Trends and Future Burden of Endometrial Cancer in China (1990-2041): A Comparative Analysis with G20 Countries based on the Global Burden of Disease Study 2021

Trends and Future Burden of Endometrial Cancer in China (1990-2041): A Comparative Analysis with G20 Countries based on the Global Burden of Disease Study 2021 | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 9 September 2025 V1 Latest version Share on Trends and Future Burden of Endometrial Cancer in China (1990-2041): A Comparative Analysis with G20 Countries based on the Global Burden of Disease Study 2021 Authors : Shuyang Yu 0000-0001-5128-411X , Jinhua Chen , Wan Shu , Xiaoyu Shen , Guanxiao Chen , Shuangshuang Cheng , and Hongbo Wang [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175742013.31420144/v1 270 views 140 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective To analyse and compare the burden and trends of endometrial cancer (EC) in China with G20 countries and predict future patterns. Design Population-Based Study. Setting Data from the Global Burden of Disease (GBD) 2021 Study. Population Women diagnosed with EC in China and G20 countries, 1990–2021. Methods Data on incidence, mortality, prevalence, disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) were extracted from GBD 2021. Age-standardized rates were calculated for cross-country compare. Joinpoint regression was applied to identify temporal trend changes; age–period–cohort modeling assessed age, period and cohort effects; decomposition analysis quantified contributions of aging, population growth and age-specific rates; and ARIMA modeling was used to forecast incidence to 2040. All estimates were reported with 95% uncertainty intervals. Main Outcome Measures The burden and trends of EC in China and G20 countries. Results In 2021, age-standardized incidence and mortality rates (ASIR and ASMR) in China were lower than G20 averages, but absolute cases and deaths accounted for 17.4% and 18.5% of the G20 totals. Burden concentrated in women≥60. ASIR plateaued after 2005, ASMR declined, while G20 incidence continued to rise. Incidence growth in China was driven by population aging/scale; mortality decline reflected improved age-specific survival. By 2040, ASIR in China is projected stable, while G20 rises further. Conclusion China has reduced mortality but still faces a heavy EC burden. It’s essential to strengthen early screening, standardize treatment, and intervene high-risk groups, in order to manage aging and metabolic risks. Trends and Future Burden of Endometrial Cancer in China (1990-2041): A Comparative Analysis with G20 Countries based on the Global Burden of Disease Study 2021 Shuyang Yu 1 , Jinhua Chen 1 , Wan Shu 1 , Xiaoyu Shen 1 , Guanxiao Chen 1 , Shuangshuang Cheng 1 , Hongbo Wang 1,2* 1 Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. 2 Clinical Research Center of Cancer Immunotherapy, Hubei, 430022, Wuhan, China. Shuyang Yu and Jinhua Chen contributed equally to this work. * Correspondence: Corresponding Author [email protected] Objective To analyse and compare the burden and trends of endometrial cancer (EC) in China with G20 countries and predict future patterns. Design Population-Based Study. Setting Data from the Global Burden of Disease (GBD) 2021 Study. Population Women diagnosed with EC in China and G20 countries, 1990–2021. Methods Data on incidence, mortality, prevalence, disability-adjusted life years (DALYs), years of life lost (YLLs) and years lived with disability (YLDs) were extracted from GBD 2021. Age-standardized rates were calculated for cross-country compare. Joinpoint regression was applied to identify temporal trend changes; age–period–cohort modeling assessed age, period and cohort effects; decomposition analysis quantified contributions of aging, population growth and age-specific rates; and ARIMA modeling was used to forecast incidence to 2040. All estimates were reported with 95% uncertainty intervals. Main Outcome Measures The burden and trends of EC in China and G20 countries. Results In 2021, age-standardized incidence and mortality rates (ASIR and ASMR) in China were lower than G20 averages, but absolute cases and deaths accounted for 17.4% and 18.5% of the G20 totals. Burden concentrated in women≥60. ASIR plateaued after 2005, ASMR declined, while G20 incidence continued to rise. Incidence growth in China was driven by population aging/scale; mortality decline reflected improved age-specific survival. By 2040, ASIR in China is projected stable, while G20 rises further. Conclusion China has reduced mortality but still faces a heavy EC burden. It’s essential to strengthen early screening, standardize treatment, and intervene high-risk groups, in order to manage aging and metabolic risks. Keywords Disease burden, Endometrial cancer, Epidemiology, Temporal trend, China, G20 countries Introduction Endometrial