Disease Burden and Changing Trends of Kidney Cancer between 1990 and 2021: A Comparative Analysis of China and the World

Disease Burden and Changing Trends of Kidney Cancer between 1990 and 2021: A Comparative Analysis of China and the World | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Disease Burden and Changing Trends of Kidney Cancer between 1990 and 2021: A Comparative Analysis of China and the World Zhongli Qiao, lin Chen, Shenyu Zhang, Jialin Wang, Runze Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4606810/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted 4 You are reading this latest preprint version Abstract Background Kidney cancer, a prevalent malignant tumor in the urinary system, poses a significant disease burden and remains a crucial public health concern. Methods Utilizing GBD2021 data, our study examined the standardized incidence, mortality, prevalence, and DALYs rate of renal cancer. We calculated the (1-MIR) value to assess treatment outcomes and survival rates, employed a joinpoint regression model to determine the AAPC, and conducted comparative and longitudinal analyses between China and global trends. Through the joinpoint regression model, we calculated the AAPC and conducted a comprehensive analysis of the disease burden of kidney cancer, evaluating its current status and changing trends. Results From 1990 to 2021, the age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, and age-standardized DALYs rate of kidney cancer in China were lower than those in the world as a whole. However, the growth rate in China was significantly faster than the global average. The age-standardized incidence rate and prevalence rate of kidney cancer in males showed a greater increase compared to females, both in China and globally. Additionally, the age-standardized rate of kidney cancer in males was notably higher than in females, particularly among middle-aged males. The (1-MIR) of renal cancer increased from 0.36 to 0.62 in China and from 0.49 to 0.58 globally. Overall, the treatment effect of renal cancer has shown some successful outcomes. Conclusions From 1990 to 2021, there was a noticeable increase in the global incidence of kidney cancer. Specifically, the standardized incidence and prevalence of kidney cancer in the Chinese population saw a more rapid rise compared to the global trend. Additionally, the disease burden of kidney cancer remained significantly higher in males than in females. Biological sciences/Cancer Health sciences/Health care Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1 Introduction Kidney cancer, a prevalent malignancy of the urinary system, poses a significant global health burden. In 2020, there were approximately 431,000 new cases reported worldwide, as per the latest data from the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO). The incidence and mortality rates of kidney cancer exhibit variations across regions, age groups, and genders. While developed countries currently report the highest rates, trends suggest a potential decline in the future. For instance, some Western European nations have witnessed a decrease in kidney cancer mortality over recent decades [ 1 ] . In the United States, the age-adjusted mortality rate (ASMR) for kidney cancer varies significantly based on sex, race, and age [ 2 ] . However, projections indicate a continued rise in both incidence and mortality globally, including in developing and less developed countries. Notably, kidney cancer ranks as the second most common genitourinary cancer in China, comprising 2–3% of adult cancers and 20% of pediatric cases. Therefore, a comprehensive understanding of the disease burden and epidemiological characteristics of kidney cancer is crucial for the development of effective prevention and intervention strategies. Previous studies have explored the impact of socioeconomic status on the changing burden of kidney cancer [ 3 ][ 4 ][ 5 ] . Recent research has shown that exposure to various risk factors has played a role in influencing the prevalence of kidney cancer [ 6 ] . A significant portion of global cancer-related deaths are preventable, with smoking, alcohol consumption, and high BMI being key factors contributing to both cancer deaths and DALYs [ 7 ] . Smoking has been identified as a known risk factor for kidney cancer [ 8 ] [ 9 ] , with heavy smokers in the Japanese population having a higher risk of renal cell carcinoma, similar to findings in Western countries [ 10 ] . Moreover, smoking has been linked to prognosis in renal cell carcinoma survival across different populations [ 11 ] . Additionally, high BMI, hypertension, and diabetes mellitus have also been recognized as risk factors for kidney cancer [ 12 ] . The association between alcohol consumption and kidney cancer risk remains controversial. Epidemiological trends of kidney cancer vary geographically, and the impact of these risk factors on different genders and age groups is not fully understood. Current research primarily focuses on clinical and treatment aspects of kidney cancer, with limited attention to disease burden. There is a gap in comparative analysis between China and the global landscape, as well as a lack of longitudinal analysis of kidney cancer burden. Therefore, continuous monitoring and analysis of kidney cancer burden, prevention, and control efforts are necessary to comprehensively understand epidemiological characteristics and risk factors across different countries and regions, facilitating more precise prevention and control strategies for kidney cancer. 2 Method Data sources This study was based on data from the Global Burden of Disease (GBD) 2021 database, which assesses the burden of disease of 459 diseases and injuries and risk factors in 204 countries or regions. Detailed data were downloaded from the Global Health Data Exchange (GHDx) database. incidence, mortality, prevalence, disability-adjusted life years ratio (DALYs), and 1-MIR (mortality-to-incidence ratio) were used to estimate the disease burden of kidney cancer. (1-MIR) can be calculated by the formula 1-mortality/incidence, which is widely used as a surrogate indicator for the 5-year relative survival rate of cancer and an indicator for evaluating the effectiveness of cancer prevention and control [ 13 ][ 14 ] . Statistical analysis Based on comprehensive observation of the data of kidney cancer patients, the disease burden of kidney cancer in China and the world in 1990 and 2021 was compared by gender group. The line chart was used to show the changing trend of the standardized incidence, mortality, prevalence, and DALY rate of kidney cancer in China and around the world from 1990 to 2021. Bar charts were used to describe the proportion of standardized incidence and mortality of kidney cancer in different age groups of men and women in China and the world in 1990 and 2021. According to the global age-standardized population weight [ 15 ] , the direct standardization method was used to calculate the corresponding standardized rate of some age groups. The formula was as follows: the standardized rate of an index in a certain age group = ∑ the population of the standard age group in the same age group (1 group every 5 years) × the crude rate of the index in the age group/the total standard population. Using the Joinpoint Regression Program 5.1.0 software developed by the American Cancer Institute, a log-linear regression model was used to calculate the average annual percent change (AAPC) of age-standardized incidence, age-standardized mortality, age-standardized prevalence, and DALYs age-standardized rate of kidney disease in China and the world from 1990 to 2021. 3 Results 3.1 Disease burden of kidney cancer from 1990 to 2021 From 1990 to 2021, the age-standardized incidence, mortality, prevalence, and DALYs rate of kidney cancer in China were lower than the global level. In 2021, the age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, and age-standardized DALYs rate of kidney cancer in China were 3.319/10, 1.5246/10 5 , 17.754/10 5 , and 34.176/10 5 , respectively, which were higher than those in the world (4.524/10 5 , 1.912/10 5 , and 22.695/10 5 ,) and 47.327/10 5 , respectively. Compared with 1990, the age-standardized incidence (3.319/10 5 , vs. 1.794/10 5 ,), age-standardized mortality (1.246/10 5 , vs. 1.140/10 5 ,), and age-standardized prevalence (17.754/10 5 , vs. 7.191/10 5 ,) of kidney cancer in China increased in 2021. The standardized DALYs rate (34.176/10 5 , vs. 35.838/10 5 ,) decreased, as shown in Fig. 1, Fig. 2, and Table 1 . From 1990 to 2021, the age-standardized rate of kidney cancer in males was higher than that in females, both in China and globally. The Chinese standardized incidence and prevalence of kidney cancer growth were significantly higher than the overall global standardized incidence and prevalence of the disease in men than in women, with a significantly higher standardized incidence and prevalence of growth. The age-standardized DALYs rate in Chinese women showed a downward trend, while the age-standardized DALYs rate in Chinese men showed an upward trend. See Fig. 3 . Table 1 Age-standardized rates of kidney cancer burden in China and globally in 1990 and 2021(/105 ) Criteria China Globally 1990 2021 1990 2021 Age-standard incidence rate Both 1.794 3.319 3.886 4.524 Female 1.364 1.947 2.874 2.996 Male 2.302 4.795 5.091 6.265 