Global burden and trends of ovarian cancer attributable to occupational exposure to asbestos: A study based on 1990-2019 GBD data.

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Kunyu Wang, Wei Mao, You Wu, Yan Song, Yanan Zhang, Bin Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4933345/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ovarian cancer remains a major health issue, with occupational asbestos exposure possibly contributing to its risk. We comprehensively assess the global burden of asbestos-related ovarian cancer, explore disparities, and project future trends to inform prevention strategies. Methods We evaluated deaths and disease-adjusted life years (DALYs) globally in 2019, analyzed temporal trends (1990–2019), and used the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model to predict future burdens. Decomposition analysis identified drivers of burden change, and frontier analysis assessed the correlation with socio-demographic development. Results In 2019, occupational exposure to asbestos was a significant contributor to the substantial burden of ovarian cancer, exhibiting considerable disparities across age groups, Socio-demographic Index (SDI) regions, Global Burden of Disease (GBD) regions, and countries. Despite a global trend of declining age-standardized rates (ASRs) between 1990 and 2019, the absolute number of deaths and DALYs associated with asbestos-related ovarian cancer continued to rise. The APC model predicted a steady escalation in the number of deaths and DALYs from 2019 to 2030 while forecasting a decrease in the ASRs. However, contrasting results emerged from the BAPC model, which indicates that both the number of deaths and DALYs, as well as their ASRs, are anticipated to decline. Furthermore, the frontier analysis suggested that countries with higher SDI scores exhibit greater potential for reducing the disease burden. Our decomposition analysis revealed that aging and population growth were the primary drivers of the increasing disease burden, whereas epidemiological change exerted a negative influence. Conclusions Occupational exposure to asbestos is a substantial contributor to the disease burden of ovarian cancer. Success with reducing asbestos occupational exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. ovarian cancer occupational exposure to asbestos deaths DALYs Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Ovarian cancer, a leading cause of death among women, has been a persistent health challenge worldwide ( 1 – 3 ). Its etiology is multifactorial, encompassing genetic predisposition, hormonal factors, and environmental exposures ( 4 – 6 ). Among these, the potential role of asbestos exposure in ovarian cancer development has garnered increasing attention ( 7 , 8 ). Asbestos, a naturally occurring mineral fiber, has been widely used in various industries for its unique physical properties ( 9 – 11 ). However, its widespread use has also led to concerns regarding its carcinogenicity, particularly in occupational settings ( 12 – 14 ). Previous studies have examined the association between asbestos exposure and ovarian cancer, but the results have been inconsistent ( 15 – 19 ). Some studies have reported a significant positive association ( 15 – 17 ), while others have failed to find a conclusive link ( 18 – 20 ). This inconsistency may be attributed to differences in study design, population characteristics, and exposure assessment methods. A comprehensive analysis of the global burden of ovarian cancer attributable to occupational exposure to asbestos is lacking. Moreover, given the complexities and inconsistencies surrounding the association between asbestos exposure and ovarian cancer, there is a pressing need for further investigation. By leveraging large-scale datasets, such as the Global Burden of Disease (GBD) Study, we can offer a comprehensive understanding of the burden of ovarian cancer attributable to asbestos exposure. In this study, we aim to analyze the deaths and DALYs of ovarian cancer attributable to occupational exposure to asbestos using GBD data from 1990 to 2019. Our study will employ rigorous statistical methods to analyze the GBD data. The results of this study will contribute to the existing knowledge on the health impacts of asbestos exposure and inform future research and policy efforts aimed at reducing the burden of ovarian cancer. Materials and Methods Overview The annual number of ovarian cancers attributable to occupational exposure to asbestos cases and their corresponding age-standardized rates (ASRs) were retrieved from the GBD 2019 Study database. This study stands as the most comprehensive and scientifically rigorous assessment of the global epidemiological burden, encompassing data on 369 diseases and injuries, along with 87 risk factors ( 21 , 22 ). The GBD 2019 database encompassed a vast array of 204 countries and territories, providing a comprehensive temporal coverage from 1990 to 2019 ( 21 , 22 ). For analysis, the 204 countries and territories were categorized into 22 GBD super regions and 45 GBD regions, reflecting their geographical distributions ( 21 , 22 ). Additionally, a socio-demographic index (SDI), a composite indicator of sociodemographic developmental status developed by the GBD team to categorize the 204 countries into five socioeconomic developmental levels, was employed to further categorize these countries and territories into five distinct regions ( 21 , 22 ). In estimating the disease burden, the GBD 2019 study utilized the DisMod-MR, a Bayesian meta-regression modelling tool that serves as the standard modeling framework within the GBD ( 23 , 24 ). This tool allowed us to meticulously describe the ovarian cancer burden by sex, age, location, and year. The assessment of disease burden data involved rigorous criteria, and systematic biases were adjusted through crosswalks, leveraging adjustment factors estimated by the MR-BRT tool. Notably, in the current iteration of the DisMod-MR model, the additional mortality and remission were assumed to be zero. The data utilized in the 2019 GBD study were sourced from diverse and reliable channels, including household surveys, vital statistics, and other authoritative sources, ensuring the accuracy and representational of our findings ( 21 )[22]. Statistical analysis First, the number of deaths and DALYs cases attributable to occupational exposure to asbestos-related ovarian cancer and their corresponding ASRs were assessed in 2019 globally and by different sub-types including age, SDI regions, GBD regions, and countries. Secondly, a thorough analysis was conducted to explore the temporal trend of this disease burden globally and by subtype, spanning from 1990 to 2019. The Estimated Annual Percentage Change (EAPC) value was calculated using a linear regression model. Furthermore, a hierarchy cluster analysis was performed, leveraging the EAPC values, to assess the evolving patterns of disease burden across various GBD regions and identify those with similar trends. Consequently, all 45 GBD regions were categorized into four distinct groups: significant increase, minor increase, remained stable or minor decrease, and significant decrease. Moreover, we utilized both the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model, integrated with nested Laplace approximations, to predict the future disease burden from 2020 to 2030. To further delve into the factors driving changes in the disease burden between 1990 and 2019, decomposition analyses were conducted, focusing on age structure, population size, and epidemiological shifts. Lastly, frontier analysis was employed to assess the correlation between disease burden and sociodemographic development. By establishing a nonlinear frontier, we were able to identify the lowest achievable burden based on a country's or region's current development status. This analysis was facilitated by non-parametric data envelope analysis, drawing upon previous studies for methodological guidance. The effective difference, representing the gap between the observed DALYs rate and the frontier, signifies the potential health gains that could be realized given the current level of development. If the P-value fell below 0.05, it was deemed statistically significant. For the construction, collation, and analysis of the database, we utilized the R software (version 4.0.2). Results The disease burden of ovarian cancer attributable to occupational exposure to asbestos in 2019 In 2019, the burden of ovarian cancer attributable to occupational exposure to asbestos was substantial. Specifically, 6557 deaths cases [95% uncertainty interval (UI): 2951–10664) were attributed to this exposure. The corresponding age-standardized deaths rate stood at 0.08 per 100,000 population, with a 95% UI of 0.04 to 0.14. Furthermore, the disease's impact on individuals' quality of life was reflected in the significant number of disability-adjusted life years (DALYs) lost, totaling 113268 cases (95% UI: 50081–184671). The age-standardized rate of DALYs was 1.4, with a 95% UI of 0.62 to 2.28 ( Tables S1-2 ). Figure S1 provides the detailed disease burden of deaths and DALYs across various age groups in 2019. Notably, the age-standardized deaths rate exhibited a consistent upward trend with increasing age. However, the age-standardized DALYs rate initially rose with age, peaking in the 85-89-year-old group, before subsequently decreasing. The observed patterns in the number of deaths and DALYs cases closely mirrored the trend exhibited by the age-standardized DALYs rate, as reflected in Tables S1-2 . Regarding the disease burden across SDI regions, the age-standardized rates (ASRs) of deaths and DALYs initially decrease and then increase as the SDI decreases. Notably, the high SDI regions exhibit the highest ASRs, while the middle SDI regions have the lowest. Conversely, the number of deaths and DALYs cases is inversely related to the SDI, meaning that the highest number of cases is observed in the high SDI regions, with the lowest number in the low SDI regions ( Figure S2, Tables S1-2 ). The Results section of our study reveals intriguing patterns across the 45 GBD regions in terms of deaths and DALYs cases, as well as their respective ASRs. Among these regions, the World Bank High Income region emerged as the leading GBD region