cancer (EC), a prevalent gynecologic malignancy, continues to exhibit a rising global disease burden 1 . It has testified to be driven primarily by population aging, increasing obesity, and unhealthy lifestyles 2 . And it also presents a significant regional disparity: high-income regions such as North America and Europe report elevated incidence rates, whereas Asian countries are experiencing growing pressures though with lower rates 3 . Notably, EC demonstrates distinct age-related characteristics. According to GBD 2021 study, individuals aged 60 and older account for over 88% of global cases, highlighting its urgency in aging society. China faces a growing EC burden, driven by rapid population aging and rising women obesity rates, exceeding the global average 4 . As one of the world’s largest aging populations, China is undergoing increasing age-related disease burdens. In 2021, EC ranked as the 13th leading cause of cancer DALYs in China, indicating the need for assessing epidemiological to guide resource allocation and prevention strategies. Furthermore, G20 nations represent 80% of global economic output and 65% of the worldwide population. Its DALYs of EC account for over 70% of global, with China, the U.S., and India bearing the highest burden. The significant variations of G20 in economic and health systems underlie disparities in EC disease burden 5 . Based on GBD 2021 study, comparative analysis between China and other G20 members can support more effective health resource allocation. Therefore, using GBD 2021 data from 1990 to 2021, this study provides detailed estimates and comparisons of EC burden by age, year, and region across China and G20 countries, and projects future trends to support EC management. Method 2.1 Data sources Data were obtained from the GBD 2021 study, which contains epidemiological estimates for 369 diseases across 204 countries from 1990 to 2021. We extracted all-age and age-standardized metrics related to EC—including incidence, mortality, prevalence, YLLs, YLDs, and DALYs for China and all G20 countries. The data sources include cancer registries, vital registration, hospital records, surveys, and literature. All estimates were standardized with 95% uncertainty intervals (UI). 2.2 Definition Uterine cancer is identified using the code C54 as per the International Classification of Diseases, Tenth Edition (ICD-10). Age-standardized rates (ASRs) for incidence (ASIR), mortality (ASMR), and DALYs (ASDR) were calculated using the GBD reference population. The Socio-demographic Index (SDI), combining income, education, and fertility, was used to assess national development levels. 2.3 Descriptive analysis We described EC burden in China and G20 from 1990 to 2021 using counts and ASRs for incidence, mortality, and DALYs, with cross-country and temporal comparisons in 2021. Age-specific rates were grouped in 5 years to highlight distribution across age groups. All results presented point estimates and 95% UI. 2.4 Decomposition Analysis This analysis quantified contributions of three factors on EC incidence and mortality between 1990 and 2021: age-specific rates, population ageing, and population growth. 2.5 Joinpoint regression model Joinpoint regression (v4.9.1.0, NCI) identified significant trend changes in ASRs from 1990–2021. The model used Monte Carlo permutation to detect inflection points. Annual percent change (APC) and average APC (AAPC) with 95% CI were calculated for each segment and the overall period (α = 0.05). 2.6 Age–period–cohort analysis Age–period–cohort (APC) models estimated independent effects of age, period, and cohort on incidence and mortality trends. Outcomes included net drift (overall trend), local drift (age-specific trends), and relative risks (RRs) for period and cohort. 2.7 Frontier analysis We plotted ASDR against SDI for G20 countries (1990–2020) to evaluate efficiency of burden control. A frontier curve defined the lowest achievable burden per SDI level. The vertical distance from a country’s point to the frontier indicated performance—shorter distances reflect higher efficiency. 2.8 Prediction of incidence The forecast of ASIR (2022–2041) trends used the Autoregressive Integrated Moving Average (ARIMA) model. Parameters were selected using time-series diagnostics and model fit criteria (AIC, BIC). Final models generated forecasts with 95% prediction intervals. 