The global burden of female breast cancer attributable to high fasting plasma glucose: A comprehensive analysis of the GBD database from 1990 to 2023

Background High fasting plasma glucose (HFPG) is an established risk factor for breast cancer (BC). However, accurate and up-to-date estimates of the global burden of breast cancer attributable to high fasting plasma glucose (BC-HFPG) are scarce. This study aims to provide a comprehensive analysis of the burden of BC-HFPG using data from the Global Burden of Disease (GBD) database from 1990 to2023. Methods We performed a comprehensive descriptive analysis of the burden of female BC-HFPG based on the GBD 2023 database. The core metrics analyzed were the absolute number of death and disability-adjusted life years (DALY). To ensure comparability across populations with differing age structures, we also analyzed the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR). The average annual percent change (AAPC) was used to further comprehensively describe the burden of disease and its changing trends. In addition to the retrospective analysis from 1990 to 2023, we used the Bayesian age-period-cohort (BAPC) model to generate predicted data on the burden of female BC-HFPG from 2024 to 2050. Results Female BC-HFPG accounted for 48,307 deaths and 1,406,186 DALYs globally in 2023. From 1990 to 2023, the global ASMR and ASDR of female BC-HFPG showed overall upward trends, with an average annual percentage change (AAPC) of 0.28% (95% CI: 0.18% to 0.38%) for ASMR and 0.44% (95% CI: 0.37% to 0.51%) for ASDR; the two rates increased from 0.92 and 26.22 per 100,000 in 1990 to 1.00 and 30.17 per 100,000 in 2023, respectively. The burden varied substantially across the 21 GBD regions and 204 countries and territories in 2023. In 2023, SDI was only weakly correlated with ASMR (Spearman ρ = 0.20, P = 0.004) and not significantly correlated with ASDR, and the burden peaked in low-middle SDI quintile countries. The BAPC model projected that the ASMR and ASDR of female BC-HFPG would continue to rise from 2024 to 2050. Conclusion The global burden of female BC-HFPG increased from 1990 to 2023 and is projected to continue rising through 2050, disproportionately affecting low- and low-middle SDI regions. These findings suggest that glycemic management and metabolic risk-factor control warrant consideration within comprehensive breast cancer prevention frameworks. However, because this is an ecological, population-level analysis, whether glucose lowering interventions can reduce breast cancer incidence remains to be established in prospective interventional studies. Our results may help prioritize regions and populations for future etiological and intervention research.