to both deaths (4,266, 95% UI: 1,931-7,058) and DALYs cases (65,334, 95% UI: 29,273 − 108,779). Immediately following was the European Region, closely followed by Europe & Central Asia - WB. At the opposite end of the spectrum, Oceania recorded the lowest number of deaths (1, 95% UI: 0–2) and DALYs cases (23, 95% UI: 6–64), followed by Caribbean and Central Sub-Saharan Africa. When considering the ASRs, a different ranking emerged. The Commonwealth High Income region topped the list for both deaths (ASR: 0.36, 95% UI: 0.16–0.58) and DALYs (ASR: 5.78, 95% UI: 2.61–9.64), preceded by Australasia and Western Europe. Conversely, the Middle East & North Africa - WB region recorded the lowest ASRs for both deaths (0.01, 95% UI: 0.01–0.02) and DALYs (0.25, 95% UI: 0.12–0.48) ( Figure S3, Tables S1-2 ). The global burden of ovarian cancer attributed to occupational asbestos exposure exhibited significant variation among different countries of the world. Notably, the United Kingdom exhibited the highest age-standardized death rate and DALYs rate among all the countries surveyed, with 0.51 deaths (95% UI: 0.22–0.82) and 8.31 DALYs (95% UI: 3.59–13.67) per 100,000 populations in 2019. Norway followed closely in terms of these rates. Conversely, Guam reported the lowest age-standardized death rate and DALYs rate, with zero deaths (95% UI: 0-0.01) and 0.05 DALYs (95% UI: 0.01–0.13) per 100,000, followed by the Syrian Arab Republic and Cabo Verde. When considering the absolute numbers, the United States of America stood out as having the highest number of deaths and DALYs, totaling 932 deaths (95% UI: 415–1545) and 14,431 DALYs (95% UI: 6,223 − 24,325), respectively. The United Kingdom also ranked highly in this regard. On the other hand, Tokelau reported the lowest number of deaths and DALYs in 2019, with numbers close to zero, followed by Niue and Nauru (Fig. 1 , Tables S1-2 ). Temporal trend for disease burden of ovarian cancer attributable to occupational exposure to asbestos from 1990 to 2019 Globally, the number of deaths of ovarian cancer attributable to occupational exposure to asbestos rose significantly by 62.70%, from 4030 (95% UI: 1857–6541) in 1990 to 6557 (95% UI: 2951–10664) in 2019. However, the trend in the age-standardized deaths rate exhibited an opposing direction, with a significant decrease indicated by the EAPC of -1.12 [95% confidence interval (CI): -1.16–1.07). Similarly, the pattern observed in DALYs estimates mirrored this trend, with an increase of 47.16% in the number of DALYs cases, yet a decrease in the age-standardized DALYs rate, reflected by the EAPC value of -1.37 (95% CI: -1.40 to -1.33) ( Tables S1-2 , Fig. 2 ). The trends observed in the number of deaths and DALYs across all age groups exhibited consistency with those of the overall population. Nevertheless, when analyzing the ASRs of deaths and DALYs, a notable exception was observed among individuals aged 90–94 years and those over 95 years. For these two specific age groups, the ASRs demonstrated an upward trend, indicating a distinct pattern compared to other age categories ( Figure S4, Tables S1-2 ). The trends in the number of deaths and DALYs across all SDI regions mirrored those observed in the overall population. Nevertheless, when examining the ASRs of deaths and DALYs, a distinct pattern emerged. The trends in High SDI regions and High-middle SDI regions were comparable, deviating from the remaining three SDI regions. Specifically, for these three regions, the ASRs exhibited a notable upward trend from 1990 to 2019, indicating a significant increase in the burden over time ( Figure S5, Tables S1-2 ). Across 45 GBD regions, significant variation was observed in the disease burden of ovarian cancer attributable to occupational exposure. To identify regions exhibiting similar patterns of disease burden variation, a hierarchical clustering analysis was conducted in this study. The results of this analysis are presented in Figure S6 . Notably, a significant increase in ASRs of deaths and DALYs was observed in several regions, including World Bank High Income, Western Europe, High-income Asia Pacific, North America, High-income North America, Commonwealth High Income, European Region, Europe & Central Asia -WB, Europe, Region of the Americas, and America. Conversely, a significant decrease in these rates was observed in North Africa and Middle East, Australasia, Eastern Europe, Middle East & North Africa -WB, East Asia & Pacific-WB, Central Asia, World Bank Upper Middle Income, and Tropical Latin America ( Figure S6 ). Across various countries and territories, the most significant increase in ASRs of deaths and DALYs from 1990 to 2019 was observed in Georgia. Specifically, the EAPC for deaths in Georgia was 8.67 [95% confidence interval (CI): 6.98–10.39]. Similarly, the EAPC for DALYs in Georgia was 8.44 (95% CI: 6.79–10.11). Trinidad and Tobago and Nicaragua followed Georgia in terms of this upward trend. Conversely, the largest decrease in ASRs of deaths and DALYs was recorded in Ireland. The EAPC for deaths in Ireland was − 3.88 (95% CI: -4.29–3.47), indicating a substantial decline. Similarly, the EAPC for DALYs in Ireland was − 4.46 (95% CI -4.90–4.02) ( Figure S7, Tables S1-2 ). The predicted results for disease burden of ovarian cancer attributable to occupational exposure to asbestos from 2020 to 2030 The anticipated disease burden forecast for the period 2020 to 2030 revealed distinct patterns in both the APC and BAPC models ( Tables S3-4 , Figs. 3 – 4 ). Specifically, the ASRs were predicted to decrease annually in both models. However, when considering the number of deaths and DALYs cases, the APC model anticipated an increase, whereas the BAPC model projected a slight decrease. Decomposition analyses Over the past three decades, a remarkable global surge in deaths and DALYs cases had been observed. Notably, the highest increase in deaths was concentrated in regions with a high SDI, while the largest increase in DALYs cases was recorded in high-middle SDI regions. Aging and population growth played pivotal roles in this trend, accounting for 65.75% and 107.85% of the worldwide rise in deaths, respectively. Similarly, these factors contributed to 43.48% and 162.40% of the global increase in DALYs. The aging effect was particularly significant in the high SDI regions, contributing to 123.36% of the deaths and 159.63% of the DALYs, where population growth exerted the greatest influence on DALYs growth (103.20%) and deaths growth (269.52%). However, the effect of epidemiological change on deaths and DALYs growth was negative (deaths: -73.60%; DALYs: -105.88%) worldwide, and this effect was the most pronounced in the high SDI regions (deaths: -126.56%; DALYs: -329.16%) (Table S5-S6 , Fig. 5 ). Frontier analysis of the age-standardized DALYs rate During the period spanning 1990 to 2019, Fig. 6 portrayed the unattained health gains among countries or regions at varying developmental levels. Specifically, Figs. 6 A and 6 B highlighted the DALYs burden and the significant variations in this burden among countries or regions with diverse SDI in 2019. Notably, as sociodemographic development progressed, the effective difference in DALYs burden tended to increase, suggesting that countries or regions with a higher SDI possessed greater potential for improvement in health outcomes. Specifically, our analysis revealed an inverse correlation between the SDI and the age-standardized DALYs rate of ovarian cancer attributed to occupational exposure to asbestos (Fig. 6 ). This indicated that regions with a higher level of socio-economic development tend to experience a lower rate of health losses due to occupational asbestos exposure-related ovarian cancer. It was noteworthy that once the SDI surpasses 0.40, the age-standardized DALYs rate for this particular health outcome exhibited a stabilized trend. Discussion This study offers a comprehensive evaluation and quantification of the global burden of ovarian cancer attributable to occupational asbestos exposure. In 2019, occupational exposure to asbestos-related ovarian cancer significantly contributed to the substantial disease burden, exhibiting notable disparities across age groups, SDI regions, GBD regions, and countries. Despite a global decline in ASRs from 1990 to 2019, the absolute number of deaths and DALYs continued to rise. The APC model predicted a steady increase in number of deaths and DALYs cases from 2019 to 2030, albeit with anticipated decreases in ASRs. However, the BAPC model forecasted a decline in both the number and ASRs of deaths and DALYs over the next 11 years. Furthermore, the frontier analysis suggested that countries with higher SDI scores possessed the greater potential for reducing this disease burden. Decomposition analysis highlighted that aging and population growth were the primary drivers of the increasing disease burden, while epidemiological change exerted negative influences. In our study, we found that occupational exposure to asbestos is a substantial contributor to the disease burden of ovarian cancer, corroborating previous research findings ( 25 , 26 ). For instance, Roberto Pasetto et al. utilized mortality data from the World Health Organization's Health Statistics database for 2009 and, by applying estimated population-attributable fractions, determined that the number of deaths attributable to occupational asbestos exposure for ovarian cancer over a five-year period was 14 in Argentina, 43 in Brazil, 9 in Colombia, and 22 in Mexico ( 25 ). Similarly, Lucia Fazzo et al. noted 16 deaths per year attributable to asbestos-related ovarian cancers in Italy during the 2010–2016 period ( 26 ). These findings align with our observations, further strengthening the evidence that occupational asbestos exposure significantly impacts the global burden of ovarian cancer. The global trend in ovarian cancer deaths attributable to occupational asbestos exposure saw a substantial increase in absolute numbers over the past three decades, likely reflecting improved diagnostic methods and reporting. However, the age-standardized death rate and DALYs rate declined significantly, suggesting that the burden is becoming more concentrated in older age groups. This pattern reflects progress in prevention and control measures, particularly for younger workers. Nonetheless, the