2.9 Statistical analysis Analyses used R (v4.2.2) and Joinpoint software. R packages “forecast” and “APC” supported ARIMA and APC modelling. Statistical significance was set at p < 0.05. Results are presented as estimates with 95% UI. Results 3.1 The global burden of EC in G20 countries in 2021 In 2021, the highest incidence rates of EC were observed in North America and Eastern Europe, and many European countries also shown high levels (Figure 1A). China’s incidence was lower compared to the G20 average, though its mortality rate was intermediate, similar to Argentina and South Africa, but higher than Australia and Japan (Figure 1B). The total number of EC cases in G20 countries reached 2.87 million, with 73,600 deaths and 1.89 million DALYs (Table 1). China’s age-standardized prevalence and mortality rates (46.52 and 1.24 per 100,000, respectively) were below the G20 averages (85.33 and 2.08). However, due to its large population, China accounted for 17.4% of cases (500,659) and 18.5% of deaths (13,599) within the G20. Premature mortality, reflected in years of life lost (YLLs), constituted 91.2% of total DALYs, indicating high fatality. Figure 1. Global heatmaps of EC incidence (A) and mortality (B), highlighting China (green/red) and G20 countries (blue). Table 1. All-age cases and age-standardized prevalence, incidence, deaths, YLLs, YLDs, and DALYs rates in 2021 for EC in China and G20. (Provided separately as table materials) 3.2 Comparations of burdens for different age groups in China and the G20 region in 2021 The burden of EC in both China and G20 countries concentrated in women aged 50‒69, peaking at 50–64 in G20 and 60–69 in China (Figure 2A-2D). Deaths and DALYs were mostly among those ≥65. Mortality and DALY rates increased with age, rising significantly after age 80 in G20 countries but more gradually in China (Figure 2C, 2D). Incidence and prevalence were highest in the 60–69 group in both regions, but age-specific rates of G20 were consistently higher across all age groups (Figure 2A, 2B). 3.3 Comparative Epidemiological Study of EC (1990 - 2021): China vs. G20 Region From 1990 to 2021, ASIR and ASPR of China remained lower than those of the G20 and stabilized after 2005, while G20 rates continued rising (Figure 2E, 2F). And ASMR and ASDR of China declined markedly, especially after 2010, ending significantly lower than G20 levels in 2021. In contrast, G20 ASMR and ASDR decreased modestly and remained comparatively high (Figure 2G, 2H). 3.4 Comparations of the long-term trend changes of DALYs, mortality rates and morbidity rates in China and G20 countries The Estimated Annual Percentage Change (EAPC) of DALYs shown that DALYs of China remained relatively stable and no significant upward trend has emerged. In contrast, the G20 region shown a slight increase, indicating a little change in the disease burden of G20. Among them, Italy demonstrated a significant growth trend, manifesting that its DALYs burden has increased over the past few decades. Other countries, such as Indonesia and Japan, also presented a significant growth trend (Figure 2K). Comparing the EAPC of incidence rates, Italy also shown the most significant growth trend, other countries such as South Korea and Japan, also had a relatively high increase rate, which may be closely related to population aging and lifestyle. Therefore, the incidence rate in China changed relatively a few and even appeared a downward trend, while that in G20 was gradually increasing, especially in some high-income countries, which may reflect differences in their health levels and disease prevention measures (Figure 2I). Focusing on the EAPC estimates of mortality rates, the upward trends in Italy and Japan were obvious, which may be related to an aging society, an increase in chronic diseases, and other factors. Besides, the mortality rate of both China and G20 shown a downward trend, although some countries had a high mortality rate with a stable state (Figure 2J). Figure 2. The descriptive statistics of EC burden in China and G20 region. Age-specific burden of EC in China and G20 countries (2021): prevalence (A), incidence (B), deaths (C), and DALYs (D). Trends in prevalence (E), incidence (F), mortality (G), and DALYs (H) of EC in China and G20 region, 1990–2021. Estimated annual percentage change (EAPC) in mortality (I), incidence (J), and DALYs (K) for EC in China and G20 countries. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate. 3.5 Decomposition Analysis of Incidence and Mortality Focusing on the mortality changes in China, the decline mainly attributed to the reduction of age effects, while the increase was partially offset by the growth of population structure and size. And the increase of mortality in the G20 countries was mostly driven by population structure effects and size effects (Figure 3A). Besides, the growth of incidence in China was mainly forced by population structure and size effects, while the G20 countries showed a more significant influence, and the age effect contributed prominently in the United States, Italy, and some European countries (Figure 3B). In a word, the age effect in China has dominated the changes in incidence and mortality, whereas the population structure and size effects have played a mitigating role. Although the G20 countries are similar to China, the impact of incidence changes in the G20 countries are more obvious, especially the influence of population aging and size effects on incidence is more significant. 