Age-standard death rate Both 1.140 1.246 1.994 1.912 Female 0.806 0.687 1.390 1.187 Male 1.570 1.918 2.752 2.788 Age-standard prevalence rate Both 7.191 17.754 17.256 22.695 Female 6.082 10.697 13.663 15.697 Male 8.330 24.815 21.223 30.260 Age-standard DALYs rate Both 35.838 34.176 53.017 47.327 Female 27.634 18.458 37.405 28.907 Male 44.841 50.811 70.827 67.791 3.2 Survival of kidney cancer from 1990 to 2021 From 1990 to 2021, renal cancer (1-MIR) showed an upward trend in both China and the world, and the increase rate of renal cancer (1-MIR) in China was more obvious. The 1-MIR of kidney cancer in China increased from 0.36 to 0.62, and the 1-MIR of kidney cancer globally increased from 0.49 to 0.58. The renal cancer (1-MIR) in China was lower than the global level from 1990 to 2010, but higher than the global level from 2010 to 2021. See Table 2 . Table.2 Survival of kidney cancer in China and globally, 1990-2021 Year China Global Age-standard incidence rate Age-standard Death rate 1-MIR Age-standard incidence rate Age-standard Death rate 1-MIR number ASR(/10 5 ) number ASR(/10 5 ) number ASR(/10 5 ) number ASR(/10 5 ) 1990 16232 1.79 9051 1.14 0.36 159774 3.89 77421 1.99 0.49 1995 17433 1.78 9413 1.09 0.39 193597 4.26 89094 2.07 0.51 2000 21900 2.04 11433 1.17 0.43 221603 4.39 99014 2.06 0.53 2005 31735 2.52 14791 1.28 0.49 265445 4.67 113483 2.09 0.55 2010 42467 2.88 17623 1.27 0.56 311309 4.81 128177 2.06 0.57 2015 50785 3.00 19854 1.22 0.59 350316 4.75 144009 2.01 0.58 2021 65799 3.32 24867 1.25 0.62 387829 4.52 161195 1.91 0.58 ASR.Age-standard rate;MIR.Morality-to-incidence ratio. 3.3 Survival analysis of renal cell carcinoma in different age and gender groups from 1990 to 2021 Compared with 1990, the proportion of kidney cancer cases in men in all age groups showed an increasing trend, while the proportion of women in all age groups showed a decreasing trend both in China and globally. In 2021, the proportion of kidney cancer cases in males was much higher than that in females in all age groups under 95 years old in China, especially in the 40–49 year old group. The proportion of kidney cancer cases in males vs. females aged 40–44 years old and 45–49 years old was 79.09% vs. 20.91% and 79.08% vs. 20.92%, respectively. At the same time, the proportion of males in the incidence of kidney cancer in 5–64 years old and > 75 years old and above in China was higher than that of the corresponding global level, especially in the 35–39 age group, which was 77.37% in China and 64.14% in the world, as shown in Fig. 4. Compared with 1990, in 2021, the proportion of male kidney cancer deaths in all age groups in China and the world showed an increasing trend, especially in people under 5 years old, with an increase of 15.2% and 14.3% in this age group, respectively. In 2021, the proportion of kidney cancer cases in males in all age groups in China was higher than that at the corresponding global level. The proportion of kidney cancer deaths in males was higher than that in females in all age groups in China and the world under 95 years old, especially in the age group 40–54 years old in China. The proportion of male kidney cancer deaths in the 40–44 years old, 45–59 years old, and 50–54 years groups was 82.30%, 83.0%, and 82.37%, respectively, and the corresponding global age level was 73.43%, 75.04%, and 75.56%. See Fig. 5. 3.4 Joinpoint regression analysis of the disease burden of kidney cancer from 1990 to 2021 From 1990 to 2021, the standardized incidence and prevalence of kidney cancer in China and worldwide exhibited an increasing trend, while the standardized DALYs rate showed a decreasing trend. Notably, the standardized mortality rate in China increased, contrasting the global decreasing trend. The rise in age-standardized incidence and prevalence rates in China outpaced those observed globally. The AAPC values for age-standardized incidence, mortality, prevalence, and DALY rate of kidney cancer in China were 1.98%, 0.18%, 2.94%, and − 0.28%, respectively, whereas the global AAPCs were 0.49%, -0.13%, -0.89%, and − 0.37%, respectively. The most significant change was seen in the age-standardized prevalence of kidney cancer. Refer to Table 3 for detailed data. When analyzing the period from 1990 to 2021, the age-standardized incidence and prevalence rates of kidney cancer displayed an upward trajectory in both men and women in China and globally, with the age-standardized mortality rate decreasing in women but increasing in men. The changes observed in age-standardized rates for men and women in China were more pronounced than those at the global level. Specifically, the age-standardized incidence rates for Chinese males vs. Chinese females and global males vs. global females were 2.33% vs. 1.12% and 0.68% vs. 0.15%, respectively. The age-standardized incidence rates for Chinese men vs. Chinese women and global men vs. global women were 3.58% vs. 1.81% and 1.15% vs. 0.43%, respectively. Refer to Table 3 for prevalence figures. Table 3 Joinpoint regression analysis of trends in disease burden of kidney cancer burden in China and globallyfrom 1990 to 2021[%(95%CI)] Criteria AAPC China Globally Age-standard incidence rate Both 1.98 b (1.85 ~ 2.08) 0.49 b (0.46 ~ 0.51) Female 1.12 b (0.99 ~ 1.24) 0.15 b (0.11 ~ 0.17) Male 2.33 b (2.23 ~ 2.40) 0.68 b (0.64 ~ 0.70) Age-standard death rate Both 0.18 a (0.08 ~ 0.27) -0.13 b (-0.16~-0.11) Female -0.58 b (-0.70~-0.47) -0.50 b (-0.53~-0.48) Male 0.62 b (0.52 ~ 0.71) 0.05 a (0.01 ~ 0.07) Age-standard prevalence rate Both 2.94 b (2.84 ~ 3.02) 0.89 b (0.86 ~ 0.91) Female 1.81 b (1.62 ~ 1.94) 0.43 b (0.37 ~ 0.47) Male 3.58 b (3.51 ~ 3.64) 1.15 b (1.11 ~ 1.18) Age-standard DALYs rate Both -0.28 b (-0.41~-0.16) -0.37 b (-0.40~-0.34) Female -1.37 b (-1.54~-1.22) -0.82 b (-0.85~-0.78) Male 0.30 a (0.09 ~ 0.44) -0.14 b (-0.18~-0.11) a P <0.05; b P <0.001 4 Discussion This study analyzed the burden of kidney cancer in China over a 30-year period using the latest GBD2021 cancer statistics. The research compared the incidence, mortality, prevalence, and DALY rate of kidney cancer in China to global levels from 1990 to 2021. The findings revealed that the age-standardized rates of kidney cancer in China were lower than the global average, but the growth rate of incidence and prevalence in China outpaced the global trends. While the incidence and prevalence rates increased in both China and globally, the age-standardized DALYs rate decreased. The study also noted a rising trend in 1-MIR for kidney cancer in both China and worldwide, with a more significant increase observed in China. Notably, since 2010, the 1-MIR of kidney cancer in China has surpassed the global level, suggesting improved survival rates and successful prevention and control efforts. From 1990 to 2021, the incidence of kidney cancer in China has been steadily increasing, with the age-standardized incidence rate remaining below the global average. However, the annual increase in the age-standardized incidence rate among the Chinese population has been higher than the global average, with China experiencing a threefold increase compared to the global level. The rise in kidney cancer incidence in China may be attributed to overdiagnosis in recent decades, facilitated by advancements in detection methods that can now identify even small renal masses [ 16 ][ 17 ] . Furthermore, both the prevalence and mortality rates of kidney cancer in China have been on the rise, aligning with findings from previous research [ 18 ] . Lifestyle factors such as smoking and alcohol consumption have been identified as potential risk factors for kidney cancer [19] , with smoking significantly increasing the risk and alcohol consumption also being confirmed as a significant risk factor [ 20 ] . The increasing prevalence of chronic diseases in recent years may also contribute to the rising rates of kidney cancer, with studies showing associations between hypertension, diabetes, chronic kidney disease, and the risk of developing kidney cancer [ 21 ][ 22 ] . From 1990 to 2021, the age-standardized incidence, mortality, and prevalence of kidney cancer in men in China and globally were consistently higher than those in women. This trend of higher rates in men was also observed in previous studies [ 23 ][ 24 ] . Specifically, the standardized mortality rate of kidney cancer in men has increased, indicating a higher risk of death in recent years compared to women [ 25 ] . Previous research has highlighted that men with chronic kidney disease are more likely to be diagnosed with advanced cancer and have a higher mortality rate. Smoking is a known risk factor for kidney cancer incidence and prognosis [ 26 ] . Furthermore, studies suggest that women's greater emphasis on health checkups may lead to earlier detection and treatment of kidney cancer, resulting in lower mortality rates [ 27 ] . Gender differences in the pathogenesis, clinical manifestations, and imaging findings of renal cell carcinoma may impact diagnosis and treatment strategies [ 28 ] . In terms of age distribution, the proportion of males in all age groups has increased from 1990 to 2021, contrasting with the trend in females. Notably, the high proportion of standardized mortality rate in males is concentrated in the middle-aged group, particularly significant in Chinese males aged 40–54 in 2021, highlighting the severity of kidney cancer in the