continuing increase in absolute numbers highlights the need for sustained efforts to reduce exposure and improve detection, particularly in high-risk regions. In our study, we observed intriguing trends in age-specific mortality and DALYs related to the target disease. Notably, the age-standardized death rates increase steadily with age, underscoring the disproportionate impact on older individuals, which aligns with age being a significant risk factor for chronic diseases ( 27 , 28 ). However, the age-standardized DALYs rate initially rises, peaking in the 85–89 age group, and then declines, indicating a reduction in disease severity at extreme ages. This could be attributed to shorter life expectancy and potentially reduced disease duration or severity among the oldest individuals. The close correlation between the patterns observed in the number of deaths and DALYs cases with the age-standardized DALYs rate further solidifies our understanding of the age-related burden of this disease. This finding underscores the importance of considering both mortality and morbidity metrics in assessing the overall burden of disease, as they provide complementary insights into different aspects of the disease burden. While the consistency in trends across age groups is remarkable, the deviation in age-standardized rates (ASRs) among individuals aged 90–94 and over 95 is particularly intriguing. The upward trend in ASRs for these oldest age groups suggests a relative increase in the burden of ovarian cancer deaths and DALYs compared to the general population. This could be attributed to the cumulative effect of asbestos exposure over a longer lifetime, combined with age-related declines in immune function and other physiological changes ( 29 , 30 ). Further research is necessary to elucidate the specific factors contributing to this pattern and to develop targeted interventions for this vulnerable segment of the population. In our analysis of disease burden across SDI regions, we uncovered intriguing patterns pertaining to the ASRs of deaths and DALYs related to this disease. Notably, this burden peaks in high SDI regions, suggesting a non-uniform distribution across SDI levels. While high SDI regions enjoy advanced healthcare, they are nonetheless burdened significantly by obesity, lifestyle-related diseases, and aging ( 31 ). Middle SDI regions, on the other hand, exhibit lower ASRs, potentially attributable to healthier behaviors and effective disease prevention strategies. However, a reverse trend emerges when considering absolute case numbers, reflecting the intricate interplay between socio-economic factors and disease burden. The trends in deaths and DALYs across SDI regions mirror those observed in the general population. However, a closer examination of ASRs reveals a distinct pattern. High and high-middle SDI regions exhibit similar trends, which diverge from those of low, low-middle, and middle SDI regions. Remarkably, the latter three regions demonstrate a significant upward trend in ASRs from 1990 to 2019, indicating an escalating burden over time. This divergence may stem from varying degrees of healthcare access, socioeconomic factors, or differences in disease prevention strategies across SDI regions ( 32 , 33 ). Further investigation of these factors is imperative to gain a deeper understanding of the dynamics of disease burden across SDI regions. The global distribution of ovarian cancer burden attributed to occupational asbestos exposure reveals striking disparities. Notably, the World Bank High Income region, led by the United Kingdom, emerges as a significant hotspot for both deaths and DALYs, indicating a high burden despite the presence of advanced healthcare systems. Conversely, Oceania and Caribbean regions exhibit a comparatively lower burden. However, when considering ASRs, a different picture emerges, with Commonwealth High Income regions topping the list, highlighting a disproportionate impact on specific populations. Intriguingly, the United States, despite not ranking highest in ASRs, stands out for its substantial absolute burden of ovarian cancer deaths and DALYs. This underscores the importance of employing both standardized and absolute metrics in comprehensive disease burden analyses. The hierarchical clustering analysis further sheds light on these disparities, revealing significant regional variations in ASRs of ovarian cancer deaths and DALYs attributable to occupational exposure. High-income regions like Western Europe and North America exhibit an upward trend, whereas regions like North Africa and the Middle East display a decline. The significant increases observed in Georgia, Trinidad and Tobago, and Nicaragua suggest potential occupational risk factors or changing exposure patterns. Conversely, the substantial decline in Ireland points to possible improvements in occupational safety or changes in risk factors. The anticipated disease burden forecast for 2020 to 2030 exhibits contrasting trends between the APC and BAPC models. While both models predict a yearly decline in ASRs, their divergence in forecasting deaths and DALYs cases is noteworthy. The APC model's prediction of an increase suggests that the disease's impact may persist, despite improvements in overall health indicators. Conversely, the BAPC model's slight decrease indicates a possible slowdown in the disease's burden. This divergence highlights the complexity of disease forecasting and the need to consider multiple models. It also underscores the importance of monitoring both ASRs and absolute numbers of deaths and DALYs to gain a comprehensive understanding of disease burden trends. Over the past three decades, the significant global rise in deaths and DALYs cases has been a matter of grave concern. The concentration of the highest death increase in high SDI regions and the largest DALYs increase in high-middle SDI regions reveals a complex interplay between socioeconomic development and health outcomes ( 34 ). Aging and population growth have emerged as key drivers, with aging particularly impact in high SDI regions. This is evident from the disproportionately high contributions to both deaths and DALYs, emphasizing the need for targeted interventions to address the aging population's health needs. However, the negative impact of epidemiological changes on deaths and DALYs growth, especially in high SDI regions, is noteworthy. This suggests that while socioeconomic progress brings with it improved healthcare and life expectancy, it may also introduce new health challenges that need to be addressed ( 35 , 36 ). The pronounced decrease in deaths and DALYs attributable to epidemiological changes in high SDI regions highlights the potential for effective prevention and control strategies to mitigate the burden of disease ( 37 ). Frontier analysis highlighted the attained health gains across countries or regions with varying developmental levels from 1990 to 2019. Notably, as socio-demographic development increases, the discrepancy in DALYs burden also rises, indicating greater potential for health improvement in higher SDI regions. Our analysis further reveals an inverse relationship between SDI and the age-standardized DALYs rate for ovarian cancer attributed to occupational asbestos exposure. As SDI surpasses 0.40, this rate stabilizes, suggesting that higher socio-economic development may mitigate health losses due to this exposure. In our study, we acknowledge two limitations. Firstly, the precision of our estimated burden is heavily contingent upon the availability and quality of the procured data ( 38 ). Secondly, the compilation of epidemiological statistics for a given country often relies solely on one or a select few registries situated in specific geographical areas. This becomes particularly pertinent in underdeveloped countries, where the scarcity of registries may necessitate the utilization of data from a solitary regional registry. To enhance data representativeness, it is advisable to add more registries ( 39 ). Conclusions In conclusion, our study offers a comprehensive global overview of the substantial burden of ovarian cancer attributable to occupational asbestos exposure, revealing stark disparities across age groups, regions, and nations. These findings underscore the imperative for tailored prevention and control measures, particularly in high-risk locales and among vulnerable populations. The contrasting trends of rising deaths and DALYs despite decreasing age-standardized death rates highlight the urgency of tackling this malignancy. Moreover, the projected steady escalation in future burden underscores the need for sustained efforts in prevention and early detection. The identification of aging and population growth as major drivers of this burden highlights the importance of addressing these factors in policymaking. The observed greater improvement potential in countries with higher socio-demographic index scores indicates that targeted interventions in these regions could significantly reduce disease burden. Overall, our study deepens the understanding of the global ovarian cancer burden associated with occupational asbestos exposure, paving the way for more effective prevention and control strategies. Abbreviations APC, age-period-cohort; ASRs, age-standardized rates; BAPC, Bayesian age-period-cohort; DALY, disability-adjusted life-year; CI, confidence interval; EAPC, estimated annual percentage change; GBD, Global Burden of Disease; SDI, socio-demographic index; UI, uncertainty interval. Declarations Ethics approval and consent to participate The GBD 2019 study is an open database, and all data is anonymous. Consent for publication Not applicable. Data availability The datasets generated and/or analysed during the current study are available in the GBD website. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the National Natural Science Foundation of China (grant number 82272726), the Capital Health Development Research Project (2020-2-4024), and the special research fund for central universities, peking union medical college (grant number 33332023025). Authors' contributions Kunyu Wang, Wei Mao, Yan Song, and Bin Li contributed to the study conception and design. Kunyu Wang, Wei Mao and You Wu contributed to data interpretation and analysis. The first draft of the manuscript was written by Kunyu Wang, Wei Mao, and Yanan Zhang. Bin Li supervised the study and critically revised the manuscript. All authors approved the final manuscript. Acknowledgments We extend our profound gratitude to the collaborative efforts of the Global Burden of Disease Study 2019 team, who have furnished an unparalleled, comprehensive assessment of various diseases impacting the global community. References Arora T, Mullangi S, Lekkala MR. Ovarian Cancer. