of PC in high-income countries showed a downward trend, while in middle-income and low-income countries, it had an upward trend from 1990 to 2019. Compared with governments of all income levels worldwide, the age-standardized DALYs rate in the WPR was lower than the average, with a slight descending movement.
All age and age-standardized incidence trends, mortality, prevalence, YLLs, YLDs, and DALYs in the World, the WPR, and China are shown in Fig. 1. Figure 2 shows the DALYs trends of prostate cancer in the World. The age-standardized DALYs trends in different SDI regions or World Bank income level regions are shown in Fig. 3.
3.3 Age Distribution Characteristics
As shown in Fig. 4, with the increase in age, PC patients' incidence (AAPC = 91.07 (95%CI = 77.40, 105.79) %, P < 0.001), mortality (AAPC = 114.62 (95%CI = 102.49, 127.48) %, P < 0.001), YLLs (AAPC = 84.23 (95%CI = 74.18, 94.86) %, P < 0.001), and DALYs (AAPC = 84.61 (95%CI = 74.25, 95.60) %, P < 0.001) rates showed a notable downward trend in the WPR. The AAPC of the YLDs values decreased over 80, in the WPR (AAPC = 87.95 (95%CI = 74.28.102.70) %, P < 0.001) and the World (AAPC = 94.89 (95%CI = 75.96, 115.87) %, P < 0.001). The APC of prevalence values had the same trend in the WPR (APC = 97.87 (95%CI = 82.65, 114.37) %, P < 0.001) and the World (APC = 113.07 (95%CI = 92.86, 135.39) %, P < 0.001). Additionally, the above rate values for people under 40 were significantly lower.
Figure 4 showed the incidence, mortality, prevalence, YLLs, YLDs, and DALYs rates of PC patients in different age groups in the WPR, the World, and China from 1990 to 2019
3.4 Regional differences in PC burden in the Western Pacific Region
The Western Pacific region includes many countries with different levels of economic development, healthcare resources, and cultural backgrounds.(10, 11) As shown in Fig. 1B, the PC burden in this diverse region varied significantly from 1990 to 2019.
The trend of the PC burden in high-income countries in the WPR, including Australia, Japan, Singapore, Guam, New Zealand, and Samoa, showed a decline from 1990 to 2019, except for the Republic of Korea, whose PC burden didn't change conspicuously. In addition, the DALYs rate of PC burden in Australia was consistently higher than the regional average. The trend for the DALYs rate in New Zealand (AAPC = -1.60 (95% CI =-1.76, -1.43) %, P < 0.001) and Australia (AAPC = -1.27 (95% CI =-1.45, -1.09) %, P < 0.001) showed the most rapid decline.
The situation varied in emerging countries. The age-standardized DALYs of PC increased in low-income countries, including Viet Nam, Niue, and Tokelau, except in the Cook Islands. For middle-income economies, it showed a decline in China and Kiribati. In contrast, the age-standardized DALYs of PC in other middle-income countries, including the Philippines, showed an increasing trend or had no apparent changes. The trend for the DALYs rate in Viet Nam (AAPC = 0.78 (95% CI = 0.75, 0.81) %, P < 0.001) showed the fastest upward trend from 1990 to 2019. Our analysis showed regional differences in PC burden in the Western Pacific Region.