Epidemiological trends and burden of thyroid cancer mortality in South Asia: A retrospective analysis from 1990 to 2023 with advanced machine learning forecasting to 2050.

e18126 Background: Thyroid cancer mortality shows regional heterogeneity, with rising trends in many low- and middle-income settings including South Asia, potentially driven by improved detection, environmental exposures, and changing risk profiles. Methods: This study utilized age-standardized mortality rates (ASMR per 100,000) for thyroid cancer from the IHME Global Burden of Disease 2023 database, covering South Asia and its key countries (Bangladesh, Bhutan, India, Nepal, Pakistan) from 1990 to 2023, stratified by sex. Historical trends were quantified using estimated annual percentage change (EAPC) derived from log-linear regression of ASMR. Future mortality projections to 2050 were generated using autoregressive integrated moving average (ARIMA) time-series models fitted to historical data, yielding point forecasts and 95% prediction intervals (PI). Results: In South Asia (Both sexes), ASMR rose from 0.55 (1990) to 0.76 (2023), EAPC +0.93% (95% CI +0.84 to +1.02); males +1.20% (+1.09 to +1.31), females +0.69% (+0.59 to +0.80). Country patterns varied markedly: Bangladesh Both EAPC +0.65% (+0.42 to +0.87), ASMR 0.63 (1990) to 0.98 (2023), forecast 1.12 (0.50–1.75) by 2050; Bhutan Both +0.87% (+0.72 to +1.02), ASMR 0.56 (1990) to 0.81 (2023), forecast 1.02 (0.39–1.64) in 2050; India Both +1.01% (+0.89 to +1.14), ASMR 0.51 (1990) to 0.69 (2023), forecast 0.86 (0.69–1.03) in 2050; Nepal Both +0.20% (0.00 to +0.40), ASMR 0.43 (1990) to 0.57 (2023), forecast 0.52 (0.40–0.63) in 2050; Pakistan Both +0.81% (+0.71 to +0.90), ASMR 0.87 (1990) to 1.09 (2023), forecast 1.28 (1.09–1.46) in 2050. Sex disparities were evident: India males +1.35% (+1.20 to +1.49), Bangladesh males +1.03% (+0.94 to +1.12), Bhutan males +1.06% (+0.93 to +1.19). ARIMA projections indicate continued regional rise to 0.92 (0.80–1.04) by 2050, with Pakistan reaching 1.28, India 0.86, Bangladesh 1.12, Bhutan 1.02, and Nepal stabilizing near 0.52. Conclusions: Thyroid cancer mortality in South Asia increased steadily from 1990–2023 (EAPC +0.93%), with strongest rises in India, Bangladesh, and Bhutan, particularly among males. Projections to 2050 forecast further escalation across most subregions, highlighting the need for enhanced surveillance, risk factor research, early detection, and equitable treatment access. Location Sex EAPC Lower 95%CI Upper 95%CI Bangladesh Both 0.65 0.42 0.87 Bangladesh Female 0.30 -0.02 0.62 Bangladesh Male 1.03 0.94 1.12 Bhutan Both 0.87 0.72 1.02 Bhutan Female 0.79 0.61 0.97 Bhutan Male 1.06 0.93 1.19 India Both 1.01 0.89 1.14 India Female 0.75 0.62 0.88 India Male 1.35 1.20 1.49 Nepal Both 0.20 0.00 0.40 Nepal Female -0.16 -0.39 0.08 Nepal Male 0.74 0.55 0.93 Pakistan Both 0.81 0.71 0.90 Pakis