S163 India as a Hotspot of Gallbladder and Biliary Tract Cancer: 3 Decades of Trends in Mortality and Morbidity Outcomes

Introduction: Gallbladder and biliary tract cancer (GBBTC) is a rare but highly lethal malignancy globally. Yet, India—particularly its northeastern and Gangetic states—emerges as a global hotspot, reporting among the highest incidence and mortality rates worldwide. This striking geographic concentration is believed to stem from a unique interplay of environmental toxins (e.g., arsenic exposure), gallstone prevalence, genetic susceptibility, and female-predominant risk. Despite its epidemiological uniqueness, GBBTC in India remains underprioritized in global cancer agendas. Methods: Using the Global Burden of Disease 2021 framework, we analyzed trends in age-standardized incidence, mortality, and years lived with disability for GBBTC across Indian states from 1990 to 2021. Annualized Percentage Change (APC) was calculated to capture long-term shifts in disease burden stratified by age, sex, year and location. Results: In 2021, India accounted for 12.04% of global incident cases and 15.55% of all deaths due to GBBTC. From 1990 to 2021, the age-standardized prevalence rate increased at an annualized rate of 1.39%, followed by age-standardized incidence rate (ASIR) by 1.25%, death rate (ASMR) by 1.19%, disability-adjusted life years rate (ASDALR) by 1.02%, and years lived with disability rate (ASYLDsR) by 1.26%. Subnationally, the steepest rise in ASMR was observed in Uttar Pradesh (APC: 2.08%), followed by Odisha (1.83%) and Uttarakhand (1.79%). In 2021, the highest incidence burden was recorded in the 65–69-year age group, with 4,361 cases (95% UI: 3,002–5,181), while DALYs peaked in the 60–64-year group at 111,170 (95% UI: 72,943–134,532). Gender-wise, men experienced a slightly higher increase in burden over the 3 decades, with APC in ASMR of 0.44% vs 0.42% in women, age-standardized prevalence rate of 0.48% vs 0.44%, and ASDALR of 0.37% vs 0.34%. Conclusion: GBBTC is no longer a localized concern but a global public health signal emerging from India. The persistent rise across Indian states calls for urgent investment in early detection, regional cancer control strategies, and global collaborations. Recognizing India’s role in the GBBTC landscape may unlock broader insights into carcinogenesis and guide interventions in other underserved, high-risk populations worldwide.