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Sanjana Mullangi declares no relevant financial relationships with ineligible companies. 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Collaborators GRF. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-49. Zhang Y, Liu J, Han X, Jiang H, Zhang L, Hu J, et al. Long-term trends in the burden of inflammatory bowel disease in China over three decades: A joinpoint regression and age-period-cohort analysis based on GBD 2019. Front Public Health. 2022;10:994619. Collaborators GMS. Global, regional, and national burden of multiple sclerosis 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(3):269-85. Pasetto R, Terracini B, Marsili D, Comba P. Occupational burden of asbestos-related cancer in Argentina, Brazil, Colombia, and Mexico. Ann Glob Health. 2014;80(4):263-8. Fazzo L, Binazzi A, Ferrante D, Minelli G, Consonni D, Bauleo L, et al. Burden of Mortality from Asbestos-Related Diseases in Italy. Int J Environ Res Public Health. 2021;18(19). Niccoli T, Partridge L. Ageing as a Risk Factor for Disease. Current Biology. 2012;22(17):R741-R52. Bland JS. Age as a Modifiable Risk Factor for Chronic Disease. Integr Med (Encinitas). 2018;17(4):16-9. Korchevskiy AA, Wylie AG. Asbestos exposure, lung fiber burden, and mesothelioma rates: Mechanistic modelling for risk assessment. Computational Toxicology. 2022;24:100249. Weiskopf D, Weinberger B, Grubeck-Loebenstein B. The aging of the immune system. Transpl Int. 2009;22(11):1041-50. Collaborators GV. Five insights from the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1135-59. Ciampi E, Soler B, Uribe-San-Martin R, Jürgensen L, Guzman I, Keller K, et al. Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile. Mult Scler Relat Disord. 2023;78:104918. Loue S. Disparities in Health, Health Care, and Healthcare Access. In: Loue S, editor. Diversity, Cultural Humility, and the Helping Professions: Building Bridges Across Difference. Cham: Springer International Publishing; 2022. p. 69-87. Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014;129 Suppl 2(Suppl 2):19-31. Lobanov-Rostovsky S, He Q, Chen Y, Liu Y, Wu Y, Liu Y, et al. Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people. BMC Public Health. 2023;23(1):1272. Zarulli V, Sopina E, Toffolutti V, Lenart A. Health care system efficiency and life expectancy: A 140-country study. PLoS One. 2021;16(7):e0253450. Collaborators GCRF. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400(10352):563-91. Li Z, Zhang X, Sun C, Li Z, Fei H, Zhao D. Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of Disease Study 2019: a cross-sectional study. Int J Surg. 2024;110(4):1929-40. Wang S, Dong Z, Wan X. Global, regional, and national burden of inflammatory bowel disease and its associated anemia, 1990 to 2019 and predictions to 2050: An analysis of the global burden of disease study 2019. Autoimmun Rev. 2024;23(3):103498. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.docx File name:Additional file 1. Title of data: Supplementary Information. Description of data: The supplementary information provided contains detailed data related to the burden of ovarian cancer attributable to occupational exposure to asbestos, as analyzed through the 1990-2019 Global Burden of Disease (GBD) data. The document includes tables and figures that summarize the global trends in the number of deaths, age-standardized death rates, disability-adjusted life years (DALYs), and age-standardized DALY rates associated with occupational asbestos exposure. Tables: Table S1: This table presents the number of death cases and age-standardized death rates of ovarian cancer attributable to occupational asbestos exposure in 1990 and 2019, along with the estimated annual percentage change (EAPC) in these metrics from 1990 to 2019. Table S2: Similar to Table S1, this table provides the number of DALYs cases and age-standardized DALY rates in 1990 and 2019, and their trends over time. Table S3 and S4: These tables forecast the numbers and age-standardized rates of deaths and DALYs of ovarian cancer attributable to occupational asbestos exposure by sex globally from 1990 to 2030 using the age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models, respectively. Table S5 and S6: These tables detail the changes in the number of deaths and DALYs of ovarian cancer attributable to occupational asbestos exposure based on population-level determinants and causes between 1990 and 2019. Figures: Figure S1: This figure displays the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure for different age groups in 2019. Figure S2: It shows the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure for different SDI (Socio-demographic Index) regions in 2019. Figure S3: It depicts the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure for different GBD regions in 2019. Figure S4: This figure illustrates the trends in the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure globally by age groups from 1990 to 2019. Figure S5: It shows similar trends as Figure S4 but by SDI regions from 1990 to 2019. Figure S6: This figure presents the results of cluster analysis based on the EAPC values of the age-standardized death and DALY rates of ovarian cancer attributable to occupational asbestos exposure from 1990 to 2019. Figure S7: It includes the EAPC values for the age-standardized death and DALY rates of ovarian cancer attributable to occupational asbestos exposure from 1990 to 2019, along with the relative change in the numbers of deaths and DALYs cases between 1990 and 2019. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4933345","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343467897,"identity":"128882e6-4c9b-40ee-bfc6-64106d0efadc","order_by":0,"name":"Kunyu Wang","email":"","orcid":"","institution":"Cancer Hospital of Chinese Academy of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kunyu","middleName":"","lastName":"Wang","suffix":""},{"id":343467899,"identity":"8e75b357-1126-4dc5-a8fc-b6b9c277d246","order_by":1,"name":"Wei Mao","email":"","orcid":"","institution":"Cancer Hospital of Chinese Academy of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Mao","suffix":""},{"id":343467900,"identity":"e8f28bae-8128-453d-bc6b-fd957367dae0","order_by":2,"name":"You Wu","email":"","orcid":"","institution":"Cancer Hospital of Chinese Academy of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"You","middleName":"","lastName":"Wu","suffix":""},{"id":343467902,"identity":"a18fe33b-deb8-4d23-bb0b-7e78dc825fc9","order_by":3,"name":"Yan Song","email":"","orcid":"","institution":"Cancer Hospital of Chinese Academy of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Song","suffix":""},{"id":343467903,"identity":"58068d52-9c97-4126-942c-e424dfcafaa2","order_by":4,"name":"Yanan Zhang","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yanan","middleName":"","lastName":"Zhang","suffix":""},{"id":343467904,"identity":"34fcdf01-cc64-46e3-a95b-99c2360762de","order_by":5,"name":"Bin Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYBACPmYehgMMFQw8xGthA2s5Q5IWkGLGNlIcxsbOe/Bw4Tw7Gf7208kfGGrsGPhnNxByGF/C4ZnbknkkzuRuk2A4lswgcecAIS08Bod5tx3gMWDI3QbkHmAwkEggRsscoBb+t5s/MPwjWksDUItE7gYJxjaitAD9wnMM6Jcbb7dJJPaBGAS08POfPfyZp8bOnr8/d/OHD9/s5PhnENCCCoCKSYjTUTAKRsEoGAU4AQANbjfvGpxGPwAAAABJRU5ErkJggg==","orcid":"","institution":"Cancer Hospital of Chinese Academy of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-08-18 12:36:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4933345/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4933345/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64762110,"identity":"b837d262-0769-480b-973d-f984bb325240","added_by":"auto","created_at":"2024-09-18 13:15:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1575678,"visible":true,"origin":"","legend":"\u003cp\u003eAsbestos-related ovarian cancer deaths and DALYs by country/territory in 2019.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/14bd269dbb997fbc50f4674f.png"},{"id":64762935,"identity":"b31e7ee0-c396-4647-bde1-e2bcbd99bc33","added_by":"auto","created_at":"2024-09-18 13:23:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":347515,"visible":true,"origin":"","legend":"\u003cp\u003eGlobal trends in asbestos-related ovarian cancer deaths and DALYs (1990-2019). Abbreviations: DALYs, disability-adjusted-life-years.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/78cb76bda272d15994706893.png"},{"id":64763754,"identity":"c48335a5-4cbe-4a1e-bdb7-2f4be422989b","added_by":"auto","created_at":"2024-09-18 13:31:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":135542,"visible":true,"origin":"","legend":"\u003cp\u003eAPC model predictions for global asbestos-related ovarian cancer deaths and DALYs (1990-2030).\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/bac5b388438c6acc999d26d7.png"},{"id":64762109,"identity":"1878dafc-2a81-486d-8287-ffa386946e00","added_by":"auto","created_at":"2024-09-18 13:15:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":230196,"visible":true,"origin":"","legend":"\u003cp\u003eBAPC model predictions for global asbestos-related ovarian cancer deaths and DALYs (1990-2030).\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/199361feb1434646be2b8850.png"},{"id":64762112,"identity":"fe70a07d-c9e4-479e-b436-04ca1839b20b","added_by":"auto","created_at":"2024-09-18 13:15:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":105376,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in asbestos-related ovarian cancer deaths and DALYs by population factors (1990-2019).