Global burden of ovarian cancer in middle-aged and older women

In 2021, the age-standardized incidence rate (ASIR) for ovarian cancer in middle-aged and older women was 19.07 (95% UI: 16.91, 20.88) per 100,000, the age-standardized prevalence rate (ASPR) was 67.66 (95% UI: 60.44, 73.98) per 100,000, the age-standardized mortality rate (ASMR) was 13.53 (95% UI: 11.97, 14.83) per 100,000 per year, and the age-standardized disability-adjusted life years (ASDR) was 346.85 (95% UI: 310.08, 380.08) per 100,000. This indicates that in 2021, there were 239,682.42 (95% UI: 212,535.20, 262,405.58) new cases of ovarian cancer in middle-aged and older women, 843,405.02 (95% UI: 753,478.23, 922,077.27) existing cases, 171,245.50 (95% UI: 151,451.32, 187,707.48) deaths, and 4,352,538.86 (95% UI: 3,891,470.80, 4,769,012.59) DALYs. From 1990 to 2021, the EAPC for ASIR, ASPR, ASMR, and ASDR all showed negative values, indicating a significant decrease in the disease burden. See Table 1 for details.

Table 1 Age-standardized ovarian cancer burden results for the global population, five SDI regions, and 21 GBD regionsRegional burden of ovarian cancer in middle-aged and older women

Among the five SDI regions, the High SDI region had the highest ASIR (25.35 (95% UI: 22.90, 27.09) per 100,000), ASPR (101.19 (95% UI: 92.71, 107.48) per 100,000), ASMR (17.43 (95% UI: 15.54, 18.73) per 100,000), and ASDR (425.27 (95% UI: 389.01, 452.21) per 100,000 per year) in 2021, significantly higher than other regions. In contrast, the Middle SDI region had the lowest ASIR (15.14 (95% UI: 12.94, 17.33) per 100,000), ASMR (10.26 (95% UI: 8.81, 11.74) per 100,000), and ASDR (280.42 (95% UI: 241.62, 319.92) per 100,000 per year), while the Low SDI region had the lowest ASPR (44.56 (95% UI: 34.16, 53.97) per 100,000). From 1990 to 2021, the disease burden in the High SDI and High-Middle SDI regions significantly decreased (with EAPC values and their confidence intervals all less than 0), while the disease burden in the Middle SDI, Low-Middle SDI, and Low SDI regions significantly increased (with EAPC values and their confidence intervals all greater than 0). See Table 1 for details.

Among the 21 GBD regions, Central Europe had the highest ASIR (33.08 (95% UI: 29.69, 36.42) per 100,000), ASPR (116.46 (95% UI: 104.38, 128.82) per 100,000), ASMR (25.30 (95% UI: 22.76, 27.76) per 100,000), and ASDR (652.82 (95% UI: 589.76, 715.87) per 100,000 per year) in 2021. In contrast, Oceania had the lowest ASIR (10.64 (95% UI: 6.40, 15.78) per 100,000), ASMR (6.48 (95% UI: 3.94, 9.48) per 100,000), ASDR (174.70 (95% UI: 104.16, 259.55) per 100,000 per year), and Western Sub-Saharan Africa had the lowest ASPR (30.19 (95% UI: 19.65, 39.53) per 100,000). From 1990 to 2021, Andean Latin America had the fastest increase in ASIR (EAPC = 1.98 (95% CI 1.63, 2.34)), ASPR (EAPC = 2.59 (95% CI 2.21, 2.97)), ASMR (EAPC = 1.76 (95% CI 1.41, 2.11)), and ASDR (EAPC = 1.77 (95% CI 1.43, 2.11)), while Australasia had the fastest decrease in ASIR (EAPC = − 2.26 (95% CI 2.64, − 1.88)), ASPR (EAPC = − 2.12 (95% CI − 2.56, − 1.68)), ASMR (EAPC = − 2.21 (95% CI − 2.56, − 1.86)), and ASDR (EAPC =− 2.50 (95% CI − 2.84, − 2.16)). See Table 1 for details.

National burden of ovarian cancer in middle-aged and older women

In 2021, the United Arab Emirates had the highest age-standardized incidence rate (ASIR) of 83.32 (95% UI: 54.38, 123.82) per 100,000, age-standardized prevalence rate (ASPR) of 202.15 (95% UI: 130.92, 304.26) per 100,000, age-standardized mortality rate (ASMR) of 74.94 (95% UI: 49.00, 110.17) per 100,000, and age-standardized disability-adjusted life years (ASDR) of 1470.21 (95% UI: 960.48, 2179.98) per 100,000. In contrast, Palau had the lowest ASIR (3.76 (95% UI: 2.23, 5.90) per 100,000), ASMR (2.39 (95% UI: 1.45, 3.66) per 100,000), and ASDR (55.79 (95% UI: 33.43, 86.75) per 100,000), while Kiribati had the lowest ASPR (11.89 (95% UI: 6.15, 19.64) per 100,000). From 1990 to 2021, among the 204 countries and regions analyzed, 40 countries showed a significant decrease in ASIR, 30 countries in ASPR, 45 countries in ASMR, and 48 countries in ASDR. Fifteen countries showed no significant change in ASIR, 13 countries in ASPR, 14 countries in ASMR, and 11 countries in ASDR, while the remaining countries experienced a significant increase in disease burden. See Fig. 1 and Supplementary Table 1 for details.

