The GBD cancer mortality and YLL estimation process included 2 primary steps (eFigure 2 in the
Supplement), beginning with the estimation of cancer MIRs, which provide an association between mortality and incidence estimation, maximizing data availability. The MIRs were modeled using a space-time Gaussian process regression approach
26 (link) (MIR methods are described in the eAppendix in the
Supplement) using matched incidence and mortality data from cancer registries (eTable 6 in the
Supplement) and the GBD-estimated health care access and quality index
33 (link) as a covariate. These estimated MIRs were then used to convert cancer registry incidence data into inputs for mortality modeling.
Estimating cancer mortality was the second step. The GBD 2019 study used a Cause of Death Ensemble model (CODEm) approach that combined data from vital registration systems, cancer registries, and verbal autopsy reports to estimate mortality across several submodels.
34 (link) Covariates provided for potential inclusion in the submodels of the ensemble, such as smoking prevalence or alcohol use, can be found in the eAppendix and eTables 7 and 8 in the
Supplement. Ensemble model construction and performance was evaluated through out-of-sample predictive validity tests (eTable 9 in the
Supplement). For each cancer, sex-specific CODEm models generated mortality estimates across locations, years, and age groups. These cancer mortality estimates were then scaled to align with the total mortality for all causes of death, which was separately estimated in GBD 2019 (eTable 10 in the
Supplement).
21 (link) To estimate YLLs, a standard age-specific GBD life expectancy was applied to mortality estimates by age group (eAppendix in the
Supplement).
20 (link)The GBD cancer incidence and YLD estimation process included 2 additional steps (eFigure 3 in the
Supplement), starting with estimating incidence. Incidence was estimated by taking mortality estimates from the second step described previously and dividing by MIR estimates from the first step described previously for each cancer type, sex, location, year, and 5-year age group. Additional information can be found in the eAppendix in the
Supplement.
Next, YLDs were estimated by combining prevalence estimates with disability weights associated with various phases of cancer survival. To estimate 10-year cancer prevalence, survival curves estimated from MIRs were combined with GBD-estimated background mortality and applied to incidence estimates. Additional information regarding survival and prevalence estimation can be found in the eAppendix and eFigure 3 in the
Supplement. These 10-year prevalence estimates were then partitioned into 4 sequelae according to the expected person-time spent in these 4 phases of cancer survival: (1) diagnosis/treatment, (2) remission, (3) metastatic/disseminated, and (4) terminal (eTable 11 in the
Supplement). Each sequela prevalence was multiplied by a sequela-specific disability weight that represented the magnitude of health loss (eTable 12 in the
Supplement).
20 (link) For 5 cancer types (bladder, breast, colorectal, larynx, and prostate cancer), the total prevalence additionally included lifetime prevalence of procedure-related disability (eg, laryngectomy due to larynx cancer). These procedure-related prevalence estimates were modeled in the Bayesian meta-regression tool DisMod-MR, version 2.1,
20 (link) using medical records data on the proportion of patients with cancer who underwent these procedures and the estimated number of 10-year survivors (eAppendix in the
Supplement). These procedure-related prevalence estimates were then multiplied by procedure-specific disability weights (eTable 12 in the
Supplement). Total cancer-specific YLDs were estimated by summing across these sequelae. Finally, DALYs were estimated as the sum of YLDs and YLLs.
20 (link)
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