\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/93fadd98e52a332e3673e474.png"},{"id":64762107,"identity":"d27ca3fe-4d58-45c6-8c7f-09ce0dc8fbdc","added_by":"auto","created_at":"2024-09-18 13:15:00","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":316392,"visible":true,"origin":"","legend":"\u003cp\u003eFrontier analysis of SDI vs. asbestos-related ovarian cancer DALYs (2019). The frontier is delineated in solid black color; countries and territories are represented as dots. The top 15 countries with the largest effective difference (largest DALYs gap from the frontier) are labeled in black; examples of frontier countries with low SDI (\u0026lt;0.5) and low effective difference are labeled in blue, and examples of countries and territories with high SDI (\u0026gt;0.85) and relatively high effective difference for their level of development are labeled in red. Red dots indicate an increase in age-standardized DALYs rate from 1990 to 2019; blue dots indicate a decrease in age-standardized DALYs rate between 1990 and 2019.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/b0af5e8f21d15d7a32b39398.png"},{"id":73254989,"identity":"27926937-c582-43d3-8348-c981c154be46","added_by":"auto","created_at":"2025-01-08 08:32:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3150181,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/7ea07511-8330-4b1b-addf-ce4c48561a86.pdf"},{"id":64762111,"identity":"39775fb4-0835-4c37-aa26-e81cd614b022","added_by":"auto","created_at":"2024-09-18 13:15:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2474435,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFile name:\u003c/strong\u003eAdditional file 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTitle of data: \u003c/strong\u003eSupplementary Information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescription of data:\u003c/strong\u003e The supplementary information provided contains detailed data related to the burden of ovarian cancer attributable to occupational exposure to asbestos, as analyzed through the 1990-2019 Global Burden of Disease (GBD) data. The document includes tables and figures that summarize the global trends in the number of deaths, age-standardized death rates, disability-adjusted life years (DALYs), and age-standardized DALY rates associated with occupational asbestos exposure.\u003c/p\u003e\n\u003cp\u003eTables:\u003c/p\u003e\n\u003cp\u003eTable S1: This table presents the number of death cases and age-standardized death rates of ovarian cancer attributable to occupational asbestos exposure in 1990 and 2019, along with the estimated annual percentage change (EAPC) in these metrics from 1990 to 2019.\u003c/p\u003e\n\u003cp\u003eTable S2: Similar to Table S1, this table provides the number of DALYs cases and age-standardized DALY rates in 1990 and 2019, and their trends over time.\u003c/p\u003e\n\u003cp\u003eTable S3 and S4: These tables forecast the numbers and age-standardized rates of deaths and DALYs of ovarian cancer attributable to occupational asbestos exposure by sex globally from 1990 to 2030 using the age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models, respectively.\u003c/p\u003e\n\u003cp\u003eTable S5 and S6: These tables detail the changes in the number of deaths and DALYs of ovarian cancer attributable to occupational asbestos exposure based on population-level determinants and causes between 1990 and 2019.\u003c/p\u003e\n\u003cp\u003eFigures:\u003c/p\u003e\n\u003cp\u003eFigure S1: This figure displays the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure for different age groups in 2019.\u003c/p\u003e\n\u003cp\u003eFigure S2: It shows the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure for different SDI (Socio-demographic Index) regions in 2019.\u003c/p\u003e\n\u003cp\u003eFigure S3: It depicts the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure for different GBD regions in 2019.\u003c/p\u003e\n\u003cp\u003eFigure S4: This figure illustrates the trends in the numbers and age-standardized rates of ovarian cancer deaths and DALYs attributable to occupational asbestos exposure globally by age groups from 1990 to 2019.\u003c/p\u003e\n\u003cp\u003eFigure S5: It shows similar trends as Figure S4 but by SDI regions from 1990 to 2019.\u003c/p\u003e\n\u003cp\u003eFigure S6: This figure presents the results of cluster analysis based on the EAPC values of the age-standardized death and DALY rates of ovarian cancer attributable to occupational asbestos exposure from 1990 to 2019.\u003c/p\u003e\n\u003cp\u003eFigure S7: It includes the EAPC values for the age-standardized death and DALY rates of ovarian cancer attributable to occupational asbestos exposure from 1990 to 2019, along with the relative change in the numbers of deaths and DALYs cases between 1990 and 2019.\u003c/p\u003e","description":"","filename":"Additionalfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4933345/v1/85b5301aaaeabf4571ec0808.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global burden and trends of ovarian cancer attributable to occupational exposure to asbestos: A study based on 1990-2019 GBD data.","fulltext":[{"header":"Background","content":"\u003cp\u003eOvarian cancer, a leading cause of death among women, has been a persistent health challenge worldwide (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Its etiology is multifactorial, encompassing genetic predisposition, hormonal factors, and environmental exposures (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Among these, the potential role of asbestos exposure in ovarian cancer development has garnered increasing attention (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Asbestos, a naturally occurring mineral fiber, has been widely used in various industries for its unique physical properties (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, its widespread use has also led to concerns regarding its carcinogenicity, particularly in occupational settings (\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies have examined the association between asbestos exposure and ovarian cancer, but the results have been inconsistent (\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Some studies have reported a significant positive association (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), while others have failed to find a conclusive link (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This inconsistency may be attributed to differences in study design, population characteristics, and exposure assessment methods.\u003c/p\u003e \u003cp\u003eA comprehensive analysis of the global burden of ovarian cancer attributable to occupational exposure to asbestos is lacking. Moreover, given the complexities and inconsistencies surrounding the association between asbestos exposure and ovarian cancer, there is a pressing need for further investigation. By leveraging large-scale datasets, such as the Global Burden of Disease (GBD) Study, we can offer a comprehensive understanding of the burden of ovarian cancer attributable to asbestos exposure.\u003c/p\u003e \u003cp\u003eIn this study, we aim to analyze the deaths and DALYs of ovarian cancer attributable to occupational exposure to asbestos using GBD data from 1990 to 2019. Our study will employ rigorous statistical methods to analyze the GBD data. The results of this study will contribute to the existing knowledge on the health impacts of asbestos exposure and inform future research and policy efforts aimed at reducing the burden of ovarian cancer.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOverview\u003c/h2\u003e \u003cp\u003eThe annual number of ovarian cancers attributable to occupational exposure to asbestos cases and their corresponding age-standardized rates (ASRs) were retrieved from the GBD 2019 Study database. This study stands as the most comprehensive and scientifically rigorous assessment of the global epidemiological burden, encompassing data on 369 diseases and injuries, along with 87 risk factors (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The GBD 2019 database encompassed a vast array of 204 countries and territories, providing a comprehensive temporal coverage from 1990 to 2019 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). For analysis, the 204 countries and territories were categorized into 22 GBD super regions and 45 GBD regions, reflecting their geographical distributions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Additionally, a socio-demographic index (SDI), a composite indicator of sociodemographic developmental status developed by the GBD team to categorize the 204 countries into five socioeconomic developmental levels, was employed to further categorize these countries and territories into five distinct regions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn estimating the disease burden, the GBD 2019 study utilized the DisMod-MR, a Bayesian meta-regression modelling tool that serves as the standard modeling framework within the GBD (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This tool allowed us to meticulously describe the ovarian cancer burden by sex, age, location, and year. The assessment of disease burden data involved rigorous criteria, and systematic biases were adjusted through crosswalks, leveraging adjustment factors estimated by the MR-BRT tool. Notably, in the current iteration of the DisMod-MR model, the additional mortality and remission were assumed to be zero.\u003c/p\u003e \u003cp\u003eThe data utilized in the 2019 GBD study were sourced from diverse and reliable channels, including household surveys, vital statistics, and other authoritative sources, ensuring the accuracy and representational of our findings (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)[22].