3.6 Joinpoint regression analysis in China and G20 region Between 1990 and 2021, trends in endometrial cancer age-standardized rates differed markedly between China and the G20 region. The ASIR in China increased gradually until 2004–2010, declined, then rose slightly after 2015, showing an overall fluctuating pattern (Figure 3C). In contrast, G20 ASIR rose slowly but continuously throughout the period, remaining elevated in 2021 (Figure 3D). And ASMR in China declined consistently since 1990, with acceleration after 2010, ending significantly lower than in 1990 (Figure 3E). The ASMR in G20 also declined modestly, stabilizing after 2010 at a level higher than that in China (Figure 3F). Similarly, ASDR decreased substantially in China, particularly after 2010, while the G20 also experienced a decline but maintained a higher rate than China (Figure 3G, 3H). 3.7 Age-period-cohort analysis Based on the age-period-cohort analysis, both China and the G20 region exhibited similar age effects, with endometrial cancer risk increasing with age, peaking between 60 and 80 years, and slightly declining thereafter. However, the peak risk in China was significantly lower than in the G20. For period effects, the G20 showed a sustained upward trend since 2000, while China exhibited only minor fluctuations. Cohort effects indicated that risk remained close to a relative risk of 1 from 1900 to 2000 in both regions, with any apparent increase after 2000 likely attributable to model boundary effects and thus of limited interpretability. Overall, risk levels were higher in the G20, with period effects being more pronounced (Figure 3I, 3J). Mortality rates also increased with age in both regions, peaking around age 60. China’s mortality rates were consistently lower than those in the G20, with a more gradual decline among the elderly. Period effects on mortality were minimal and stable in China, whereas the G20 experienced a gradual decline since the 1990s, especially in older age groups. Birth cohort effects on mortality were not significant in China, but the G20 showed a clear intergenerational improvement, with early cohorts (around 1900) having significantly higher mortality than those born after 1950 (Figure 3I, 3J). Figure 3. The analysis of EC burden trend in Chian and G20 region. Decomposition analysis of incidence (A) and mortality (B) of EC in China and G20 countries. Joinpoint regression analysis of ASIR (C, D), ASMR (E, F), and ASDR (G, H) for EC in China and G20, 1990–2021. Age-period-cohort analysis of EC in China (I) and G20 region (J), including local drift, longitudinal age curve, period and cohort relative risks (RR), and age/period/cohort effects. *p < 0.05. 3.8 Frontier analysis From 1990 to 2020, EC burden of China improved alongside rising SDI, gradually approaching the global frontier. However, China’s level remained suboptimal compared to high-SDI G20 countries—such as the United States, the United Kingdom, Germany, and Japan—which consistently achieved the lowest burden levels. Meanwhile, medium- to low-SDI nations (e.g. South Africa and Indonesia) lagged further behind (Figure 4A). Among G20 members, China occupied a middle position, indicating continued potential for reducing EC burden through development and policy efforts (Figure 4B). 3.9 The predicted trend of EC incidence in China and G20 region from 1990 to 2041 Based on ARIMA predictions from 1990 to 2040, ASIR of China peaked around 2010, then declined and rebounded around 2020, further is projected to stabilize thereafter with moderate fluctuations (Figure 4C). In contrast, the G20 region performed a continuous slow increase in ASIR throughout the period. Overall, China’s ASIR remains lower and relatively stable, while the G20 shows a persistent upward trend (Figure 4D). Figure 4. Frontier analysis of EC burden by Socio-demographic Index (SDI) from 1990 to 2020 (A) and comparison among G20 countries in 2020 (B); China highlighted in red. Observed and predicted ASIR of EC in China (C) and G20 region (D), 1990–2041. Shaded area indicates 95% UI. Discussion 4.1 Main Findings This study reveals several key patterns in the burden of EC across China and G20 countries from 1990 to 2021, with projections to 2040. Although ASIR and ASMR of China were lower than the G20 averages, its absolute disease burden remains substantial due to its large population base 4 . China exhibited a “low incidence, medium mortality” profile, with YLLs accounting for over 90% of DALYs, indicating a high proportion of premature deaths 6 . While ASIR of China stabilized after 2005, rates continued to rise across most G20 nations. In contrast, China achieved a significant decline in ASMR, outpacing the modest reductions observed in the G20. Decomposition analysis indicated that population aging and growth were the primary drivers of increased EC cases in China, while reductions in age-specific mortality rates contributed to the observed decline in deaths. Projections suggest a stable ASIR in China through 2040, though absolute case numbers may rise with an aging population. 