middle-aged male population. The prevention of cancer and reduction in associated deaths can largely be achieved through widespread adoption of effective prevention measures. It is crucial to assess the long-term success and efficiency of such prevention programs. The Mortality-to-Incidence Ratio (MIR) is recognized as a straightforward and informative measure to gauge the effectiveness of cancer control programs [ 29 ] . Previous research has demonstrated that (1-MIR) is linked to the success of cancer prevention and control efforts, and has been utilized to explore the correlation between healthcare systems and cancer outcomes on a national [ 30 ] and global scale [ 31 ] . Previous studies have shown that (1-MIR) is associated with the effectiveness of cancer prevention and control, and this indicator has been used to examine the relationship between the health care system and cancer outcomes in the United States and globally [ 32 ][ 33 ] . In this study, (1-MIR) was used to evaluate the survival of kidney cancer and the effectiveness of cancer control in China and globally. This study employed (1-MIR) to assess the survival rates of kidney cancer and the effectiveness of cancer control efforts in China and globally. Between 1990 and 2021, the (1-MIR) for kidney cancer exhibited an upward trajectory in both China and worldwide, with a more pronounced increase observed in China. Throughout this period, the (1-MIR) for kidney cancer in China remained below the global average, but surpassed it after 2010, indicating a significant enhancement in kidney cancer survival rates. This improvement in kidney cancer survival could be attributed to factors such as socio-economic development and advancements in healthcare systems [ 34 ] [ 35 ] . Furthermore, the continual enhancement of cancer prevention and control systems over the past three decades has played a pivotal role in this progress [ 36 ] . This study examined the disease burden trends of kidney cancer from 1990 to 2021, comparing data between China and the global population. Findings indicate that the global disease burden continues to increase, with males experiencing a significantly higher burden than females. The age-standardized incidence and prevalence of kidney cancer in China are rising at a faster rate than the global average. The study underscores the urgent need for increased attention to the serious disease burden of kidney cancer. It also highlights the importance of enhancing research on risk factor exposure and strengthening prevention and control strategies. Declarations Contribution list: All authors wrote the main manuscript text. Xiong Jun reviewed the manuscript. Acknowledgement: NO Funding Statement: NO Conflict of Interest Statements: All authors have approved the manuscript for submission and without any potential competing interests. Grant Number: NO Ethical Committee: Public information were used and analyzed in this study, so no ethical approval was required. Data Availability ： The data that support the findings of this study are available in GBD2021 at ghdx.healthdata.org. References Levi, F., Lucchini, F., Negri, E., & La Vecchia, C. (2004). Decreasing mortality from kidney cancer in Europe. Annals of Oncology, 15(7), 1130–1135. Abdallah, Nour, et al., "Kidney cancer mortality in the United States between 1999 and 2020: An observational analysis of outcomes by gender, race, and ethnicity." (2023): 4563–4563. Kim, L. H. et al.: Alcohol consumption and socioeconomic status associated with the risk of kidney cancer in a large Australian cohort study. Ann. Epidemiol. 84, 16–24 (2023). Mellemgaard, A., Engholm, G., and McLaughlin, J. K. & Olsen, J. H. Risk factors for renal cell carcinoma in Denmark. I. Role of socioeconomic status, tobacco use, beverages, and family history. Cancer Causes Control 5(2), 105–13 (1994). Zi, H. et al., Global, regional, and national burden of kidney, bladder, and prostate cancers and their attributable risk factors, 1990–2019 Mil. Med. Res. 8(1), 60 (2021). Tian, Y. Q. et al., Trends and risk factors of global incidence, mortality, and disability of genitourinary cancers from 1990 to 2019: systematic analysis for the Global Burden of Disease Study 2019. Front. Public Health 11, 1119374 (2023). Tran, Khanh Bao, et al. The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 400.10352 (2022): 563-591. Washoo M., Mori M., Mikami K., et al. Cigarette smoking and other risk factors for kidney cancer death in a Japanese population: Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) [J]. Asian Pacific Journal of Cancer Prevention, 2013, 14(11): 6523–6528. Kurasawa, Shimon, et al. Association of kidney function with cancer incidence and its influence on the cancer risk of smoking: The Japan Multi-Institutional Collaborative Cohort Study. International Journal of Cancer 153.4 (2023): 732–741. Huang, Junjie, et al. A global trend analysis of kidney cancer incidence and mortality and their associations with smoking, alcohol consumption, and metabolic syndrome." European urology focus 8.1 (2022): 200–209. Bara, Amrit, et al.The prognostic role of cigarette smoking in Kidney Cancer Survival." Cancer Medicine 12.13 (2023): 14756–14766. Guo, K., Wang, Z., Luo, R., Cheng, Y., Ge, S., & Xu, G. (2022). Association between chronic kidney disease and cancer, including the mortality of cancer patients: national health and nutrition examination survey 1999–2014, American journal of translational research, 144, 2356–2366. Asadzadeh Vostakolaei, Fatemeh, et al., "The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival." The European Journal of Public Health 21.5 (2011): 573-577. Choi, Eunji, et al. Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries, Epidemiology and Health 39 (2017). GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019 [J]. Lancet, 2020, 396 (10258): 1160–1203. Sun, M., Thuret, R., Abdollah, F., Lughezzani, G., Schmitges, J., Tian, Z.,... & Karakiewicz, P. I. (2011). Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. European urology, 59(1), 135–141. Laguna, M. P. Re: international variations and trends in renal cell carcinoma incidence and mortality [J]. The Journal of Urology, 2015, 194(4): 950–951. Wang Z, Wang L, Wang S, et al. Burden of kidney cancer and attributed risk factors in China from 1990 to 2019 [J] Frontiers in Public Health, 2022, 10: 1062504. Rizzuto D, Fratiglioni L. Lifestyle factors related to mortality and survival: a mini-review [J]. Gerontology, 2014, 60(4): 327–335. Huang J., Leung D. K. W., Chan E. O. T., et al. A global trend analysis of kidney cancer incidence and mortality and their associations with smoking, alcohol consumption, and metabolic syndrome [J] European urology focus, 2022, 8(1): 200–209. Haggstrom C, Rapp K, Stocks T, et al. Metabolic factors associated with risk of renal cell carcinoma [J]. PloS One, 2015, 38 (1): 61–69. 2013, 8(2): e57475. Hofmann, J. N., Corley, D. A., Zhao, W. K., et al. Chronic kidney disease and risk of renal cell carcinoma: differences by race [J]. Epidemiology, 2015, 26(1): 59–67. Martin R. F. Robotic Surgery [J]. Surgical Clinics, 2020, 100(2): xiii–xiv. Liu J., Wang D., Zhang C., et al. Identification of liver metastasis-associated genes in human colon carcinoma by mRNA profiling [J]. Chinese Journal of Cancer Research, 2018, 30(6): 633. Shemilt, Richard, et al. # 5996 Sex Differences in the Diagnosis of Advanced Cancer and Subsequent Outcome in People with CKD. Nephrology Dialysis Transplantation 38.Supplement_1 (2023): gfad063c_5996. Mangone, Lucia, et al. Trends in incidence and mortality of kidney cancer in a northern italian province: An update to 2020 "Biology 11.7 (2022) : 1048. Jani C, Arora S, Abdallah N, et al. Examining Trends in Kidney Cancer Mortality by Gender and Race in the United States: A 20-Year Analysis[J]. The Oncologist, 2023, 28(Supplement_1): S8-S9. Beebe-Dimmer J L, Colt J S, Ruterbusch J J, et al. Body mass index and renal cell cancer: the influence of race and sex[J]. Epidemiology, 2012, 23(6): 821-828. Asadzadeh Vostakolaei F, Karim-Kos HE, Janssen-Heijnen ML,Visser O, Verbeek AL, Kiemeney LA. The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival. Eur J Public Health 2011; 21:57 3-577. Sugerman PB, Savage NW. Oral cancer in Australia: 1983-1996.Aust Dent J. 2002; 47 (1) : 45-56. Wang SC, Sung WW, Kao YL, et al. The gender difference and mortality-to-incidence ratio relate to health care disparities in bladder cancer: national estimates from 33 countries. Sci Rep.2017; 7 (1) : 4360. Adams SA, Choi SK, Khang L, A Campbell D, Friedman DB, Eberth JM, et al. Decreased cancer mortality-to-incidence ratios with in­creased accessibility of federally qualified health centers. J Com­munity Health 2015; Observed 33-641. Sunkara V, Hebert JR. The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care. Cancer 2015; 121:1563-1569. a, XF., Wang, YQ., Shao, SY. et al. The relationship between urologic cancer outcomes and national Human Development Index: trend in recent years. BMC Urol 22, 2 (2022). Sung,Wen-Wei,et al. "Favorable mortality-to-incidence ratios of kidney Cancer are associated with advanced health care systems." BMC cancer 18 (2018): 1-7. Eisinger, Francois." Knowledge-based Cancer control." Current Oncology Reports 20.Suppl 1 (2018): 19. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted Editor assigned by journal 04 Jul, 2024 Editor invited by journal 25 Jun, 2024 Submission checks completed at journal 24 Jun, 2024 First submitted to journal 19 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board 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-4606810","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":323931441,"identity":"f718cb96-d9ee-4fa1-833b-b2057c68c01b","order_by":0,"name":"Zhongli Qiao","email":"","orcid":"","institution":"Hangzhou Normal University","correspondingAuthor":false,"prefix":"","firstName":"Zhongli","middleName":"","lastName":"Qiao","suffix":""},{"id":323931442,"identity":"84d7e375-81d6-4847-b74d-246acbee7917","order_by":1,"name":"lin Chen","email":"","orcid":"","institution":"Hangzhou Normal University","correspondingAuthor":false,"prefix":"","firstName":"lin","middleName":"","lastName":"Chen","suffix":""},{"id":323931443,"identity":"f2515303-9c5a-474e-859a-06788d1a67d8","order_by":2,"name":"Shenyu Zhang","email":"","orcid":"","institution":"Hangzhou Normal University","correspondingAuthor":false,"prefix":"","firstName":"Shenyu","middleName":"","lastName":"Zhang","suffix":""},{"id":323931444,"identity":"59f70b0d-dcc7-4325-8521-96b4a6d3ba5f","order_by":3,"name":"Jialin Wang","email":"","orcid":"","institution":"Hangzhou Normal University","correspondingAuthor":false,"prefix":"","firstName":"Jialin","middleName":"","lastName":"Wang","suffix":""},{"id":323931445,"identity":"c356423b-388d-4242-944a-b6386851ad7b","order_by":4,"name":"Runze Chen","email":"","orcid":"","institution":"Hangzhou Normal University","correspondingAuthor":false,"prefix":"","firstName":"Runze","middleName":"","lastName":"Chen","suffix":""},{"id":323931446,"identity":"fba5b724-750c-4000-b3b0-9a6087269c05","order_by":5,"name":"Jun Xiong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIie3RsarCMBSA4ZTAcUntmiL6DCmBuFz0VSqFunRw7KZQqNudc+E+RMEXCBTq0gco6CAInRx0dtCKuIikujnkHw/nW85ByGT6whxsLZjPADv0PrAWbcRdJmp2jLsdV75LWFn4J1kOHFa9S1AVeSs7FT2+WdZ7gn76mcL1TicsGXFupyEXWzXlBIU8UzBkOoJpJBpSBKLyix5B+SRTBKiOAI2GZzu9zFdykjbk0k4IKXxPloAZDaAhqp3QTqLYMQZMqxDcfxbwvxyElozzxyvltKaHeNT/XSe1ljx1OxX+YN9kMplMr7sCsLRGv2uiTdYAAAAASUVORK5CYII=","orcid":"","institution":"Hangzhou Normal University","correspondingAuthor":true,"prefix":"","firstName":"Jun","middleName":"","lastName":"Xiong","suffix":""}],"badges":[],"createdAt":"2024-06-19 15:09:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4606810/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4606810/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-88682-1","type":"published","date":"2025-02-07T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60376209,"identity":"7eb15262-f661-49db-aa33-eccf3fd0394f","added_by":"auto","created_at":"2024-07-16 06:18:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":315000,"visible":true,"origin":"","legend":"\u003cp\u003eGlobal estimated incidence of kidney cancer in 2021 for both sexes and all ages.ASR=age-standardized rate.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-4606810/v1/47b95ecb5a9500853b8ae902.png"},{"id":60376212,"identity":"3976ce9e-cd65-4ea8-84a7-1e1a9baadbe8","added_by":"auto","created_at":"2024-07-16 06:18:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":316419,"visible":true,"origin":"","legend":"\u003cp\u003eGlobal estimated death of kidney cancer in 2021 for both sexes and all ages.ASR=age-standardized rate.\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-4606810/v1/2a18bb131c325146843f341c.png"},{"id":60376211,"identity":"bf3239c7-5aac-4f0e-a051-4ed1a4eb5ed7","added_by":"auto","created_at":"2024-07-16 06:18:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":447570,"visible":true,"origin":"","legend":"\u003cp\u003eDifferent ASR of kidney cancer between 1990 and 2021(a) Age-standard incidence rate, (b) Age-standard death rate, (c) Age-standard prevalence rate, (d) Age-standard death rate\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-4606810/v1/e3432149df4b205a268396cf.png"},{"id":60376214,"identity":"cad80477-188f-4a1d-9503-7c393f86814c","added_by":"auto","created_at":"2024-07-16 06:18:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":148987,"visible":true,"origin":"","legend":"\u003cp\u003eSex ratio of incidence by age group of kidney cancer in China and globally,(a)1990-China,(b)1990-Global,(c)2021-China,(d)2021-Global\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-4606810/v1/11e8ca816b1f1b7d1e4e2548.png"},{"id":60376210,"identity":"a246535e-7cdf-4c19-ae73-422cce4f3ec2","added_by":"auto","created_at":"2024-07-16 06:18:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":148411,"visible":true,"origin":"","legend":"\u003cp\u003eSex ratio of death by age group of kidney cancer in China and globally,(a)1990- China,(b)1990-Global,(c)2021-China,(d)2021-Global\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-4606810/v1/70474ef983afa26b3def940e.png"},{"id":75931281,"identity":"d7f291cd-aeba-4fb1-ac82-cd47855d80b0","added_by":"auto","created_at":"2025-02-10 16:14:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2095656,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4606810/v1/48297b1f-d372-4d4f-bb21-5645ec99dfa3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Disease Burden and Changing Trends of Kidney Cancer between 1990 and 2021: A Comparative Analysis of China and the World","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eKidney cancer, a prevalent malignancy of the urinary system, poses a significant global health burden. In 2020, there were approximately 431,000 new cases reported worldwide, as per the latest data from the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO). The incidence and mortality rates of kidney cancer exhibit variations across regions, age groups, and genders. While developed countries currently report the highest rates, trends suggest a potential decline in the future. For instance, some Western European nations have witnessed a decrease in kidney cancer mortality over recent decades\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In the United States, the age-adjusted mortality rate (ASMR) for kidney cancer varies significantly based on sex, race, and age\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. However, projections indicate a continued rise in both incidence and mortality globally, including in developing and less developed countries. Notably, kidney cancer ranks as the second most common genitourinary cancer in China, comprising 2\u0026ndash;3% of adult cancers and 20% of pediatric cases. Therefore, a comprehensive understanding of the disease burden and epidemiological characteristics of kidney cancer is crucial for the development of effective prevention and intervention strategies.\u003c/p\u003e \u003cp\u003ePrevious studies have explored the impact of socioeconomic status on the changing burden of kidney cancer\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e][\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e][\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Recent research has shown that exposure to various risk factors has played a role in influencing the prevalence of kidney cancer\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. A significant portion of global cancer-related deaths are preventable, with smoking, alcohol consumption, and high BMI being key factors contributing to both cancer deaths and DALYs\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Smoking has been identified as a known risk factor for kidney cancer\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, with heavy smokers in the Japanese population having a higher risk of renal cell carcinoma, similar to findings in Western countries\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Moreover, smoking has been linked to prognosis in renal cell carcinoma survival across different populations\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Additionally, high BMI, hypertension, and diabetes mellitus have also been recognized as risk factors for kidney cancer\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The association between alcohol consumption and kidney cancer risk remains controversial. Epidemiological trends of kidney cancer vary geographically, and the impact of these risk factors on different genders and age groups is not fully understood. Current research primarily focuses on clinical and treatment aspects of kidney cancer, with limited attention to disease burden. There is a gap in comparative analysis between China and the global landscape, as well as a lack of longitudinal analysis of kidney cancer burden. Therefore, continuous monitoring and analysis of kidney cancer burden, prevention, and control efforts are necessary to comprehensively understand epidemiological characteristics and risk factors across different countries and regions, facilitating more precise prevention and control strategies for kidney cancer.