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eFirst, the number of deaths and DALYs cases attributable to occupational exposure to asbestos-related ovarian cancer and their corresponding ASRs were assessed in 2019 globally and by different sub-types including age, SDI regions, GBD regions, and countries. Secondly, a thorough analysis was conducted to explore the temporal trend of this disease burden globally and by subtype, spanning from 1990 to 2019. The Estimated Annual Percentage Change (EAPC) value was calculated using a linear regression model. Furthermore, a hierarchy cluster analysis was performed, leveraging the EAPC values, to assess the evolving patterns of disease burden across various GBD regions and identify those with similar trends. Consequently, all 45 GBD regions were categorized into four distinct groups: significant increase, minor increase, remained stable or minor decrease, and significant decrease. Moreover, we utilized both the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model, integrated with nested Laplace approximations, to predict the future disease burden from 2020 to 2030. To further delve into the factors driving changes in the disease burden between 1990 and 2019, decomposition analyses were conducted, focusing on age structure, population size, and epidemiological shifts. Lastly, frontier analysis was employed to assess the correlation between disease burden and sociodemographic development. By establishing a nonlinear frontier, we were able to identify the lowest achievable burden based on a country's or region's current development status. This analysis was facilitated by non-parametric data envelope analysis, drawing upon previous studies for methodological guidance. The effective difference, representing the gap between the observed DALYs rate and the frontier, signifies the potential health gains that could be realized given the current level of development.\u003c/p\u003e \u003cp\u003eIf the P-value fell below 0.05, it was deemed statistically significant. For the construction, collation, and analysis of the database, we utilized the R software (version 4.0.2).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eThe disease burden of ovarian cancer attributable to occupational exposure to asbestos in 2019\u003c/h2\u003e \u003cp\u003eIn 2019, the burden of ovarian cancer attributable to occupational exposure to asbestos was substantial. Specifically, 6557 deaths cases [95% uncertainty interval (UI): 2951\u0026ndash;10664) were attributed to this exposure. The corresponding age-standardized deaths rate stood at 0.08 per 100,000 population, with a 95% UI of 0.04 to 0.14. Furthermore, the disease's impact on individuals' quality of life was reflected in the significant number of disability-adjusted life years (DALYs) lost, totaling 113268 cases (95% UI: 50081\u0026ndash;184671). The age-standardized rate of DALYs was 1.4, with a 95% UI of 0.62 to 2.28 (\u003cb\u003eTables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e\u003c/b\u003e provides the detailed disease burden of deaths and DALYs across various age groups in 2019. Notably, the age-standardized deaths rate exhibited a consistent upward trend with increasing age. However, the age-standardized DALYs rate initially rose with age, peaking in the 85-89-year-old group, before subsequently decreasing. The observed patterns in the number of deaths and DALYs cases closely mirrored the trend exhibited by the age-standardized DALYs rate, as reflected in \u003cb\u003eTables S1-2\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the disease burden across SDI regions, the age-standardized rates (ASRs) of deaths and DALYs initially decrease and then increase as the SDI decreases. Notably, the high SDI regions exhibit the highest ASRs, while the middle SDI regions have the lowest. Conversely, the number of deaths and DALYs cases is inversely related to the SDI, meaning that the highest number of cases is observed in the high SDI regions, with the lowest number in the low SDI regions (\u003cb\u003eFigure S2, Tables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe \u003cspan refid=\"Sec5\" class=\"InternalRef\"\u003eResults\u003c/span\u003e section of our study reveals intriguing patterns across the 45 GBD regions in terms of deaths and DALYs cases, as well as their respective ASRs. Among these regions, the World Bank High Income region emerged as the leading GBD region to both deaths (4,266, 95% UI: 1,931-7,058) and DALYs cases (65,334, 95% UI: 29,273\u0026thinsp;\u0026minus;\u0026thinsp;108,779). Immediately following was the European Region, closely followed by Europe \u0026amp; Central Asia - WB. At the opposite end of the spectrum, Oceania recorded the lowest number of deaths (1, 95% UI: 0\u0026ndash;2) and DALYs cases (23, 95% UI: 6\u0026ndash;64), followed by Caribbean and Central Sub-Saharan Africa. When considering the ASRs, a different ranking emerged. The Commonwealth High Income region topped the list for both deaths (ASR: 0.36, 95% UI: 0.16\u0026ndash;0.58) and DALYs (ASR: 5.78, 95% UI: 2.61\u0026ndash;9.64), preceded by Australasia and Western Europe. Conversely, the Middle East \u0026amp; North Africa - WB region recorded the lowest ASRs for both deaths (0.01, 95% UI: 0.01\u0026ndash;0.02) and DALYs (0.25, 95% UI: 0.12\u0026ndash;0.48) (\u003cb\u003eFigure S3, Tables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe global burden of ovarian cancer attributed to occupational asbestos exposure exhibited significant variation among different countries of the world. Notably, the United Kingdom exhibited the highest age-standardized death rate and DALYs rate among all the countries surveyed, with 0.51 deaths (95% UI: 0.22\u0026ndash;0.82) and 8.31 DALYs (95% UI: 3.59\u0026ndash;13.67) per 100,000 populations in 2019. Norway followed closely in terms of these rates. Conversely, Guam reported the lowest age-standardized death rate and DALYs rate, with zero deaths (95% UI: 0-0.01) and 0.05 DALYs (95% UI: 0.01\u0026ndash;0.13) per 100,000, followed by the Syrian Arab Republic and Cabo Verde. When considering the absolute numbers, the United States of America stood out as having the highest number of deaths and DALYs, totaling 932 deaths (95% UI: 415\u0026ndash;1545) and 14,431 DALYs (95% UI: 6,223\u0026thinsp;\u0026minus;\u0026thinsp;24,325), respectively. The United Kingdom also ranked highly in this regard. On the other hand, Tokelau reported the lowest number of deaths and DALYs in 2019, with numbers close to zero, followed by Niue and Nauru (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cb\u003eTables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTemporal trend for disease burden of ovarian cancer attributable to occupational exposure to asbestos from 1990 to 2019\u003c/b\u003e \u003c/p\u003e \u003cp\u003eGlobally, the number of deaths of ovarian cancer attributable to occupational exposure to asbestos rose significantly by 62.70%, from 4030 (95% UI: 1857\u0026ndash;6541) in 1990 to 6557 (95% UI: 2951\u0026ndash;10664) in 2019. However, the trend in the age-standardized deaths rate exhibited an opposing direction, with a significant decrease indicated by the EAPC of -1.12 [95% confidence interval (CI): -1.16\u0026ndash;1.07). Similarly, the pattern observed in DALYs estimates mirrored this trend, with an increase of 47.16% in the number of DALYs cases, yet a decrease in the age-standardized DALYs rate, reflected by the EAPC value of -1.37 (95% CI: -1.40 to -1.33) (\u003cb\u003eTables S1-2\u003c/b\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe trends observed in the number of deaths and DALYs across all age groups exhibited consistency with those of the overall population. Nevertheless, when analyzing the ASRs of deaths and DALYs, a notable exception was observed among individuals aged 90\u0026ndash;94 years and those over 95 years. For these two specific age groups, the ASRs demonstrated an upward trend, indicating a distinct pattern compared to other age categories (\u003cb\u003eFigure S4, Tables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe trends in the number of deaths and DALYs across all SDI regions mirrored those observed in the overall population. Nevertheless, when examining the ASRs of deaths and DALYs, a distinct pattern emerged. The trends in High SDI regions and High-middle SDI regions were comparable, deviating from the remaining three SDI regions. Specifically, for these three regions, the ASRs exhibited a notable upward trend from 1990 to 2019, indicating a significant increase in the burden over time (\u003cb\u003eFigure S5, Tables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAcross 45 GBD regions, significant variation was observed in the disease burden of ovarian cancer attributable to occupational exposure. To identify regions exhibiting similar patterns of disease burden variation, a hierarchical clustering analysis was conducted in this study. The results of this analysis are presented in \u003cb\u003eFigure S6\u003c/b\u003e. Notably, a significant increase in ASRs of deaths and DALYs was observed in several regions, including World Bank High Income, Western Europe, High-income Asia Pacific, North America, High-income North America, Commonwealth High Income, European Region, Europe \u0026amp; Central Asia -WB, Europe, Region of the Americas, and America. Conversely, a significant decrease in these rates was observed in North Africa and Middle East, Australasia, Eastern Europe, Middle East \u0026amp; North Africa -WB, East Asia \u0026amp; Pacific-WB, Central Asia, World Bank Upper Middle Income, and Tropical Latin America (\u003cb\u003eFigure S6\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAcross various countries and territories, the most significant increase in ASRs of deaths and DALYs from 1990 to 2019 was observed in Georgia. Specifically, the EAPC for deaths in Georgia was 8.67 [95% confidence interval (CI): 6.98\u0026ndash;10.39]. Similarly, the EAPC for DALYs in Georgia was 8.44 (95% CI: 6.79\u0026ndash;10.11). Trinidad and Tobago and Nicaragua followed Georgia in terms of this upward trend. Conversely, the largest decrease in ASRs of deaths and DALYs was recorded in Ireland. The EAPC for deaths in Ireland was \u0026minus;\u0026thinsp;3.88 (95% CI: -4.29\u0026ndash;3.47), indicating a substantial decline. Similarly, the EAPC for DALYs in Ireland was \u0026minus;\u0026thinsp;4.46 (95% CI -4.90\u0026ndash;4.02) (\u003cb\u003eFigure S7, Tables S1-2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe predicted results for disease burden of ovarian cancer attributable to occupational exposure to asbestos from 2020 to 2030\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe anticipated disease burden forecast for the period 2020 to 2030 revealed distinct patterns in both the APC and BAPC models (\u003cb\u003eTables S3-4\u003c/b\u003e, Figs.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Specifically, the ASRs were predicted to decrease annually in both models. However, when considering the number of deaths and DALYs cases, the APC model anticipated an increase, whereas the BAPC model projected a slight decrease.