Trends and future projections of endometrial cancer burden attributable to high BMI in China: an age-period-cohort analysis based on 1990–2021 data

OBJECTIVE: Research on endometrial cancer burden associated with high body mass index (BMI) in China remains limited. This study analyzes the characteristics of high BMI-related endometrial cancer burden in China from 1990 to 2035. METHODS: Joinpoint regression was used to analyze trends in age-standardized mortality rates and disability-adjusted life years (DALYs). An annual percentage change (APC) model was utilized to analyze the effects of these 3 factors on disease burden. The disease burden trends from 2022 to 2035 were predicted using the Bayesian APC model and the Nordpred model. RESULTS: From 1990 to 2021, the number of endometrial cancer deaths attributable to high BMI in China increased by 196.78%, while DALYs rose by 179.31%. Age-standardized mortality and DALY rates increased by 19.46% and 20.86%, respectively, with average APCs of 0.56 (95% confidence interval [CI]=0.42 to 0.70) and 0.64 (95% CI=0.45 to 0.83). APC analysis revealed an initial increase followed by a decrease in mortality risk and DALYs with advancing age, an N-shaped temporal trend, and reduced burden among later birth cohorts. The Bayesian APC model projected that by 2035, the number of deaths and DALYs would increase by 158.10% and 126.89%, respectively, compared to 2021. A sensitivity analysis using the Nordpred model confirmed this upward trend. CONCLUSION: China faces a growing disease burden from endometrial cancer attributable to high BMI, with projections indicating a continued increase. These findings underscore the critical need for public health interventions focused on BMI management to prevent endometrial cancer, particularly among high-risk populations.