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cp\u003e \u003cb\u003eData sources\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study was based on data from the Global Burden of Disease (GBD) 2021 database, which assesses the burden of disease of 459 diseases and injuries and risk factors in 204 countries or regions. Detailed data were downloaded from the Global Health Data Exchange (GHDx) database. incidence, mortality, prevalence, disability-adjusted life years ratio (DALYs), and 1-MIR (mortality-to-incidence ratio) were used to estimate the disease burden of kidney cancer. (1-MIR) can be calculated by the formula 1-mortality/incidence, which is widely used as a surrogate indicator for the 5-year relative survival rate of cancer and an indicator for evaluating the effectiveness of cancer prevention and control\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBased on comprehensive observation of the data of kidney cancer patients, the disease burden of kidney cancer in China and the world in 1990 and 2021 was compared by gender group. The line chart was used to show the changing trend of the standardized incidence, mortality, prevalence, and DALY rate of kidney cancer in China and around the world from 1990 to 2021. Bar charts were used to describe the proportion of standardized incidence and mortality of kidney cancer in different age groups of men and women in China and the world in 1990 and 2021. According to the global age-standardized population weight\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, the direct standardization method was used to calculate the corresponding standardized rate of some age groups. The formula was as follows: the standardized rate of an index in a certain age group = \u0026sum; the population of the standard age group in the same age group (1 group every 5 years) \u0026times; the crude rate of the index in the age group/the total standard population. Using the Joinpoint Regression Program 5.1.0 software developed by the American Cancer Institute, a log-linear regression model was used to calculate the average annual percent change (AAPC) of age-standardized incidence, age-standardized mortality, age-standardized prevalence, and DALYs age-standardized rate of kidney disease in China and the world from 1990 to 2021.\u003c/p\u003e "},{"header":"3 Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Disease burden of kidney cancer from 1990 to 2021\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, the age-standardized incidence, mortality, prevalence, and DALYs rate of kidney cancer in China were lower than the global level. In 2021, the age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, and age-standardized DALYs rate of kidney cancer in China were 3.319/10, 1.5246/10\u003csup\u003e5\u003c/sup\u003e, 17.754/10\u003csup\u003e5\u003c/sup\u003e, and 34.176/10\u003csup\u003e5\u003c/sup\u003e, respectively, which were higher than those in the world (4.524/10\u003csup\u003e5\u003c/sup\u003e, 1.912/10\u003csup\u003e5\u003c/sup\u003e, and 22.695/10\u003csup\u003e5\u003c/sup\u003e,) and 47.327/10\u003csup\u003e5\u003c/sup\u003e, respectively. Compared with 1990, the age-standardized incidence (3.319/10\u003csup\u003e5\u003c/sup\u003e, vs. 1.794/10\u003csup\u003e5\u003c/sup\u003e,), age-standardized mortality (1.246/10\u003csup\u003e5\u003c/sup\u003e, vs. 1.140/10\u003csup\u003e5\u003c/sup\u003e,), and age-standardized prevalence (17.754/10\u003csup\u003e5\u003c/sup\u003e, vs. 7.191/10\u003csup\u003e5\u003c/sup\u003e,) of kidney cancer in China increased in 2021. The standardized DALYs rate (34.176/10\u003csup\u003e5\u003c/sup\u003e, vs. 35.838/10\u003csup\u003e5\u003c/sup\u003e,) decreased, as shown in Fig.\u0026nbsp;1, Fig.\u0026nbsp;2, and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, the age-standardized rate of kidney cancer in males was higher than that in females, both in China and globally. The Chinese standardized incidence and prevalence of kidney cancer growth were significantly higher than the overall global standardized incidence and prevalence of the disease in men than in women, with a significantly higher standardized incidence and prevalence of growth. The age-standardized DALYs rate in Chinese women showed a downward trend, while the age-standardized DALYs rate in Chinese men showed an upward trend. See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge-standardized rates of kidney cancer burden in China and globally in 1990 and 2021(/105 )\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGlobally\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1990\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1990\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003eincidence rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.524\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.996\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003edeath rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.912\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003eprevalence rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.697\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003eDALYs rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e47.327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67.791\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Survival of kidney cancer from 1990 to 2021\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, renal cancer (1-MIR) showed an upward trend in both China and the world, and the increase rate of renal cancer (1-MIR) in China was more obvious. The 1-MIR of kidney cancer in China increased from 0.36 to 0.62, and the 1-MIR of kidney cancer globally increased from 0.49 to 0.58. The renal cancer (1-MIR) in China was lower than the global level from 1990 to 2010, but higher than the global level from 2010 to 2021. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eTable.2 Survival of kidney cancer in China and globally, 1990-2021\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"776\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.701030927835052%\" rowspan=\"3\"\u003e\n \u003cp\u003eYear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.74742268041237%\" colspan=\"6\"\u003e\n \u003cp\u003eChina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.448453608247423%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45.103092783505154%\" colspan=\"7\"\u003e\n \u003cp\u003eGlobal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.724137931034484%\" colspan=\"2\"\u003e\n \u003cp\u003eAge-standard\u003c/p\u003e\n \u003cp\u003eincidence rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.3448275862068964%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.310344827586206%\" colspan=\"2\"\u003e\n \u003cp\u003eAge-standard\u003c/p\u003e\n \u003cp\u003eDeath rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.586206896551724%\" rowspan=\"2\"\u003e\n \u003cp\u003e1-MIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6206896551724137%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.75862068965517%\" colspan=\"2\"\u003e\n \u003cp\u003eAge-standard\u003c/p\u003e\n \u003cp\u003eincidence rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.0344827586206895%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.620689655172413%\" colspan=\"2\"\u003e\n \u003cp\u003eAge-standard\u003c/p\u003e\n \u003cp\u003eDeath rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.862068965517241%\" rowspan=\"2\"\u003e\n \u003cp\u003e1-MIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.13793103448275862%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.440456769983687%\"\u003e\n \u003cp\u003enumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.887438825448614%\"\u003e\n \u003cp\u003eASR(/10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7732463295269167%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.298531810766722%\"\u003e\n \u003cp\u003enumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.539967373572594%\"\u003e\n \u003cp\u003eASR(/10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.099510603588907%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.298531810766722%\"\u003e\n \u003cp\u003enumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.887438825448614%\"\u003e\n \u003cp\u003eASR(/10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.5889070146818924%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.135399673735726%\"\u003e\n \u003cp\u003enumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.887438825448614%\"\u003e\n \u003cp\u003eASR(/10\u003csup\u003e5\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1631321370309951%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e1990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e16232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e9051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e159774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e3.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e77421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e1995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e17433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e9413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e193597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e89094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e21900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e11433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e221603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e4.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e99014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e2005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e31735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e14791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e265445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e113483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e42467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e17623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e311309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e4.