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDecomposition analyses\u003c/h2\u003e \u003cp\u003eOver the past three decades, a remarkable global surge in deaths and DALYs cases had been observed. Notably, the highest increase in deaths was concentrated in regions with a high SDI, while the largest increase in DALYs cases was recorded in high-middle SDI regions. Aging and population growth played pivotal roles in this trend, accounting for 65.75% and 107.85% of the worldwide rise in deaths, respectively. Similarly, these factors contributed to 43.48% and 162.40% of the global increase in DALYs. The aging effect was particularly significant in the high SDI regions, contributing to 123.36% of the deaths and 159.63% of the DALYs, where population growth exerted the greatest influence on DALYs growth (103.20%) and deaths growth (269.52%). However, the effect of epidemiological change on deaths and DALYs growth was negative (deaths: -73.60%; DALYs: -105.88%) worldwide, and this effect was the most pronounced in the high SDI regions (deaths: -126.56%; DALYs: -329.16%) \u003cb\u003e(Table S5-S6\u003c/b\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig13\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFrontier analysis of the age-standardized DALYs rate\u003c/h2\u003e \u003cp\u003eDuring the period spanning 1990 to 2019, Fig.\u0026nbsp;\u003cspan refid=\"Fig15\" class=\"InternalRef\"\u003e6\u003c/span\u003e portrayed the unattained health gains among countries or regions at varying developmental levels. Specifically, Figs.\u0026nbsp;\u003cspan refid=\"Fig15\" class=\"InternalRef\"\u003e6\u003c/span\u003eA and \u003cspan refid=\"Fig15\" class=\"InternalRef\"\u003e6\u003c/span\u003eB highlighted the DALYs burden and the significant variations in this burden among countries or regions with diverse SDI in 2019. Notably, as sociodemographic development progressed, the effective difference in DALYs burden tended to increase, suggesting that countries or regions with a higher SDI possessed greater potential for improvement in health outcomes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSpecifically, our analysis revealed an inverse correlation between the SDI and the age-standardized DALYs rate of ovarian cancer attributed to occupational exposure to asbestos (Fig.\u0026nbsp;\u003cspan refid=\"Fig15\" class=\"InternalRef\"\u003e6\u003c/span\u003e). This indicated that regions with a higher level of socio-economic development tend to experience a lower rate of health losses due to occupational asbestos exposure-related ovarian cancer. It was noteworthy that once the SDI surpasses 0.40, the age-standardized DALYs rate for this particular health outcome exhibited a stabilized trend.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study offers a comprehensive evaluation and quantification of the global burden of ovarian cancer attributable to occupational asbestos exposure. In 2019, occupational exposure to asbestos-related ovarian cancer significantly contributed to the substantial disease burden, exhibiting notable disparities across age groups, SDI regions, GBD regions, and countries. Despite a global decline in ASRs from 1990 to 2019, the absolute number of deaths and DALYs continued to rise. The APC model predicted a steady increase in number of deaths and DALYs cases from 2019 to 2030, albeit with anticipated decreases in ASRs. However, the BAPC model forecasted a decline in both the number and ASRs of deaths and DALYs over the next 11 years. Furthermore, the frontier analysis suggested that countries with higher SDI scores possessed the greater potential for reducing this disease burden. Decomposition analysis highlighted that aging and population growth were the primary drivers of the increasing disease burden, while epidemiological change exerted negative influences.\u003c/p\u003e \u003cp\u003eIn our study, we found that occupational exposure to asbestos is a substantial contributor to the disease burden of ovarian cancer, corroborating previous research findings (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). For instance, Roberto Pasetto et al. utilized mortality data from the World Health Organization's Health Statistics database for 2009 and, by applying estimated population-attributable fractions, determined that the number of deaths attributable to occupational asbestos exposure for ovarian cancer over a five-year period was 14 in Argentina, 43 in Brazil, 9 in Colombia, and 22 in Mexico (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Similarly, Lucia Fazzo et al. noted 16 deaths per year attributable to asbestos-related ovarian cancers in Italy during the 2010\u0026ndash;2016 period (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). These findings align with our observations, further strengthening the evidence that occupational asbestos exposure significantly impacts the global burden of ovarian cancer.\u003c/p\u003e \u003cp\u003eThe global trend in ovarian cancer deaths attributable to occupational asbestos exposure saw a substantial increase in absolute numbers over the past three decades, likely reflecting improved diagnostic methods and reporting. However, the age-standardized death rate and DALYs rate declined significantly, suggesting that the burden is becoming more concentrated in older age groups. This pattern reflects progress in prevention and control measures, particularly for younger workers. Nonetheless, the continuing increase in absolute numbers highlights the need for sustained efforts to reduce exposure and improve detection, particularly in high-risk regions.\u003c/p\u003e \u003cp\u003eIn our study, we observed intriguing trends in age-specific mortality and DALYs related to the target disease. Notably, the age-standardized death rates increase steadily with age, underscoring the disproportionate impact on older individuals, which aligns with age being a significant risk factor for chronic diseases (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, the age-standardized DALYs rate initially rises, peaking in the 85\u0026ndash;89 age group, and then declines, indicating a reduction in disease severity at extreme ages. This could be attributed to shorter life expectancy and potentially reduced disease duration or severity among the oldest individuals. The close correlation between the patterns observed in the number of deaths and DALYs cases with the age-standardized DALYs rate further solidifies our understanding of the age-related burden of this disease. This finding underscores the importance of considering both mortality and morbidity metrics in assessing the overall burden of disease, as they provide complementary insights into different aspects of the disease burden.\u003c/p\u003e \u003cp\u003eWhile the consistency in trends across age groups is remarkable, the deviation in age-standardized rates (ASRs) among individuals aged 90\u0026ndash;94 and over 95 is particularly intriguing. The upward trend in ASRs for these oldest age groups suggests a relative increase in the burden of ovarian cancer deaths and DALYs compared to the general population. This could be attributed to the cumulative effect of asbestos exposure over a longer lifetime, combined with age-related declines in immune function and other physiological changes (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Further research is necessary to elucidate the specific factors contributing to this pattern and to develop targeted interventions for this vulnerable segment of the population. In our analysis of disease burden across SDI regions, we uncovered intriguing patterns pertaining to the ASRs of deaths and DALYs related to this disease. Notably, this burden peaks in high SDI regions, suggesting a non-uniform distribution across SDI levels. While high SDI regions enjoy advanced healthcare, they are nonetheless burdened significantly by obesity, lifestyle-related diseases, and aging (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Middle SDI regions, on the other hand, exhibit lower ASRs, potentially attributable to healthier behaviors and effective disease prevention strategies. However, a reverse trend emerges when considering absolute case numbers, reflecting the intricate interplay between socio-economic factors and disease burden.\u003c/p\u003e \u003cp\u003eThe trends in deaths and DALYs across SDI regions mirror those observed in the general population. However, a closer examination of ASRs reveals a distinct pattern. High and high-middle SDI regions exhibit similar trends, which diverge from those of low, low-middle, and middle SDI regions. Remarkably, the latter three regions demonstrate a significant upward trend in ASRs from 1990 to 2019, indicating an escalating burden over time. This divergence may stem from varying degrees of healthcare access, socioeconomic factors, or differences in disease prevention strategies across SDI regions (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Further investigation of these factors is imperative to gain a deeper understanding of the dynamics of disease burden across SDI regions.\u003c/p\u003e \u003cp\u003eThe global distribution of ovarian cancer burden attributed to occupational asbestos exposure reveals striking disparities. Notably, the World Bank High Income region, led by the United Kingdom, emerges as a significant hotspot for both deaths and DALYs, indicating a high burden despite the presence of advanced healthcare systems. Conversely, Oceania and Caribbean regions exhibit a comparatively lower burden. However, when considering ASRs, a different picture emerges, with Commonwealth High Income regions topping the list, highlighting a disproportionate impact on specific populations. Intriguingly, the United States, despite not ranking highest in ASRs, stands out for its substantial absolute burden of ovarian cancer deaths and DALYs. This underscores the importance of employing both standardized and absolute metrics in comprehensive disease burden analyses. The hierarchical clustering analysis further sheds light on these disparities, revealing significant regional variations in ASRs of ovarian cancer deaths and DALYs attributable to occupational exposure. High-income regions like Western Europe and North America exhibit an upward trend, whereas regions like North Africa and the Middle East display a decline. The significant increases observed in Georgia, Trinidad and Tobago, and Nicaragua suggest potential occupational risk factors or changing exposure patterns. Conversely, the substantial decline in Ireland points to possible improvements in occupational safety or changes in risk factors.