In this study, we analyzed the temporal trends in the burden of kidney cancer (KC) in China from 1990 to 2021. In 2021, the number of incident KC cases in China reached 65,799 (4.62 cases per 100,000 total population). Additionally, KC resulted in 24,867 deaths (1.75 deaths per 100,000 total population). Over the past 30 years, both the prevalence and mortality of KC have increased significantly. We observed a notable rise in the incidence, mortality, and disability-adjusted life years (DALYs) of kidney cancer in China over the three-decade period, with more pronounced increases in males than in females. The China age-standardized incidence rate (ASIR) of kidney cancer increased from 1.79 per 100,000 in 1990 to 3.31 per 100,000 in 2021. Furthermore, the age-standardized mortality rate (ASMR) of kidney cancer also rose, from 1.14 per 100,000 in 1990 to 2.25 per 100,000 in 2021.
The increasing burden of kidney cancer can be attributed to several key factors. First, population aging is a major driver, as the incidence of kidney cancer increases with age [26, 27]. China’s population is rapidly aging, with the proportion of individuals aged 65 and older projected to rise from 15.6% in 2024 to 26% in 2050 [28]. This demographic shift toward an older population contributes to a higher risk of developing kidney cancer [7]. Risk factors such as smoking, alcohol consumption, overweight, and hypertension have important implications for both kidney cancer incidence and mortality [14, 29, 30]. Our study showed that the burden of KC in males was consistently higher than in females across different age groups. Males are generally exposed to these risk factors for longer durations, making them more susceptible to KC. For example, the global smoking rate was estimated to be 32.6% in males and 6.5% in females in 2020 [31]. Previous studies have also indicated that males tend to have higher BMIs than females [32]. Moreover, industries with higher male participation may expose individuals to occupational hazards associated with urinary tract cancers [33] Reports suggest that males are approximately twice as likely as females to be occupationally exposed to trichloroethylene, and males also exhibit higher prevalence in jobs involving trichloroethylene exposure [34]. Between 1990 and 2021, smoking and high BMI were the primary drivers of KC in individuals aged 65 and older. Smoking significantly increases the risk of KC incidence and mortality [35].
Previous epidemiological evidence has indicated that age is an independent and critical risk factor for KC, with varying numbers of deaths across different age groups [11]. According to age-period-cohort analysis, KC prevalence and mortality increase with advancing age. After the 60–64 age group, the risk trend of the age effect increases roughly exponentially. Middle-aged and elderly individuals are more likely to have long-term smoking and obesity, which elevate their risk of KC [36]. The period effect refers to changes in medical technology, diagnostic methods, and economic and cultural factors that influence the disease burden of KC during specific time periods. According to the current study, the period effect on KC prevalence showed a slight decrease, possibly due to the recent popularization of medical knowledge in China, which has reduced some KC cases. The cohort effect highlights socioeconomic, behavioral, and environmental exposures in early life and the risks of different birth cohorts. In our study, the cohort effect on KC prevalence showed a downward trend: earlier birth cohorts had a higher risk of KC, while more recent cohorts had a lower risk. In addition to age, this decreasing effect can be attributed to better education and higher health awareness among younger generations.
Monitoring disease prevalence and predicting trends are essential components of disease prevention and control. As a predictive model, the Bayesian age-period-cohort (BAPC) model has been proven reliable [4]. Therefore, we conducted BAPC analysis to project trends in the age-standardized incidence and mortality rates of kidney cancer. According to the BAPC model, the prevalence and mortality of KC are expected to rise to 4.58 per 100,000 and 1.31 per 100,000 by 2036. The large gap between high KC prevalence and low awareness/treatment may partially explain the consistent increase in mortality in recent years. Thus, a comprehensive strategy is needed, including risk factor prevention at the primary care level, KC screening for the elderly and high-risk populations, and access to high-quality medical services, to reduce the burden of KC and achieve better health outcomes for KC patients.
Given the exponential rise in kidney cancer (KC) risk after 60–64 years of age and China’s rapidly aging population—with individuals aged ≥ 65 projected to account for 26% of the population by 2050—integrating age-stratified screening into primary care for older adults is critical. Priorities include expanding low-cost, non-invasive screening tools (e.g., urine cytology, renal ultrasound) for high-risk groups, particularly those with smoking or obesity histories. Multisectoral policies must address modifiable risks: strengthening tobacco taxation and smoke-free legislation, promoting population-wide body mass index (BMI) management through dietary and physical activity initiatives, and enhancing workplace safety regulations to reduce occupational carcinogen exposure—especially among male workers.
The lower KC risk observed in younger generations, likely linked to improved education and health awareness, highlights the need to scale public education programs emphasizing early detection, risk avoidance, and regular screening. Additionally, to address the projected rise in KC burden through 2036, healthcare infrastructure upgrades—particularly in resource-constrained regions—are essential to ensure equitable access to diagnostics and advanced therapies, such as targeted treatments for advanced KC.
Collectively, translating these findings into action requires a synergistic strategy integrating primary prevention (risk factor control), age- and sex-tailored screening, and tertiary care optimization, supported by robust surveillance models like the Bayesian age-period-cohort framework, to curtail rising KC burden and improve outcomes for at-risk populations in China.
Limitations
This analysis provides valuable data reference for KC prevention and control efforts. However, the study has several limitations. First, the data provided in GBD 2021 are based on estimates and mathematical modeling, which may affect the accuracy and reliability of burden estimates. Second, several types of KC, such as clear cell renal cell carcinoma, chromophobe renal cell carcinoma, and papillary renal cell carcinoma, are not included in the GBD database, precluding subtype-specific analysis of the KC burden. Third, our analysis of the KC burden was conducted at the national level without further exploration of the complex interactions between genetic and environmental factors contributing to KC development.