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e128177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e50785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e19854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e350316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e4.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e144009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"6.692406692406692%\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.236808236808237%\"\u003e\n \u003cp\u003e65799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.187902187902188%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e24867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.682110682110682%\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.078507078507078%\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.4453024453024454%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e387829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.831402831402831%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.207207207207207%\"\u003e\n \u003cp\u003e161195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.167310167310168%\"\u003e\n \u003cp\u003e1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.335907335907336%\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.1287001287001287%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eASR.Age-standard rate;MIR.Morality-to-incidence ratio.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3 Survival analysis of renal cell carcinoma in different age and gender groups from 1990 to 2021\u003c/b\u003e \u003c/p\u003e \u003cp\u003eCompared with 1990, the proportion of kidney cancer cases in men in all age groups showed an increasing trend, while the proportion of women in all age groups showed a decreasing trend both in China and globally. In 2021, the proportion of kidney cancer cases in males was much higher than that in females in all age groups under 95 years old in China, especially in the 40\u0026ndash;49 year old group. The proportion of kidney cancer cases in males vs. females aged 40\u0026ndash;44 years old and 45\u0026ndash;49 years old was 79.09% vs. 20.91% and 79.08% vs. 20.92%, respectively. At the same time, the proportion of males in the incidence of kidney cancer in 5\u0026ndash;64 years old and \u0026gt;\u0026thinsp;75 years old and above in China was higher than that of the corresponding global level, especially in the 35\u0026ndash;39 age group, which was 77.37% in China and 64.14% in the world, as shown in Fig.\u0026nbsp;4.\u003c/p\u003e \u003cp\u003eCompared with 1990, in 2021, the proportion of male kidney cancer deaths in all age groups in China and the world showed an increasing trend, especially in people under 5 years old, with an increase of 15.2% and 14.3% in this age group, respectively. In 2021, the proportion of kidney cancer cases in males in all age groups in China was higher than that at the corresponding global level. The proportion of kidney cancer deaths in males was higher than that in females in all age groups in China and the world under 95 years old, especially in the age group 40\u0026ndash;54 years old in China. The proportion of male kidney cancer deaths in the 40\u0026ndash;44 years old, 45\u0026ndash;59 years old, and 50\u0026ndash;54 years groups was 82.30%, 83.0%, and 82.37%, respectively, and the corresponding global age level was 73.43%, 75.04%, and 75.56%. See Fig.\u0026nbsp;5.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Joinpoint regression analysis of the disease burden of kidney cancer from 1990 to 2021\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, the standardized incidence and prevalence of kidney cancer in China and worldwide exhibited an increasing trend, while the standardized DALYs rate showed a decreasing trend. Notably, the standardized mortality rate in China increased, contrasting the global decreasing trend. The rise in age-standardized incidence and prevalence rates in China outpaced those observed globally. The AAPC values for age-standardized incidence, mortality, prevalence, and DALY rate of kidney cancer in China were 1.98%, 0.18%, 2.94%, and \u0026minus;\u0026thinsp;0.28%, respectively, whereas the global AAPCs were 0.49%, -0.13%, -0.89%, and \u0026minus;\u0026thinsp;0.37%, respectively. The most significant change was seen in the age-standardized prevalence of kidney cancer. Refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for detailed data.\u003c/p\u003e \u003cp\u003eWhen analyzing the period from 1990 to 2021, the age-standardized incidence and prevalence rates of kidney cancer displayed an upward trajectory in both men and women in China and globally, with the age-standardized mortality rate decreasing in women but increasing in men. The changes observed in age-standardized rates for men and women in China were more pronounced than those at the global level. Specifically, the age-standardized incidence rates for Chinese males vs. Chinese females and global males vs. global females were 2.33% vs. 1.12% and 0.68% vs. 0.15%, respectively. The age-standardized incidence rates for Chinese men vs. Chinese women and global men vs. global women were 3.58% vs. 1.81% and 1.15% vs. 0.43%, respectively. Refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for prevalence figures.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eJoinpoint regression analysis of trends in disease burden of kidney cancer burden in China and globallyfrom 1990 to 2021[%(95%CI)]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAAPC\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGlobally\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003eincidence rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.98\u003csup\u003eb\u003c/sup\u003e(1.85\u0026thinsp;~\u0026thinsp;2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49\u003csup\u003eb\u003c/sup\u003e(0.46\u0026thinsp;~\u0026thinsp;0.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12\u003csup\u003eb\u003c/sup\u003e(0.99\u0026thinsp;~\u0026thinsp;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003csup\u003eb\u003c/sup\u003e(0.11\u0026thinsp;~\u0026thinsp;0.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.33\u003csup\u003eb\u003c/sup\u003e(2.23\u0026thinsp;~\u0026thinsp;2.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68\u003csup\u003eb\u003c/sup\u003e(0.64\u0026thinsp;~\u0026thinsp;0.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003edeath rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.18\u003csup\u003ea\u003c/sup\u003e(0.08\u0026thinsp;~\u0026thinsp;0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.13\u003csup\u003eb\u003c/sup\u003e(-0.16~-0.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.58\u003csup\u003eb\u003c/sup\u003e(-0.70~-0.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.50\u003csup\u003eb\u003c/sup\u003e(-0.53~-0.48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003csup\u003eb\u003c/sup\u003e(0.52\u0026thinsp;~\u0026thinsp;0.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05\u003csup\u003ea\u003c/sup\u003e(0.01\u0026thinsp;~\u0026thinsp;0.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003eprevalence rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.94\u003csup\u003eb\u003c/sup\u003e(2.84\u0026thinsp;~\u0026thinsp;3.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003csup\u003eb\u003c/sup\u003e(0.86\u0026thinsp;~\u0026thinsp;0.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.81\u003csup\u003eb\u003c/sup\u003e(1.62\u0026thinsp;~\u0026thinsp;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.43\u003csup\u003eb\u003c/sup\u003e(0.37\u0026thinsp;~\u0026thinsp;0.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.58 \u003csup\u003eb\u003c/sup\u003e (3.51\u0026thinsp;~\u0026thinsp;3.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15\u003csup\u003eb\u003c/sup\u003e(1.11\u0026thinsp;~\u0026thinsp;1.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-standard\u003c/p\u003e \u003cp\u003eDALYs rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.28\u003csup\u003eb\u003c/sup\u003e(-0.41~-0.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.37\u003csup\u003eb\u003c/sup\u003e(-0.40~-0.34)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.37\u003csup\u003eb\u003c/sup\u003e(-1.54~-1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.82\u003csup\u003eb\u003c/sup\u003e(-0.85~-0.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003csup\u003ea\u003c/sup\u003e(0.09\u0026thinsp;~\u0026thinsp;0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.14\u003csup\u003eb\u003c/sup\u003e(-0.18~-0.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05;\u003csup\u003eb\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study analyzed the burden of kidney cancer in China over a 30-year period using the latest GBD2021 cancer statistics. The research compared the incidence, mortality, prevalence, and DALY rate of kidney cancer in China to global levels from 1990 to 2021. The findings revealed that the age-standardized rates of kidney cancer in China were lower than the global average, but the growth rate of incidence and prevalence in China outpaced the global trends. While the incidence and prevalence rates increased in both China and globally, the age-standardized DALYs rate decreased. The study also noted a rising trend in 1-MIR for kidney cancer in both China and worldwide, with a more significant increase observed in China. Notably, since 2010, the 1-MIR of kidney cancer in China has surpassed the global level, suggesting improved survival rates and successful prevention and control efforts.