\u003c/p\u003e \u003cp\u003eThe anticipated disease burden forecast for 2020 to 2030 exhibits contrasting trends between the APC and BAPC models. While both models predict a yearly decline in ASRs, their divergence in forecasting deaths and DALYs cases is noteworthy. The APC model's prediction of an increase suggests that the disease's impact may persist, despite improvements in overall health indicators. Conversely, the BAPC model's slight decrease indicates a possible slowdown in the disease's burden. This divergence highlights the complexity of disease forecasting and the need to consider multiple models. It also underscores the importance of monitoring both ASRs and absolute numbers of deaths and DALYs to gain a comprehensive understanding of disease burden trends.\u003c/p\u003e \u003cp\u003eOver the past three decades, the significant global rise in deaths and DALYs cases has been a matter of grave concern. The concentration of the highest death increase in high SDI regions and the largest DALYs increase in high-middle SDI regions reveals a complex interplay between socioeconomic development and health outcomes (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Aging and population growth have emerged as key drivers, with aging particularly impact in high SDI regions. This is evident from the disproportionately high contributions to both deaths and DALYs, emphasizing the need for targeted interventions to address the aging population's health needs. However, the negative impact of epidemiological changes on deaths and DALYs growth, especially in high SDI regions, is noteworthy. This suggests that while socioeconomic progress brings with it improved healthcare and life expectancy, it may also introduce new health challenges that need to be addressed (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The pronounced decrease in deaths and DALYs attributable to epidemiological changes in high SDI regions highlights the potential for effective prevention and control strategies to mitigate the burden of disease (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrontier analysis highlighted the attained health gains across countries or regions with varying developmental levels from 1990 to 2019. Notably, as socio-demographic development increases, the discrepancy in DALYs burden also rises, indicating greater potential for health improvement in higher SDI regions. Our analysis further reveals an inverse relationship between SDI and the age-standardized DALYs rate for ovarian cancer attributed to occupational asbestos exposure. As SDI surpasses 0.40, this rate stabilizes, suggesting that higher socio-economic development may mitigate health losses due to this exposure.\u003c/p\u003e \u003cp\u003eIn our study, we acknowledge two limitations. Firstly, the precision of our estimated burden is heavily contingent upon the availability and quality of the procured data (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Secondly, the compilation of epidemiological statistics for a given country often relies solely on one or a select few registries situated in specific geographical areas. This becomes particularly pertinent in underdeveloped countries, where the scarcity of registries may necessitate the utilization of data from a solitary regional registry. To enhance data representativeness, it is advisable to add more registries (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, our study offers a comprehensive global overview of the substantial burden of ovarian cancer attributable to occupational asbestos exposure, revealing stark disparities across age groups, regions, and nations. These findings underscore the imperative for tailored prevention and control measures, particularly in high-risk locales and among vulnerable populations. The contrasting trends of rising deaths and DALYs despite decreasing age-standardized death rates highlight the urgency of tackling this malignancy. Moreover, the projected steady escalation in future burden underscores the need for sustained efforts in prevention and early detection. The identification of aging and population growth as major drivers of this burden highlights the importance of addressing these factors in policymaking. The observed greater improvement potential in countries with higher socio-demographic index scores indicates that targeted interventions in these regions could significantly reduce disease burden. Overall, our study deepens the understanding of the global ovarian cancer burden associated with occupational asbestos exposure, paving the way for more effective prevention and control strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPC, age-period-cohort; ASRs, age-standardized rates; BAPC, Bayesian age-period-cohort; DALY, disability-adjusted life-year; CI, confidence interval; EAPC, estimated annual percentage change; GBD, Global Burden of Disease; SDI, socio-demographic index; UI, uncertainty interval.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe GBD 2019 study is an open database, and all data is anonymous.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available in the GBD website.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (grant number 82272726), the Capital Health Development Research Project (2020-2-4024), and the special research fund for central universities, peking union medical college (grant number 33332023025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKunyu Wang, Wei Mao, Yan Song, and Bin Li contributed to the study conception and design. Kunyu Wang, Wei Mao and You Wu contributed to data interpretation and analysis. The first draft of the manuscript was written by Kunyu Wang, Wei Mao, and Yanan Zhang. Bin Li supervised the study and critically revised the manuscript. All authors approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our profound gratitude to the collaborative efforts of the Global Burden of Disease Study 2019 team, who have furnished an unparalleled, comprehensive assessment of various diseases impacting the global community.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eArora T, Mullangi S, Lekkala MR. Ovarian Cancer. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Sanjana Mullangi declares no relevant financial relationships with ineligible companies. 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Health care system efficiency and life expectancy: A 140-country study. PLoS One. 2021;16(7):e0253450.\u003c/li\u003e\n\u003cli\u003eCollaborators GCRF. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400(10352):563-91.\u003c/li\u003e\n\u003cli\u003eLi Z, Zhang X, Sun C, Li Z, Fei H, Zhao D. Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of Disease Study 2019: a cross-sectional study. Int J Surg. 2024;110(4):1929-40.\u003c/li\u003e\n\u003cli\u003eWang S, Dong Z, Wan X. Global, regional, and national burden of inflammatory bowel disease and its associated anemia, 1990 to 2019 and predictions to 2050: An analysis of the global burden of disease study 2019. Autoimmun Rev. 2024;23(3):103498.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ovarian cancer, occupational, exposure to asbestos, deaths, DALYs","lastPublishedDoi":"10.21203/rs.3.rs-4933345/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4933345/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOvarian cancer remains a major health issue, with occupational asbestos exposure possibly contributing to its risk. We comprehensively assess the global burden of asbestos-related ovarian cancer, explore disparities, and project future trends to inform prevention strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe evaluated deaths and disease-adjusted life years (DALYs) globally in 2019, analyzed temporal trends (1990\u0026ndash;2019), and used the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model to predict future burdens. Decomposition analysis identified drivers of burden change, and frontier analysis assessed the correlation with socio-demographic development.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn 2019, occupational exposure to asbestos was a significant contributor to the substantial burden of ovarian cancer, exhibiting considerable disparities across age groups, Socio-demographic Index (SDI) regions, Global Burden of Disease (GBD) regions, and countries. Despite a global trend of declining age-standardized rates (ASRs) between 1990 and 2019, the absolute number of deaths and DALYs associated with asbestos-related ovarian cancer continued to rise. The APC model predicted a steady escalation in the number of deaths and DALYs from 2019 to 2030 while forecasting a decrease in the ASRs. However, contrasting results emerged from the BAPC model, which indicates that both the number of deaths and DALYs, as well as their ASRs, are anticipated to decline. Furthermore, the frontier analysis suggested that countries with higher SDI scores exhibit greater potential for reducing the disease burden. Our decomposition analysis revealed that aging and population growth were the primary drivers of the increasing disease burden, whereas epidemiological change exerted a negative influence.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOccupational exposure to asbestos is a substantial contributor to the disease burden of ovarian cancer. Success with reducing asbestos occupational exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public.\u003c/p\u003e","manuscriptTitle":"Global burden and trends of ovarian cancer attributable to occupational exposure to asbestos: A study based on 1990-2019 GBD data.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-18 13:14:55","doi":"10.21203/rs.3.rs-4933345/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0e4efcd-5621-444f-a7f5-a6cae803952b","owner":[],"postedDate":"September 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-08T08:24:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-18 13:14:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4933345","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4933345","identity":"rs-4933345","version":["v1"]},"buildId":"CiT4i_kKBbxQbnFL0ufpk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}