Burden, Risk Factors, and Temporal Trends of Ovarian Cancer in Postmenopausal Women Aged 55 Years and Older: A Comparative Analysis in India, China, and the United States Based on the Global Burden of Disease Study 2023

Our plain-English summary of Burden, Risk Factors, and Temporal Trends of Ovarian Cancer in Postmenopausal Women Aged 55 Years and Older: A Comparative Analysis in India, China, and the United States Based on the Global Burden of Disease Study 2023, by T. Wei, H. Zheng, Y. Pei, et al (International Journal of Women's Health, 2026).

The study

• Authors: T. Wei, H. Zheng, Y. Pei, J. Huang, H. Lin, L. Song, S. Huang, Y. Wu, Y. Liu
• Journal: International Journal of Women's Health
• Published: 2026;18:634548
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Evidence remains limited on the ovarian cancer (OC) burden among women aged 55 years and older, used here as an operational proxy for the postmenopausal population, across India, China, and the United States.

Methods: We extracted data on OC-related incidence, mortality, disability-adjusted life years (DALYs), and relevant risk factors from the Global Burden of Disease (GBD) 2023 for the period 1990-2023. We assessed age-specific patterns; temporal trends using the estimated annual percentage change and Joinpoint regression; age-period-cohort (APC) patterns and estimable functions; demographic decomposition; and DALY burdens attributable to high body-mass index (BMI) and occupational asbestos exposure. The Autoregressive Integrated Moving Average (ARIMA) model and Bayesian age-period-cohort (BAPC) model were applied to predict age-standardized DALY rates of OC through 2040.

Results: Absolute incident cases, deaths, and DALYs increased in all three countries, whereas age-standardized rates increased in India and generally declined in China and the United States. India had a comparatively greater burden in younger age groups within the study population, whereas the United States had the highest burden at older ages. In China, despite an overall negative net drift, local-drift point estimates were positive among women aged 85 years and older (0.03%-0.82% per year), although the 95% confidence intervals included zero. The proportion of DALYs attributable to high BMI increased in all three countries, and population growth was the principal positive driver of the rising absolute burden. Projections suggested a continued increase in India's age-standardized DALY rate and further declines in China and the United States through 2040.

Conclusion: Age-standardized OC burden increased in India but declined in China and the United States, whereas the absolute burden rose in all three countries; the non-significant positive local-drift point estimates among the oldest-old in China warrant monitoring. These ecological findings do not establish causality and support country-specific hereditary risk management and strengthened pathways for timely diagnosis and specialist referral.

© 2026 Wei et al.

In plain English

This study analyzed Global Burden of Disease 2023 estimates of ovarian cancer in women aged 55 and older in India, China and the United States, 1990 to 2023, with projections to 2040. The authors used this age group as a stand-in for postmenopausal women. The numbers of new cases, deaths and disability-adjusted life years (DALYs) increased in all three countries. Age-standardized incidence rose in India (14.03 to 24.88 per 100,000) but fell in China (13.40 to 11.10) and the United States (53.37 to 35.46). The share of ovarian cancer DALYs attributed to occupational asbestos exposure was 4.3% in 1990 and 4.2% in 2023 in the United States, 1.3% and 1.6% in China, and 0.3% and 0.4% in India. The high body-mass index share rose in each country from 1990 to 2023 and exceeded the asbestos share in all three in 2023. Population growth was the main driver of rising case numbers. The authors concluded that these population-level findings do not demonstrate causal mechanisms. They noted that the modeled data carry inherent uncertainty and that an ecological analysis cannot determine causal relationships.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Ecological analysis of aggregated, modeled Global Burden of Disease 2023 estimates. Methods included trend analysis, Joinpoint regression, age-period-cohort modeling, decomposition analysis and forecasting models (BAPC and ARIMA).
• Who was studied: Women aged 55 years and older in India, China and the United States, 1990 to 2023. The age group was used as a stand-in for the postmenopausal population. No individual-level data were used.
• Exposure: Two risk factors drawn from the GBD 2023 Comparative Risk Assessment framework: high body-mass index and occupational asbestos exposure. The article does not name asbestos fiber types or give exposure levels.
• Main results:
  • In India, the age-standardized ovarian cancer incidence rate among women 55 and older rose from 14.03 per 100,000 in 1990 to 24.88 per 100,000 in 2023 (estimated annual percentage change 1.62, 95% CI 1.42 to 1.83).
  • In China, the age-standardized incidence rate declined from 13.40 to 11.10 per 100,000 (estimated annual percentage change -1.10, 95% CI -1.35 to -0.85).
  • In the United States, the age-standardized incidence rate dropped from 53.37 to 35.46 per 100,000 (estimated annual percentage change -1.46, 95% CI -1.65 to -1.27).
  • Proportion of ovarian cancer DALYs attributable to occupational asbestos exposure: United States 4.3% in 1990 and 4.2% in 2023; China 1.3% and 1.6%; India 0.3% and 0.4%.
  • Proportion of DALYs attributable to high body-mass index: United States 10.0% in 1990 and 14.5% in 2023; China 2.0% and 5.3%; India 0.3% and 4.0%. The share rose in each country. In India in 1990, the high-BMI and asbestos shares were both 0.3%. The authors stated that occupational asbestos exposure accounted for a smaller attributable burden than high BMI in their analysis.
  • Population growth was the leading driver of rising case numbers in all three countries.
  • In China, age-group-specific mortality trend estimates were slightly positive among women aged 85 and older, ranging from 0.03% to 0.82% per year. All corresponding 95% confidence intervals included zero, meaning the change was not statistically significant.
  • The Bayesian age-period-cohort model projected India's age-standardized DALY rate among women 55 and older to rise to 815.28 per 100,000 by 2040. The same model projected declines to 168.65 per 100,000 in China and 405.21 per 100,000 in the United States.
• The authors' conclusion: The authors concluded that from 1990 to 2023, age-standardized ovarian cancer incidence, mortality and DALY rates increased in India and generally declined in China and the United States, while the absolute burden increased in all three. They stated that these population-level findings do not demonstrate causal mechanisms.
• Limitations the authors state:
  • The GBD 2023 data carry inherent uncertainties from the quality of the input data and from the limitations of the model.
  • As an ecological analysis of aggregated data, it cannot determine causal relationships or identify individual-level confounding.
  • Women aged 55 and older were used as a proxy for postmenopausal women. Individual menopausal status could not be determined, so the group may include some premenopausal women.
  • The projection models cannot anticipate structural changes in prevention, diagnosis, treatment or data quality, and their uncertainty widens over time.

Topics

Medical terms in this study, explained in our Lexicon: Ovarian Cancer, Asbestos Exposure, confidence interval.

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