\u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, the incidence of kidney cancer in China has been steadily increasing, with the age-standardized incidence rate remaining below the global average. However, the annual increase in the age-standardized incidence rate among the Chinese population has been higher than the global average, with China experiencing a threefold increase compared to the global level. The rise in kidney cancer incidence in China may be attributed to overdiagnosis in recent decades, facilitated by advancements in detection methods that can now identify even small renal masses\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Furthermore, both the prevalence and mortality rates of kidney cancer in China have been on the rise, aligning with findings from previous research\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Lifestyle factors such as smoking and alcohol consumption have been identified as potential risk factors for kidney cancer\u003csup\u003e[19]\u003c/sup\u003e, with smoking significantly increasing the risk and alcohol consumption also being confirmed as a significant risk factor\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. The increasing prevalence of chronic diseases in recent years may also contribute to the rising rates of kidney cancer, with studies showing associations between hypertension, diabetes, chronic kidney disease, and the risk of developing kidney cancer\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e][\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFrom 1990 to 2021, the age-standardized incidence, mortality, and prevalence of kidney cancer in men in China and globally were consistently higher than those in women. This trend of higher rates in men was also observed in previous studies\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e][\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Specifically, the standardized mortality rate of kidney cancer in men has increased, indicating a higher risk of death in recent years compared to women\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. Previous research has highlighted that men with chronic kidney disease are more likely to be diagnosed with advanced cancer and have a higher mortality rate. Smoking is a known risk factor for kidney cancer incidence and prognosis\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Furthermore, studies suggest that women's greater emphasis on health checkups may lead to earlier detection and treatment of kidney cancer, resulting in lower mortality rates\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Gender differences in the pathogenesis, clinical manifestations, and imaging findings of renal cell carcinoma may impact diagnosis and treatment strategies\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. In terms of age distribution, the proportion of males in all age groups has increased from 1990 to 2021, contrasting with the trend in females. Notably, the high proportion of standardized mortality rate in males is concentrated in the middle-aged group, particularly significant in Chinese males aged 40\u0026ndash;54 in 2021, highlighting the severity of kidney cancer in the middle-aged male population.\u003c/p\u003e \u003cp\u003eThe prevention of cancer and reduction in associated deaths can largely be achieved through widespread adoption of effective prevention measures. It is crucial to assess the long-term success and efficiency of such prevention programs. The Mortality-to-Incidence Ratio (MIR) is recognized as a straightforward and informative measure to gauge the effectiveness of cancer control programs\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Previous research has demonstrated that (1-MIR) is linked to the success of cancer prevention and control efforts, and has been utilized to explore the correlation between healthcare systems and cancer outcomes on a national\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e and global scale\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. Previous studies have shown that (1-MIR) is associated with the effectiveness of cancer prevention and control, and this indicator has been used to examine the relationship between the health care system and cancer outcomes in the United States and globally\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e][\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. In this study, (1-MIR) was used to evaluate the survival of kidney cancer and the effectiveness of cancer control in China and globally. This study employed (1-MIR) to assess the survival rates of kidney cancer and the effectiveness of cancer control efforts in China and globally. Between 1990 and 2021, the (1-MIR) for kidney cancer exhibited an upward trajectory in both China and worldwide, with a more pronounced increase observed in China. Throughout this period, the (1-MIR) for kidney cancer in China remained below the global average, but surpassed it after 2010, indicating a significant enhancement in kidney cancer survival rates. This improvement in kidney cancer survival could be attributed to factors such as socio-economic development and advancements in healthcare systems\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e] [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Furthermore, the continual enhancement of cancer prevention and control systems over the past three decades has played a pivotal role in this progress\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study examined the disease burden trends of kidney cancer from 1990 to 2021, comparing data between China and the global population. Findings indicate that the global disease burden continues to increase, with males experiencing a significantly higher burden than females. The age-standardized incidence and prevalence of kidney cancer in China are rising at a faster rate than the global average. The study underscores the urgent need for increased attention to the serious disease burden of kidney cancer. It also highlights the importance of enhancing research on risk factor exposure and strengthening prevention and control strategies.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContribution list:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors wrote the main manuscript text. Xiong Jun reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003eNO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u003c/strong\u003eNO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statements:\u003c/strong\u003e All authors have approved the manuscript for submission and without any potential competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrant Number:\u003c/strong\u003eNO\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Committee:\u003c/strong\u003e Public information were used and analyzed in this study, so no ethical approval was required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe data that support the findings of this study are available in GBD2021 at ghdx.healthdata.org.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLevi, F., Lucchini, F., Negri, E., \u0026amp; La Vecchia, C. (2004). Decreasing mortality from kidney cancer in Europe. Annals of Oncology, 15(7), 1130\u0026ndash;1135. \u003c/li\u003e\n\u003cli\u003eAbdallah, Nour, et al., \u0026quot;Kidney cancer mortality in the United States between 1999 and 2020: An observational analysis of outcomes by gender, race, and ethnicity.\u0026quot; (2023): 4563\u0026ndash;4563. \u003c/li\u003e\n\u003cli\u003eKim, L. H. et al.: Alcohol consumption and socioeconomic status associated with the risk of kidney cancer in a large Australian cohort study. Ann. Epidemiol. 84, 16\u0026ndash;24 (2023). \u003c/li\u003e\n\u003cli\u003eMellemgaard, A., Engholm, G., and McLaughlin, J. K. \u0026amp; Olsen, J. H. Risk factors for renal cell carcinoma in Denmark. I. Role of socioeconomic status, tobacco use, beverages, and family history. Cancer Causes Control 5(2), 105\u0026ndash;13 (1994). \u003c/li\u003e\n\u003cli\u003eZi, H. et al., Global, regional, and national burden of kidney, bladder, and prostate cancers and their attributable risk factors, 1990\u0026ndash;2019 Mil. Med. Res. 8(1), 60 (2021). \u003c/li\u003e\n\u003cli\u003eTian, Y. Q. et al., Trends and risk factors of global incidence, mortality, and disability of genitourinary cancers from 1990 to 2019: systematic analysis for the Global Burden of Disease Study 2019. Front. Public Health 11, 1119374 (2023). \u003c/li\u003e\n\u003cli\u003eTran, Khanh Bao, et al. The global burden of cancer attributable to risk factors, 2010\u0026ndash;19: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 400.10352 (2022): 563-591. \u003c/li\u003e\n\u003cli\u003eWashoo M., Mori M., Mikami K., et al. Cigarette smoking and other risk factors for kidney cancer death in a Japanese population: Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) [J]. Asian Pacific Journal of Cancer Prevention, 2013, 14(11): 6523\u0026ndash;6528. \u003c/li\u003e\n\u003cli\u003eKurasawa, Shimon, et al. Association of kidney function with cancer incidence and its influence on the cancer risk of smoking: The Japan Multi-Institutional Collaborative Cohort Study. International Journal of Cancer 153.4 (2023): 732\u0026ndash;741. \u003c/li\u003e\n\u003cli\u003eHuang, Junjie, et al. A global trend analysis of kidney cancer incidence and mortality and their associations with smoking, alcohol consumption, and metabolic syndrome.