Cancer burden and health inequalities attributable to occupational arsenic exposure: A 32-year global, regional, and national observational study with projections to 2036.

Occupational arsenic exposure (OEA), mainly through inhalation in workplace settings, is an established carcinogenic hazard associated with lung, skin, and bladder cancers. However, long-term trends and the global cancer burden attributable to OEA remain insufficiently characterized. Data from the Global Burden of Disease Study 2021 were used to analyze the cancer burden attributable to OEA from 1990 to 2021. Indicators included summary exposure values (SEVs), deaths, years lived with disability (YLDs), and disability-adjusted life years (DALYs) at global, regional, and national levels. Estimates were reported with 95% uncertainty intervals (UIs) generated from 1000 Monte Carlo simulations. Age-standardized indicators, Joinpoint regression, inequality analysis, decomposition analysis, and frontier analysis were used to assess spatiotemporal trends, drivers, and disparities. Seven forecasting models were evaluated to predict trends from 2022 to 2036. Between 1990 and 2021, global OEA SEV increased from 0.408% to 0.496% (average annual percentage change [AAPC] = 0.288). Cancer deaths rose from 5.5 to 10.5 thousand, YLD from 1.5 to 3.3 thousand, and DALYs from 169.6 to 298.7 thousand. In contrast, age-standardized death rate (AAPC = -0.300) and DALYs rate (AAPC = -0.531) declined. Men bore higher overall burdens, but women experienced faster increases (AAPC 0.428 vs 0.171). High-socio-demographic index (SDI) countries showed continuous improvement, whereas middle- and low-SDI regions-particularly East, South, and Southeast Asia-experienced substantial increases. In East Asia, the AAPCs for age-standardized SEVs, age-standardized death rates, age-standardized YLDs rates, and DALYs rates were 0.953, 1.067, 1.849, and 0.809, respectively. Inequality analysis indicated stable absolute gaps but reduced relative disparities, with burdens still concentrated in low-SDI countries. Decomposition suggested that population growth was the main driver of global burden increases, and frontier analysis highlighted limited improvement potential in low-SDI regions. Forecasting models indicated that the absolute burden of occupational arsenic exposure will continue to rise over the next 15 years. The cancer burden attributable to OEA is still increasing globally, with persistent prevention gaps and socioeconomic disparities. Focused interventions in low- and middle-SDI countries and rapidly industrializing regions are needed, including strengthened occupational exposure regulations, improved workplace arsenic monitoring, engineering controls, personal protective equipment, and regular health surveillance for workers in high-risk industries, to reduce inequalities and mitigate public health threats.