Abstract
BACKGROUND: Cervical (CC), ovarian (OC), and uterine (UC) cancers are major contributors to global gynecological cancer (GC) burden. This research intended to update trends in disease burden and care quality for these cancers and quantify cross-country inequalities between 1990 and 2021. METHODS: We performed a secondary analysis utilizing the Global Burden of Disease 2021 database. Disease burden and care quality were evaluated through age-standardized incidence rates (ASIR), age-standardized years lived with disability rates (ASYR), and quality-of-care index (QCI). Trends were analyzed using estimated annual percentage changes, while absolute and relative cross-country inequalities were quantified using the slope index of inequality and concentration index. RESULTS: From 1990 to 2021, global ASIR and ASYR for CC and OC declined, whereas UC showed an increase in both rates. Concurrently, a general uptrend in QCI was observed for all three GCs. Across the WHO regions, the European region reported the highest ASIR and ASYR for OC and UC in 2021, and the African region recorded the highest for CC. In both 1990 and 2021, countries/territories with higher socio-demographic index (SDI) experienced a higher ASYR for OC and UC, while CC primarily concentrated in lower SDI countries/territories. Significant healthcare inequalities in age-standardized QCI were observed, with higher SDI countries/territories generally exhibiting better QCI. CONCLUSION: Trends in the burden and QCI for gynecological cancers demonstrated significant disparities among WHO regions and 204 countries/territories, with global inequalities persisting. Urgent action is needed to develop geographically tailored strategies for equitable access to high-quality healthcare.