4.2 Interpretation The stabilization of China’s EC incidence since 2005 stands in contrast to the persistent increases observed in many high-income G20 countries, including Italy, Japan, and South Korea 1 . This divergence may be attributed to China’s sustained public health efforts, such as the national “Two-Cancer Screening” program (for breast and cervical cancer) and enhanced primary healthcare services, which have improved early detection and access to treatment 7 . These initiatives, reinforced under the “Healthy China 2030” framework, have likely contributed to curbing incidence growth 8 . However, China faces mounting challenges from rapid population aging and rising obesity rates among women with exceeding the global average, which are established risk factors for EC 9 . Without effective and widespread lifestyle interventions and weight management strategies, the current stability in incidence may be undermined, potentially leading to a future resurgence. The remarkable decline in ASMR in China reflects substantial advancements in diagnostic and treatment capabilities, increased healthcare accessibility, and improved quality of care 10 . Nevertheless, the high proportion of YLLs within DALYs underscores a critical gap: many women are diagnosed at later stages, resulting in premature mortality and loss of productive life years. This highlights the need to strengthen early diagnostic capacity, particularly in primary and secondary healthcare settings, and to ensure timely referral for symptomatic patients. Age-period-cohort analysis indicated that EC risk increased with age in both China and G20 countries, peaking between ages 60–80, though age-specific risks were consistently lower in China. The period effect further confirmed that EC risk in G20 nations has risen continuously since 2000, while China’s risk remained stable, likely due to effective national cancer prevention policies. Cohort effects were minimal in both groups, suggesting that contemporary healthcare conditions and environmental factors play a larger role than historical exposures. Decomposition analysis revealed that the increase in EC cases in China was predominantly driven by demographic change specifically in population growth and aging, while the reduction in mortality was largely due to decreases in age-specific mortality rates. In contrast, in G20 countries, both demographic factors and rising age-specific incidence contributed to the growing burden. Frontier analysis demonstrated that China has made meaningful progress in controlling EC relative to its sociodemographic index (SDI), approaching the “ideal” efficiency frontier. Nonetheless, a gap remains compared to high-SDI countries such the U.S., Germany, and Japan, suggesting opportunities to further enhance early detection, standardize treatment protocols, and improve quality of life after diagnosis 11 . Finally, ARIMA model projections suggest China’s ASIR will remain stable until 2040, while G20 rates will continue slowly rising. Nevertheless, population aging in China may increase absolute case numbers, straining the health system. Targeted interventions for high-risk groups, individualized management strategies, and further health economic research are needed to support evidence-based policy-making 1 . 4.3 Strengths and Limitations A major strength of this study is its use of comprehensive, standardized data from the GBD 2021 study, which allows for robust cross-national and temporal comparisons. The application of multiple analytical methods strengthens the validity of the findings including age-period-cohort modeling, decomposition analysis, and ARIMA forecasting. However, several limitations should be acknowledged. GBD estimates are model-based and may be influenced by variations in data quality and availability across countries. Regional disparities within China were not analyzed due to data constraints, potentially masking subnational variations in EC burden. Furthermore, the analysis could not incorporate certain contextual factors such as regional healthcare policies, cultural barriers, or behavioral risk factors beyond obesity, which may affect incidence and outcomes. 