Oral cancer and cardiovascular disease share common modifiable risk factors and contribute substantially to the global burden of non-communicable diseases. However, evidence on their sex-specific coexisting burden at the population level remains limited, particularly in middle-income countries such as Malaysia. We conducted a national level, population-based analysis of the coexisting burden of oral cancer and cardiovascular disease in Malaysia using estimates from the Global Burden of Disease 2023 study. Age-standardized incidence rates, mortality rates, and disability-adjusted life year (DALY) rates from 1990 to 2023 were examined by sex. Joinpoint regression was applied to quantify temporal trends, and uncertainty intervals were propagated for all sex ratios. Risk-attributable fractions for tobacco and alcohol use were extracted from Global Burden of Disease’s comparative risk assessment framework, and a combined metric of shared risk-attributable DALY burden was calculated. Population-level smoking prevalence data were obtained from the World Health Organization. In 2023, pronounced sex differences were observed for both conditions. Males exhibited higher age-standardized DALY and mortality rates than females, with male-to-female ratios of 1.68 (95% uncertainty intervals UIs: 1.31–2.10) for cardiovascular disease and 1.32 (95% UI: 1.08–1.61) for oral cancer age-standardized DALY rates. Despite comparable oral cancer incidence between sexes (M:F ratio = 0.97, 95% UI: 0.66–1.26), males had a 19% higher mortality-to-incidence ratio proxy (59.7% vs 50.2%). Tobacco use was the dominant driver of sex disparities, accounting for 37.9% of oral cancer DALYs and 25.8% of cardiovascular DALYs in males, compared with 7.8% and 8.7% in females. Joinpoint analysis revealed a recent upturn in male cardiovascular mortality (2019–2023) and a sharp rebound in oral cancer DALYs after 2018 in both sexes. This study quantifies a substantial sex-specific risk-attributable coexisting burden of oral cancer and cardiovascular disease in Malaysia, with males experiencing consistently higher mortality and DALY burden. Quantifying the shared risk contribution, males bore a 5-fold higher combined tobacco- and alcohol-attributable DALY burden than females (1702 vs 342 per 100,000), driven predominantly by tobacco use. The findings underscore the importance of integrated, sex-sensitive prevention strategies addressing shared risk factors and provide population-level evidence to inform public health policy in Malaysia and similar middle-income settings.
Mao et al. (Fri,) studied this question.
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