{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:04:06Z","timestamp":1772496246400,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Nasopharyngeal carcinoma attributable to alcohol use (NPC-AU) contributes substantially to global cancer mortality and disability, yet its temporal and geographic patterns remain incompletely described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the global, regional, and national burden of NPC-AU from 1990 to 2021 and project trends through 2040.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Using GBD 2021 data, global, regional, and national age-standardized mortality rates (ASMR) and disability-adjusted life-years rates (ASDR) attributable to alcohol were evaluated. Trends were quantified by average annual percentage change (AAPC) and projections were generated using Bayesian age\u2013period\u2013cohort models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 1990 to 2021, global ASMR declined from 0.31 to 0.19 per 100,000 population (AAPC \u22121.66; 95% CI \u22121.79 to \u22121.52) and ASDR fell with an AAPC of \u22121.72 (95% CI \u22121.87 to \u22121.57). Male ASMR decreased from 0.42 to 0.27 per 100,000 (AAPC \u22121.60), and female ASMR from 0.21 to 0.12 per 100,000 (AAPC \u22122.25). High-middle SDI regions saw ASMR drop from 0.50 to 0.28 per 100,000 (AAPC \u22121.97), whereas low-middle SDI regions experienced an increase from 0.09 to 0.11 per 100,000 (AAPC 0.72). Regionally, East Asia's ASMR declined at an AAPC of \u22122.70, Southern Latin America at \u22123.13, and Southeast Asia increased at 1.76. Age-specific peaks in ASMR shifted from 55\u201359 and 65\u201369 years in 1990 to 65\u201369 and 70\u201374 years in 2021. Projections forecast male ASMR of 0.35 per 100,000 (95% UI 0.03\u20130.67) and female ASMR of 0.02 per 100,000 (95% UI 0.00\u20130.04) by 2040.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and significance<\/jats:title><jats:p>Although global ASMR and ASDR for NPC-AU declined markedly from 1990 to 2021, rising burdens in lower-SDI regions, persistent male predominance, and shifting peaks to older age groups highlight the need for targeted alcohol-control policies and age-tailored screening.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1623089","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T05:28:59Z","timestamp":1754544539000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Global burden of nasopharyngeal carcinoma attributable to alcohol use: a 1990\u20132021 analysis with projections to 2040"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhenyi","family":"Lu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shujun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengqi","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guixiang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1158\/1055-9965.EPI-20-1702","article-title":"The evolving epidemiology of nasopharyngeal carcinoma","volume":"30","author":"Chang","year":"2021","journal-title":"Cancer Epidemiol Biomarkers Prev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1016\/S0140-6736(19)30427-1","article-title":"Mortality, morbidity, and risk factors in China and its provinces, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"394","author":"Zhou","year":"2019","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1002\/lary.31939","article-title":"Global, regional, and national burden of nasopharyngeal carcinoma from 1990 to 2021","volume":"135","author":"Wu","year":"2025","journal-title":"Laryngoscope."},{"key":"B4","doi-asserted-by":"publisher","first-page":"102613","DOI":"10.1016\/j.arr.2024.102613","article-title":"Global, regional, and national epidemiology of nasopharyngeal carcinoma in middle-aged and elderly patients from 1990 to 2021","volume":"104","author":"Liu","year":"2025","journal-title":"Ageing Res Rev."},{"key":"B5","doi-asserted-by":"publisher","first-page":"110613","DOI":"10.1016\/j.radonc.2024.110613","article-title":"Long-term trends in the burden of nasopharyngeal carcinoma in China: a comprehensive analysis from 1990 to 2021 and projections to 2030 based on the global burden of disease study 2021","volume":"202","author":"Chen","year":"2025","journal-title":"Radiother Oncol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"720","DOI":"10.1186\/s12885-024-12480-7","article-title":"Global, regional and national burdens of nasopharynx cancer in the adolescents and young adults from 1990 to 2019 and its predictions","volume":"24","author":"Huang","year":"2024","journal-title":"BMC Cancer."},{"key":"B7","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S0140-6736(19)30956-0","article-title":"Nasopharyngeal carcinoma","volume":"394","author":"Chen","year":"2019","journal-title":"Lancet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"813","DOI":"10.20870\/oeno-one.2020.54.4.3569","article-title":"Effects of alcohol consumption in general, and wine in particular, on the risk of cancer development: a review","volume":"54","author":"Teissedre","year":"2020","journal-title":"ONEO One."