Burden, Risk Factors, and Temporal Trends of Ovarian Cancer in Postmenopausal Women Aged 55 Years and Older: A Comparative Analysis in India, China, and the United States Based on the Global Burden of Disease Study 2023.

BACKGROUND: Evidence remains limited on the ovarian cancer (OC) burden among women aged 55 years and older, used here as an operational proxy for the postmenopausal population, across India, China, and the United States. METHODS: We extracted data on OC-related incidence, mortality, disability-adjusted life years (DALYs), and relevant risk factors from the Global Burden of Disease (GBD) 2023 for the period 1990-2023. We assessed age-specific patterns; temporal trends using the estimated annual percentage change and Joinpoint regression; age-period-cohort (APC) patterns and estimable functions; demographic decomposition; and DALY burdens attributable to high body-mass index (BMI) and occupational asbestos exposure. The Autoregressive Integrated Moving Average (ARIMA) model and Bayesian age-period-cohort (BAPC) model were applied to predict age-standardized DALY rates of OC through 2040. RESULTS: Absolute incident cases, deaths, and DALYs increased in all three countries, whereas age-standardized rates increased in India and generally declined in China and the United States. India had a comparatively greater burden in younger age groups within the study population, whereas the United States had the highest burden at older ages. In China, despite an overall negative net drift, local-drift point estimates were positive among women aged 85 years and older (0.03%-0.82% per year), although the 95% confidence intervals included zero. The proportion of DALYs attributable to high BMI increased in all three countries, and population growth was the principal positive driver of the rising absolute burden. Projections suggested a continued increase in India's age-standardized DALY rate and further declines in China and the United States through 2040. CONCLUSION: Age-standardized OC burden increased in India but declined in China and the United States, whereas the absolute burden rose in all three countries; the non-significant positive local-drift point estimates among the oldest-old in China warrant monitoring. These ecological findings do not establish causality and support country-specific hereditary risk management and strengthened pathways for timely diagnosis and specialist referral.