Abstract
BACKGROUND: High body mass index (BMI) is a key modifiable risk factor for breast, ovarian, and uterine cancer. Despite the ongoing global obesity epidemic, a systematic assessment of the long-term burden trends and disparities of these cancers attributable to high BMI is lacking, particularly across regions with different sociodemographic development. This study quantifies these trends and disparities, providing an evidence base to inform equitable global cancer prevention strategies. METHODS: We extracted data on deaths and disability-adjusted life years (DALYs) for breast, ovarian, and uterine cancer attributable to high BMI from 1990 to 2021 across 204 countries from the Global Burden of Disease 2021 study. We used Joinpoint regression to analyze temporal trends in age-standardized rates (ASRs), employed efficiency frontier analysis to assess burden control, and quantified inequalities using the Slope Index of Inequality (SII) and Concentration Index (CI). Finally, an Autoregressive Integrated Moving Average (ARIMA) model was used to project burden trends to 2040. RESULTS: Globally, from 1990 to 2021, annual deaths attributable to high BMI for these cancers more than doubled from 36,000 to 88,000, while DALYs rose from 0.83 million to 2.13 million. Burden trajectories showed marked divergence by Sociodemographic Index (SDI). In high-SDI regions, the burdens of breast and ovarian cancer declined, while the uterine cancer burden increased (AAPC in ASDALYs = 0.86%). Conversely, in low- and middle-SDI regions, the burdens of three cancers increased. The most pronounced rise occurred in ovarian cancer in low-SDI regions (ASDR AAPC of 4.49%). Inequality analysis revealed a widening absolute gap in burden, with the SII for ovarian cancer increasing by 95.3%. Projections indicate that DALY burdens for breast and ovarian cancer will continue to increase by 2040. CONCLUSION: The rising global burden of female-specific cancers attributable to high BMI is shifting disproportionately to low-SDI regions, exacerbating absolute health inequalities. This highlights an urgent need to integrate weight management and nutritional interventions into equitable, context-specific prevention strategies to address this growing global health challenge.