},{"key":"B9","doi-asserted-by":"publisher","first-page":"101534","DOI":"10.1016\/j.bjorl.2024.101534","article-title":"Impact of smoking and alcohol drinking on the prognosis of 721 nasopharyngeal carcinoma","volume":"91","author":"Tian","year":"2025","journal-title":"Braz J Otorhinolaryngol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/S1470-2045(21)00279-5","article-title":"Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study","volume":"22","author":"Rumgay","year":"2021","journal-title":"Lancet Oncol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), healthy life expectancy (HALE) for 371 diseases, injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"B12","doi-asserted-by":"publisher","first-page":"102598","DOI":"10.1016\/j.arr.2024.102598","article-title":"Global, regional, and national burden of spinal cord injury from 1990 to 2021 and projections for 2050: a systematic analysis for the Global Burden of Disease 2021 study","volume":"103","author":"Lu","year":"2025","journal-title":"Ageing Res Rev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1016\/S0140-6736(24)00367-2","article-title":"Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3243","DOI":"10.1002\/hed.26378","article-title":"Global, regional, and national burden of nasopharyngeal carcinoma from 1990 to 2017-results from the Global Burden of Disease Study 2017","volume":"42","author":"Hu","year":"2020","journal-title":"Head Neck."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1016\/S0140-6736(18)31310-2","article-title":"Alcohol use and burden for 195 countries and territories, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"392","author":"GBD","year":"2018","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1016\/S0140-6736(21)01546-4","article-title":"Global, regional, and national mortality among young people aged 10\u201324 years, 1950\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"398","author":"GBD","year":"2021","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","first-page":"4310","DOI":"10.1002\/cam4.4783","article-title":"The global, regional, national burden of nasopharyngeal cancer and its attributable risk factors (1990\u20132019) and predictions to 2035","volume":"11","author":"Song","year":"2022","journal-title":"Cancer Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1007\/s00405-021-06922-2","article-title":"The global burden of nasopharyngeal carcinoma from 2009 to 2019: an observational study based on the Global Burden of Disease Study 2019","volume":"279","author":"Yu","year":"2022","journal-title":"Eur Arch Otorhinolaryngol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1186\/s12885-024-12843-0","article-title":"Comprehensive pan-cancer analysis reveals EPHB2 is a novel predictive biomarker for prognosis and immunotherapy response","volume":"24","author":"Xu","year":"2024","journal-title":"BMC Cancer."},{"key":"B20","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1080\/02770903.2024.2403740","article-title":"Causal links between immune cells and asthma: Insights from a Mendelian randomization analysis","volume":"62","author":"Xu","year":"2025","journal-title":"J Asthma."},{"key":"B21","doi-asserted-by":"publisher","first-page":"3757","DOI":"10.2147\/JIR.S509245","article-title":"The role of PLIN3 in prognosis and tumor-associated macrophage infiltration: a pan-cancer analysis","volume":"18","author":"Yang","year":"2025","journal-title":"J Inflamm Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1507501","DOI":"10.3389\/fimmu.2024.1507501","article-title":"Targeting T cell exhaustion: emerging strategies in non-small cell lung cancer","volume":"15","author":"Liu","year":"2024","journal-title":"Front Immunol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.dld.2019.10.012","article-title":"Contribution of high body mass index and alcohol use to liver cancer-related mortality: a study based on 195 countries or territories","volume":"52","author":"Zhang","year":"2020","journal-title":"Dig Liver Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1136\/jech-2017-209350","article-title":"Alcohol control policies and alcohol consumption: an international comparison of 167 countries","volume":"72","author":"Madureira-Lima","year":"2018","journal-title":"J Epidemiol Community Health."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2326","DOI":"10.1111\/add.15441","article-title":"Societal development and the alcohol-attributable burden of disease","volume":"116","author":"Shield","year":"2021","journal-title":"Addiction."},{"key":"B26","doi-asserted-by":"publisher","first-page":"109282","DOI":"10.1016\/j.isci.2024.109282","article-title":"Global burden of head and neck cancers from 1990 to 2019","volume":"27","author":"Zhou","year":"2024","journal-title":"iScience."