4.4 Conclusion China has made significant progress in controlling EC, achieving notable reductions in mortality and stabilizing incidence through strengthened health services and public policies. However, the continuing challenges of population aging and rising obesity require sustained and integrated public health efforts. Practical recommendations include expanding organized screening coverage, enhancing referral pathways for symptomatic women, and promoting weight management and healthy lifestyles—especially among high-risk groups. Future research should focus on cost-effective interventions and health economic evaluations to optimize resource allocation. Building a comprehensive lifecycle prevention system will be essential to further reduce the EC burden and support the goals of “Healthy China 2030.” Acknowledgements Acknowledgement for the data support from the Institute for Health Metrics and Evaluation (IHME) and the Global Burden of Disease study 2021 (http://ghdx.healthdata.org/gbd-results-tool). The authors also appreciate the constructive comments from anonymous reviewers, which have helped to improve the quality of this work. Authors’ contributions Shuyang Yu: Conceptualisation, Data curation, Validation, Writing—original draft. Jinhua Chen: Conceptualisation, Data curation, Validation, Writing—original draft. Wan Shu: Data curation, Validation. Xiaoyu Shen: Data curation, Validation. Guanxiao Chen: Data curation, Validation. Shuangshuang Cheng: Data curation, Supervision. Hongbo Wang: Conceptualisation, Data curation, Supervision, Writing—review and editing. Funding The authors declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the National key research and development plan (No. 2023YFC2705400), National Natural Science Foundation of China (82472965), Wuhan Knowledge Innovation Special project (202202080101045). Availability of data and materials Data used in the analyses can be obtained from the GlobalHealth Data Exchange Global Burden of Disease ResultsTool (http://ghdx.healthdata.org/gbd-results-tool). Ethics approval Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References 1. Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022;399(10333):1412-28. 2. Gu B, Shang X, Yan M, Li X, Wang W, Wang Q, et al. Variations in incidence and mortality rates of endometrial cancer at the global, regional, and national levels, 1990-2019. Gynecol Oncol. 2021;161(2):573-80. 3. Matsuo K, Mandelbaum RS, Matsuzaki S, Klar M, Roman LD, Wright JD. Ovarian conservation for young women with early-stage, low-grade endometrial cancer: a 2-step schema. Am J Obstet Gynecol. 2021;224(6):574-84. 4. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. 5. Feng J, Lin R, Li H, Wang J, He H. Global and regional trends in the incidence and mortality burden of endometrial cancer, 1990-2019: Updated results from the Global Burden of Disease Study, 2019. Chin Med J (Engl). 2024;137(3):294-302. 6. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115-32. 7. Wei W, Zeng H, Zheng R, Zhang S, An L, Chen R, et al. Cancer registration in China and its role in cancer prevention and control. Lancet Oncol. 2020;21(7):e342-e9. 8. Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, et al. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev. 2020;64:101174. 9. Wang Y, Zhao L, Gao L, Pan A, Xue H. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol. 2021;9(7):446-61. 10. Zeng H, Ran X, An L, Zheng R, Zhang S, Ji JS, et al. Disparities in stage at diagnosis for five common cancers in China: a multicentre, hospital-based, observational study. Lancet Public Health. 2021;6(12):e877-e87. 11. Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019;394(10204):1192-204. Supplementary Material File (table 1. all-age cases and age-standardized prevalence, incidence, deaths, ylls, ylds, and dalys rates in 2021 for ec in china and g20.xlsx) Download 16.84 KB Information & Authors Information Version history V1 Version 1 09 September 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords carcinoma of the endometrium: diagnosis epidemiology epidemiology: gynaecological cancer health services research Authors Affiliations Shuyang Yu 0000-0001-5128-411X Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Jinhua Chen Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Wan Shu Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Xiaoyu Shen Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Guanxiao Chen Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Shuangshuang Cheng Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Hongbo Wang [email protected] Huazhong University of Science and Technology Tongji Medical College First Clinical College Union Hospital Department of Obstetrics and Gynecology View all articles by this author Metrics & Citations Metrics Article Usage 270 views 140 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Shuyang Yu, Jinhua Chen, Wan Shu, et al. Trends and Future Burden of Endometrial Cancer in China (1990-2041): A Comparative Analysis with G20 Countries based on the Global Burden of Disease Study 2021. Authorea . 09 September 2025. DOI: https://doi.org/10.22541/au.175742013.31420144/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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