\u0026quot; European urology focus 8.1 (2022): 200\u0026ndash;209. \u003c/li\u003e\n\u003cli\u003eBara, Amrit, et al.The prognostic role of cigarette smoking in Kidney Cancer Survival.\u0026quot; Cancer Medicine 12.13 (2023): 14756\u0026ndash;14766. \u003c/li\u003e\n\u003cli\u003eGuo, K., Wang, Z., Luo, R., Cheng, Y., Ge, S., \u0026amp; Xu, G. (2022). Association between chronic kidney disease and cancer, including the mortality of cancer patients: national health and nutrition examination survey 1999\u0026ndash;2014, American journal of translational research, 144, 2356\u0026ndash;2366. \u003c/li\u003e\n\u003cli\u003eAsadzadeh Vostakolaei, Fatemeh, et al., \u0026quot;The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival.\u0026quot; The European Journal of Public Health 21.5 (2011): 573-577.\u003c/li\u003e\n\u003cli\u003eChoi, Eunji, et al. Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries, Epidemiology and Health 39 (2017). \u003c/li\u003e\n\u003cli\u003eGBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950\u0026ndash;2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019 [J]. Lancet, 2020, 396 (10258): 1160\u0026ndash;1203. \u003c/li\u003e\n\u003cli\u003eSun, M., Thuret, R., Abdollah, F., Lughezzani, G., Schmitges, J., Tian, Z.,... \u0026amp; Karakiewicz, P. I. (2011). Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. European urology, 59(1), 135\u0026ndash;141. \u003c/li\u003e\n\u003cli\u003eLaguna, M. P. Re: international variations and trends in renal cell carcinoma incidence and mortality [J]. The Journal of Urology, 2015, 194(4): 950\u0026ndash;951. \u003c/li\u003e\n\u003cli\u003eWang Z, Wang L, Wang S, et al. Burden of kidney cancer and attributed risk factors in China from 1990 to 2019 [J] Frontiers in Public Health, 2022, 10: 1062504. \u003c/li\u003e\n\u003cli\u003eRizzuto D, Fratiglioni L. Lifestyle factors related to mortality and survival: a mini-review [J]. Gerontology, 2014, 60(4): 327\u0026ndash;335. \u003c/li\u003e\n\u003cli\u003eHuang J., Leung D. K. W., Chan E. O. T., et al. A global trend analysis of kidney cancer incidence and mortality and their associations with smoking, alcohol consumption, and metabolic syndrome [J] European urology focus, 2022, 8(1): 200\u0026ndash;209. \u003c/li\u003e\n\u003cli\u003eHaggstrom C, Rapp K, Stocks T, et al. Metabolic factors associated with risk of renal cell carcinoma [J]. PloS One, 2015, 38 (1): 61\u0026ndash;69. 2013, 8(2): e57475. \u003c/li\u003e\n\u003cli\u003eHofmann, J. N., Corley, D. A., Zhao, W. K., et al. Chronic kidney disease and risk of renal cell carcinoma: differences by race [J]. Epidemiology, 2015, 26(1): 59\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eMartin R. F. Robotic Surgery [J]. Surgical Clinics, 2020, 100(2): xiii\u0026ndash;xiv. \u003c/li\u003e\n\u003cli\u003eLiu J., Wang D., Zhang C., et al. Identification of liver metastasis-associated genes in human colon carcinoma by mRNA profiling [J]. Chinese Journal of Cancer Research, 2018, 30(6): 633. \u003c/li\u003e\n\u003cli\u003eShemilt, Richard, et al. # 5996 Sex Differences in the Diagnosis of Advanced Cancer and Subsequent Outcome in People with CKD. Nephrology Dialysis Transplantation 38.Supplement_1 (2023): gfad063c_5996. \u003c/li\u003e\n\u003cli\u003eMangone, Lucia, et al. Trends in incidence and mortality of kidney cancer in a northern italian province: An update to 2020 \u0026quot;Biology 11.7 (2022) : 1048. \u003c/li\u003e\n\u003cli\u003eJani C, Arora S, Abdallah N, et al. Examining Trends in Kidney Cancer Mortality by Gender and Race in the United States: A 20-Year Analysis[J]. The Oncologist, 2023, 28(Supplement_1): S8-S9. \u003c/li\u003e\n\u003cli\u003eBeebe-Dimmer J L, Colt J S, Ruterbusch J J, et al. Body mass index and renal cell cancer: the influence of race and sex[J]. Epidemiology, 2012, 23(6): 821-828. \u003c/li\u003e\n\u003cli\u003eAsadzadeh Vostakolaei F, Karim-Kos HE, Janssen-Heijnen ML,Visser O, Verbeek AL, Kiemeney LA. The validity of the mortality to incidence ratio as a proxy for site-specific cancer survival. Eur J Public Health 2011; 21:57 3-577. \u003c/li\u003e\n\u003cli\u003eSugerman PB, Savage NW. Oral cancer in Australia: 1983-1996.Aust Dent J. 2002; 47 (1) : 45-56. \u003c/li\u003e\n\u003cli\u003eWang SC, Sung WW, Kao YL, et al. The gender difference and mortality-to-incidence ratio relate to health care disparities in bladder cancer: national estimates from 33 countries. Sci Rep.2017; 7 (1) : 4360. \u003c/li\u003e\n\u003cli\u003eAdams SA, Choi SK, Khang L, A Campbell D, Friedman DB, Eberth JM, et al. Decreased cancer mortality-to-incidence ratios with in\u0026shy;creased accessibility of federally qualified health centers. J Com\u0026shy;munity Health 2015; Observed 33-641. \u003c/li\u003e\n\u003cli\u003eSunkara V, Hebert JR. The colorectal cancer mortality-to-incidence ratio as an indicator of global cancer screening and care. Cancer 2015; 121:1563-1569. \u003c/li\u003e\n\u003cli\u003ea, XF., Wang, YQ., Shao, SY. et al. The relationship between urologic cancer outcomes and national Human Development Index: trend in recent years. BMC Urol 22, 2 (2022). \u003c/li\u003e\n\u003cli\u003eSung,Wen-Wei,et al. \u0026quot;Favorable mortality-to-incidence ratios of kidney Cancer are associated with advanced health care systems.\u0026quot; BMC cancer 18 (2018): 1-7. \u003c/li\u003e\n\u003cli\u003eEisinger, Francois.\u0026quot; Knowledge-based Cancer control.\u0026quot; Current Oncology Reports 20.Suppl 1 (2018): 19.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4606810/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4606810/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eKidney cancer, a prevalent malignant tumor in the urinary system, poses a significant disease burden and remains a crucial public health concern.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUtilizing GBD2021 data, our study examined the standardized incidence, mortality, prevalence, and DALYs rate of renal cancer. We calculated the (1-MIR) value to assess treatment outcomes and survival rates, employed a joinpoint regression model to determine the AAPC, and conducted comparative and longitudinal analyses between China and global trends. Through the joinpoint regression model, we calculated the AAPC and conducted a comprehensive analysis of the disease burden of kidney cancer, evaluating its current status and changing trends.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, the age-standardized incidence rate, age-standardized mortality rate, age-standardized prevalence rate, and age-standardized DALYs rate of kidney cancer in China were lower than those in the world as a whole. However, the growth rate in China was significantly faster than the global average. The age-standardized incidence rate and prevalence rate of kidney cancer in males showed a greater increase compared to females, both in China and globally. Additionally, the age-standardized rate of kidney cancer in males was notably higher than in females, particularly among middle-aged males. The (1-MIR) of renal cancer increased from 0.36 to 0.62 in China and from 0.49 to 0.58 globally. Overall, the treatment effect of renal cancer has shown some successful outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFrom 1990 to 2021, there was a noticeable increase in the global incidence of kidney cancer. Specifically, the standardized incidence and prevalence of kidney cancer in the Chinese population saw a more rapid rise compared to the global trend. Additionally, the disease burden of kidney cancer remained significantly higher in males than in females.\u003c/p\u003e","manuscriptTitle":"Disease Burden and Changing Trends of Kidney Cancer between 1990 and 2021: A Comparative Analysis of China and the World","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 06:17:56","doi":"10.21203/rs.3.rs-4606810/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-07-04T21:39:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-25T14:05:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-24T14:59:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-19T15:08:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be6b2bc9-d518-4e06-a797-dfa4c880886c","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":34255077,"name":"Biological sciences/Cancer"},{"id":34255078,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2025-02-10T16:10:44+00:00","versionOfRecord":{"articleIdentity":"rs-4606810","link":"https://doi.org/10.1038/s41598-025-88682-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-02-07 15:57:28","publishedOnDateReadable":"February 7th, 2025"},"versionCreatedAt":"2024-07-16 06:17:56","video":"","vorDoi":"10.1038/s41598-025-88682-1","vorDoiUrl":"https://doi.org/10.1038/s41598-025-88682-1","workflowStages":[]},"version":"v1","identity":"rs-4606810","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4606810","identity":"rs-4606810","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}