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1001\/jamaoncol.2023.2960","article-title":"The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories: a systematic analysis for the global burden of disease study 2019","volume":"9","author":"Cunha","year":"2023","journal-title":"JAMA Oncol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1931","DOI":"10.1186\/s12889-024-19228-9","article-title":"Nasopharyngeal cancer risk assessment by country or region worldwide from 1990 to 2019","volume":"24","author":"Wei","year":"2024","journal-title":"BMC Public Health."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e49968","DOI":"10.2196\/49968","article-title":"Nasopharyngeal cancer incidence and mortality in 185 countries in 2020 and the projected burden in 2040: population-based global epidemiological profiling","volume":"9","author":"Zhang","year":"2023","journal-title":"JMIR Public Health Surveill."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/01635580802372633","article-title":"Alcohol consumption and the risk of nasopharyngeal carcinoma: a systematic review","volume":"61","author":"Chen","year":"2009","journal-title":"Nutr Cancer."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1158\/1055-9965.EPI-06-0353","article-title":"The enigmatic epidemiology of nasopharyngeal carcinoma","volume":"15","author":"Chang","year":"2006","journal-title":"Cancer Epidemiol Biomarkers Prev."},{"key":"B32","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1200\/JGO.19.00239","article-title":"Attributable causes of cancer in Vietnam","volume":"6","author":"Nguyen","year":"2020","journal-title":"JCO Glob Oncol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1111\/add.13159","article-title":"Extent of alcohol prohibition in civil policy in Muslim majority countries: the impact of globalization","volume":"111","author":"Al-Ansari","year":"2016","journal-title":"Addiction."},{"key":"B34","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1186\/1471-2458-14-731","article-title":"Traditional alcohol production and use in three provinces in Vietnam: an ethnographic exploration of health benefits and risks","volume":"14","author":"Luu","year":"2014","journal-title":"BMC Public Health."},{"key":"B35","doi-asserted-by":"publisher","first-page":"19290","DOI":"10.1038\/srep19290","article-title":"Alcohol drinking as an unfavorable prognostic factor for male patients with nasopharyngeal carcinoma","volume":"6","author":"Chen","year":"2016","journal-title":"Sci Rep."},{"key":"B36","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.ejca.2012.07.004","article-title":"Sex difference in the incidence of nasopharyngeal carcinoma in Hong Kong 1983\u20132008: suggestion of a potential protective role of oestrogen","volume":"49","author":"Xie SH Yu","year":"2013","journal-title":"Eur J Cancer."},{"key":"B37","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1158\/1055-9965.EPI-08-0461","article-title":"Age-incidence curves of nasopharyngeal carcinoma worldwide: bimodality in low-risk populations and aetiologic implications","volume":"17","author":"Bray","year":"2008","journal-title":"Cancer Epidemiol Biomarkers Prev."},{"key":"B38","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.oraloncology.2011.03.017","article-title":"Tobacco smoking, alcohol drinking, and the risk of different histological types of nasopharyngeal cancer in a low-risk population","volume":"47","author":"Polesel","year":"2011","journal-title":"Oral Oncol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1093\/ntr\/ntw235","article-title":"Synergistic and non-synergistic associations for cigarette smoking and non-tobacco risk factors for cardiovascular disease incidence in the atherosclerosis risk in communities (ARIC) study","volume":"19","author":"Lubin","year":"2017","journal-title":"Nicotine Tob Res."},{"key":"B40","doi-asserted-by":"publisher","first-page":"109","DOI":"10.14740\/wjon980w","article-title":"Incidence and mortality of nasopharynx cancer and its relationship with human development index in the world in 2012","volume":"7","author":"Mahdavifar","year":"2016","journal-title":"World J Oncol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.3390\/healthcare10091615","article-title":"Mortality-to-incidence ratio for nasopharyngeal carcinoma is associated with health expenditure","volume":"10","author":"Dong","year":"2022","journal-title":"Healthcare."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B43","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1056\/NEJMra1201534","article-title":"Measuring the global burden of disease","volume":"369","author":"Murray","year":"2013","journal-title":"N Engl J Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"2019","DOI":"10.1038\/s41591-022-01990-1","article-title":"The global burden of disease study at 30 years","volume":"28","author":"Murray","year":"2022","journal-title":"Nat Med."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1623089\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T05:29:00Z","timestamp":1754544540000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1623089\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2025.1623089"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1623089","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"article-number":"1623089"}}