Abstract
BACKGROUND: Uterine cancer poses a growing global health threat, with rising incidence among women aged ≥ 50 years. This study aimed to evaluate its disease burden across regions and nations. METHODS: Using Global Burden of Disease 2021 data, we analyzed the incidence, mortality, disability-adjusted life years (DALYs), and trends via estimated annual percentage change (EAPC), decomposition, inequality analyses, and Bayesian Age-Period-Cohort modeling for 2022-2040 projections. RESULTS: In 2021, global uterine cancer cases among women ≥ 50 years reached 414,754 (95% UI: 370,388-453,502), causing 90,509 deaths (95% UI: 78,633-101,441) and 2,189,261 DALYs (95% UI: 1,920,396-2,446,737). Age-standardized incidence rate (ASIR) rose (EAPC = 0.56, 1990-2021), while mortality and DALYs declined. High-income North America had the highest ASIR (128/100,000), with the United States, China and Russia leading new cases. High Socio-demographic index (SDI) regions exhibited widening disparities, evidenced by a 21% increase in the slope index of inequality (SII) for incidence (47 in 1990 to 57 in 2021) and concentration indices (CI) rising from 0.33 (95% CI: 0.28, 0.37) in 1990 to 0.35 (95% CI: 0.29, 0.4) in 2021. Population growth drove 132.55% of DALY changes, outweighing epidemiological (-32.95%) and aging (0.4%) factors. Projections suggest declining ASIR, the age-standardized mortality rate (ASMR), and DALY rates by 2040, yet absolute cases will rise to 617,571 new cases, 131,961 deaths, and 2,851,768 DALYs. CONCLUSIONS: Despite declining mortality and DALY rates, uterine cancer incidence continued to increase globally, driven by population growth. High-income regions faced disproportionate burdens, with persistent health inequities. Projected absolute case growth demands urgent prioritization of equity-oriented screening, prevention, and resource allocation. Governments must integrate targeted interventions with global aging policies to address this dual burden of epidemiological transition and health inequity.