Global burden of lip and oral cavity cancer attributable to behavioral risk factors, 1990-2021: a systematic analysis based on the GBD 2021 database

BACKGROUND: Lip and oral cavity cancer (LOC) is a major global public health issue, with tobacco and alcohol as key modifiable behavioral risk factors. This study analyzed global LOC burden trends (1990-2021) and predicted future burden through 2051. METHODS: Data were from the Global Burden of Disease Study (GBD) 2021, including behavioral factor-attributable age-standardized disability-adjusted life year rate (ASDR) and mortality rate (ASMR). Joinpoint regression identified trend changes; Age-Period-Cohort (APC) models assessed age, period, and cohort effects. Health inequalities were evaluated via Slope Index of Inequality (SII) and Concentration Index (CI). A Bayesian APC model projected burden to 2051. RESULTS: In 2021, global ASDR and ASMR were 16.75 (95% uncertainty interval [UI]: 12.76, 20.66) and 0.60 (95% UI: 0.46, 0.75) per 100,000. Males had higher ASDR (26.94; 95% UI:19.27, 34.36) and ASMR (0.97; 95% UI:0.70, 1.24) than females (7.22 ; 95% UI: 5.55, 9.18 and 0.28; 95% UI: 0.21, 0.35). High SDI regions showed ASR declines; low-middle SDI regions had slower reductions or increases. Tobacco was the leading risk factor, with the heaviest burden in low-middle SDI regions and South Asia. Health inequalities shifted burden to lower socio-economic groups. Projections (2051) show males will have higher ASDR (27.59; 95% CI: 5.37, 49.81]) and ASMR (1.04 ; 95% CI: 0.17, 1.91). CONCLUSION: Behavioral risk factors, particularly tobacco, drive global LOC burden. Strengthening tobacco/alcohol control, promoting early detection, and reducing socioeconomic disparities are crucial for prevention.