Fig. 1

Age-standardized incidence rates (AIRS) of ovarian cancer in women aged 45 + in 2021

Age and temporal trends in the burden of ovarian cancer among middle-aged and older women

Age trend analysis revealed that the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of ovarian cancer increased with age. However, the age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life years (ASDR) decreased with age, particularly after 65 years. The highest number of new cases, prevalence, and disability-adjusted life years (DALYs) occurred in the 55–59 age group, while the highest number of deaths was observed in the 65–69 age group (Fig. 2). Temporal trend analysis indicated a declining trend in ASIR, ASPR, ASMR, and ASDR globally and in High and High-middle Social Demographic Index (SDI) regions. In contrast, Middle, Low-middle, and Low SDI regions showed increasing disease burdens (Supplementary Figs. 1–4). Similar patterns were observed across different age groups (Supplementary Figs. 5–8).

Fig. 2

Age-temporal trends in the burden of ovarian cancer in middle-aged and older women (A. ASIR; B. ASPR; C. ASMR; D. ASDR)

Joinpoint regression analysis revealed that globally, ASIR, ASMR, and ASDR followed similar patterns: from 1990 to 1995, the disease burden increased significantly, followed by a continuous decline until 2021, although the rate of decline slowed after 2015 (Figs. 3A, C, D). ASPR showed a significant increase from 1990 to 2004, followed by a consistent decline, with a slowing decline rate after 2015 (Fig. 3B). Detailed segmental trends are provided in Supplementary Table 2.

Fig. 3

Results of Joinpoint regression analysis (A. ASIR; B. ASPR; C. ASMR; D. ASDR)

Correlation between ovarian cancer burden and SDI among middle-aged and older women

A significant correlation was observed between the ovarian cancer burden and SDI (all Spearman’s correlation p-values < 0.05) across the 21 Global Burden of Disease (GBD) regions and 204 countries. Specifically, the disease burden increased with SDI and peaked around an SDI of 0.8, after which the burden gradually declined. Among the 21 GBD regions, Australasia, High-income North America, and Western Europe exhibited the most pronounced reductions in disease burden. At the national level, the United Arab Emirates showed a significantly higher burden compared to other countries (Figs. 4A–H). Correlation coefficients and p-values are detailed in Supplementary Table 3.

Fig. 4

Correlation between the burden of ovarian cancer in middle-aged and older women and SDI (A. ASIR in 21 regions; B. ASPR in 21 regions; C. ASMR in 21 regions; D. ASDR in 21 regions; E. ASIR in 204 countries; F. ASPR in 204 countries; G. ASMR in 204 countries; H. ASDR in 204 countries; I. EAPC of ASIR; J. EAPC of ASPR; K. EAPC of ASMR; L. EAPC of ASDR)

A significant correlation was also found between EAPC and SDI. As SDI increased, EAPC rose and remained positive, indicating an increasing trend in ovarian cancer burden among middle-aged and older women. When SDI reached approximately 0.6, EAPC began to decline but remained positive. At an SDI of about 0.8, EAPC fell below zero, signifying a significant decline in disease burden at this level (Figs. 4I-L).

Age-period-cohort analysis of the burden of ovarian cancer in middle-aged and older women

The age effect analysis indicated that the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of ovarian cancer in middle-aged and older women increased with age, gradually declining around the ages of 85 to 90. Conversely, the age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life years (ASDR) increased between the ages of 45 and 65, followed by a gradual decline thereafter (Fig. 5A-D). The period and cohort analysis of the disease burden also demonstrated similar trends: as time periods and birth cohorts progressed, the disease burden gradually decreased (Fig. 5E-L).

Fig. 5

Age-period-cohort analysis results for the burden of ovarian cancer in middle-aged and older women (A. Age effect on ASIR; B. Age effect on ASPR; C. Age effect on ASMR; D. Age effect on ASDR; E. Period effect on ASIR; F. Period effect on ASPR; G. Period effect on ASMR; H. Period effect on ASDR; I. Cohort effect on ASIR; J. Cohort effect on ASPR; K. Cohort effect on ASMR; L. Cohort effect on ASDR)

Decomposition analysis of the burden of ovarian cancer in middle-aged and older women

The impact of population growth, aging, and epidemiological changes varied across different regions, with population growth having the most significant effect on the disease burden, followed by epidemiological changes and aging. Specifically, in all regions, population growth contributed to an increase in the burden of ovarian cancer. In global, High SDI, High-middle SDI, High-income North America, and Western Europe, epidemiological changes reduced the burden of ovarian cancer. The role of aging in changing the disease burden was limited; in High SDI regions, aging reduced the burden, while in Middle SDI regions, aging increased the burden (Fig. 6). Detailed contributions of the three factors to the disease burden are provided in Supplementary Table 4.

Fig. 6

Decomposition analysis results of the burden of ovarian cancer in middle-aged and older women (A. ASIR; B. ASPR; C. ASMR; D. ASDR)

Predictive analysis of the burden of ovarian cancer in middle-aged and older women

From 2022 to 2050, no significant changes are expected in the burden of ovarian cancer among middle-aged and older women. By 2050, it is projected that the ASIR will reach 21.07 (95% UI: 11.19–30.96) per 100,000, the ASPR will reach 81.40 (95% UI: 32.51–130.29) per 100,000, the ASMR will reach 13.37 (95% UI: 8.41–18.34) per 100,000, and the ASDR will reach 362.02 (95% UI: 177.60–546.43) per 100,000. This implies that by 2050, there will be approximately 425,086.20 (95% UI: 225,693.28–624,479.13) new cases of ovarian cancer among middle-aged and older women, 1,642,320.15 (95% UI: 655,914.64–2,628,725.67) individuals living with ovarian cancer, 269,842.36 (95% UI: 169,641.16–370,043.57) deaths due to ovarian cancer, and a total of 7,304,135.43 (95% UI: 3,583,373.46–11,024,897.39) years of life lost (Fig. 7 and Supplementary Table 5).

Fig. 7

Predictive analysis results for the burden of ovarian cancer in middle-aged and older women (A. ASIR; B. ASPR; C. ASMR; D. ASDR)