Global burden of cancer and associated risk factors in 204 countries and territories, 1980–2021: a systematic analysis for the GBD 2021 (2025)

Background

Cancer is the second most common cause of death globally. Therefore, it is imperative to investigate cancer incidence, mortality rates, and disability-adjusted life years (DALYs) to enhance preventive measures and healthcare resource allocation. This study aimed to assess cancer burden and associated risk factors in 204 countries and territories between 1980 and 2021.

Methods

We selected data on cancer incidence and mortality rates and associated risk factors from the global burden of disease (GBD) study tool for 204 countries and territories from 1990 to 2021 and 1980 to 2021. We estimated the age-standardized incidence (ASIR) and age-standardized deaths (ASDR) of 34 cancer types categorized as level 3 causes based on theGBD hierarchy.

Results

In 2021, cancer accounted for 14.57% (95% uncertainty interval: 13.65–15.28) of total deaths and 8.8% (7.99–9.67) of total DALYs in both sexes globally. ASIR and ASDR were 790.33 (694.43–893.01) and 116.49 (107.28–124.69), respectively. Additionally, females exhibited higher ASIR than males (923.44 versus 673.09), while males exhibited higher ASDR than females (145.69 versus 93.60). This indicates that policymakers should focus on the importance of gender equality in healthcare. Non-melanoma skin cancer exhibited the highest ASIR (74.10) in both sexes, while digestive cancers accounted for 39.29% of all cancer-related deaths, and Asia exhibited the heaviest cancer burden. In females, breast cancer exhibited the highest ASIR (46.40) and ASDR (14.55). In males, tracheal, bronchial, and lung cancer exhibited the highest ASIR (37.85) and ASDR (34.32), highlighting the urgent need for targeted tobacco control measures. Different cancers in various countries exhibit unique characteristics. Therefore, policymakers should formulate specific prevention and control strategies that reflect the cancer in their country. Tobacco was the primary level 2 risk factor for cancer DALYs in males. It accounted for 29.32% (25.32–33.14) of all cancer DALYs. Dietary risks, alcohol consumption, and air pollution accounted for 5.89% (2.01–10.73), 5.48% (4.83–6.11), and 4.30% (2.77–5.95) of male cancer DALYs, respectively. Therefore, policymakers should prioritize smoking regulation and other carcinogenic risks.

Conclusion

Cancer is a significant public health concern globally. Understanding the common etiologies of different cancers is essential for developing effective control strategies and targeted interventions.

Cancer is the second leading cause of death globally, and the global cancer burden is expected to increase over the next two decades¹. In 2022, there were approximately 20 million new cancer cases, including non-melanoma skin cancers (NMSC), and 9.7 million cancer-related deaths, including NMSC². Efforts must encompass comprehensive assessments of cancer burden, including incidence and mortality rates and disability-adjusted life years (DALYs), particularly between developing and developed countries. The aging global population, combined with the prevalence of unhealthy lifestyles and environmental changes, has contributed to an increase in cancer incidence, particularly in low- and middle-income countries. Cancer epidemiological studies are essential for developing government health policies because they provide crucial data for identifying cancer risk factors, management at the population level, formulation of cancer screening policies, and allocation of resources for cancer prevention^3,4.

Although some cancer cases may be inevitable, governments can establish policies that can reduce population-level exposure to recognized cancer risk factors, including smoking, overweight, obesity, and infections. Epidemiological data and variations in cancer types differ across global regions. In 2022, Asia accounted for approximately 50% of all cancer cases (49.2%) and the highest cancer-related deaths (56.1%), while Europe accounted forapproximately 25% of global cancer cases (22.4%) and 20.4% of cancer-related deaths². In countries with higher human development index (HDI), lung, prostate, and colorectal cancers have the highest incidence among men, while in countries with lower HDI, prostate, lung, and lip and oral cavity cancers have the highest incidences². A previous study reported that prostate cancer is the most common cancer among men in 40 sub-Saharan African countries. Women have a 14.1% risk of developing cancer by the age of 75 in Sub-Saharan Africa, with breast and cervical cancers accounting for 50% of this risk at 4.1% and 3.5%, respectively⁵. In 2020, the overall risk of cancer-related death among women in Africa was similar to the risks observed in women in Northern America and the wealthiest European countries⁶. Consequently, comprehensive assessments of cancer burden will provide valuable insights for improving the global cancer quality control management system. After the COVID-19 pandemic, patients with cancer seem to experience worsened symptoms and an increased risk of death than others⁷. Therefore, assessing the trend of cancer incidence and mortalityrates after the pandemic is imperative for formulating cancer control strategies.

The Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021 (GBD 2021) framework facilitates a standardized assessment of cancer burden across various locations and timeframes, focusing on cancer incidence, mortality, and DALYs. The GBD study categorizes age into 5-year intervals and considers the long-term impact of specific disorders globally across various countries and regions. GBD 2021 revealed the proportion of cancer burden attributed to modifiable risk factors and the temporal changes in these percentages⁸. Primary and secondary preventive measures should be implemented to reduce cancer incidence and mortality while enhancing patient survival rates. Compared to GBD 2019, GBD 2021, for the first time, estimated the onset of cancer mortality from 1980, providing more data for analyzing the dynamic changes of cancer. This study utilized data from GBD 2021 to estimate the incidence, mortality, and contribution of risk factors from 1990/1980 to 2021 in 204 countries and territories to inform policy development and improve cancer prevention initiatives.

GBD source

This general framework for the GBD 2021 cancer estimation included all malignant cancers except for non-melanoma skin cancer (basal cell carcinoma and squamous cell carcinoma), benign and in situ cancer (intestinal, cervical, uterine, and other benign cancers), and myelodysplastic, myeloproliferative, and other hemopoietic cancers. According to the International Classification of Diseases (ICD), the different types of cancer are categorized into 34 categories. The cancer incidence data were collected from a single cancer registry, Nordic cancer registries, or a combined database of cancer registries, including cancer incidence in five continents, surveillance, epidemiology, and outcomes. This analysis depends on current epidemiological data and improved standardized methods. The data are accessible through the Global Health Data Exchange query tool (http://ghdx.healthdata.org/gbd-results-tool), categorized by region, gender, country, and risk factors. Additionally, GBD 2021 calculated essential statistics for 23 different age categories ranging from birth to ≥ 95 years, collectively covering males, females, and all genders. Data were collected for 204 countries and territories, categorized into 21 regions and seven super-regions. We selected neoplasm data on incidence, mortality, and associated risk factors from the GBD study tool for 204 countries and territories from 1990 to 2021 and 1980 to 2021. We estimated the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of 34 cancer types categorized as level 3 causes in the GBD hierarchy. For GBD 2021, incidence, prevalence, and disability were assessed for all cancers and benign cancer as classified in ICD-10 (C00–D49). Cancer incidence is directly derived from mortality estimates using mortality-to-incidence ratios (MIRs). The current GBD cancer mortality and MIR estimates are based on the methodology described in the latest GBD study, with additional information accessible elsewhere; a concise overview is provided below^9,10,11.

Estimates

The GBD 2021 collaborators modeled incidence and mortality estimates for male and female individuals across all age groups. The cause-of-death ensemble model was utilized to estimate cause-specific mortality for each combination of sex, age, location, and year. The GBD team developed the DisMod-MR software (version 2.1), a Bayesian meta-regression tool, to perform incidence estimations through an analytical cascade process. Before the modeling, data points and biases were adjusted by(1) disaggregating data that were not previously disaggregated by age and sex distribution and (2) applying a meta-regression—Bayesian, regularized, trimmed model to compare study designs and case definitions directly. Information regarding bias correction and other modifications implemented for each specific disorder is available in the GBD 2021 capstone report¹². DALYs, a summary measure of overall health loss, were calculated by adding years of life lost (YLLs) and years lived with disability (YLDs) for each etiology. YLLs were calculated by multiplying the number of deaths associated with specific causes by the remaining life expectancy at the time of death, based on a standard life expectancy. The GBD 2021 database of mortality causes included data from various sources, including vital registration, verbal autopsy, cancer registries, police records, sibling histories, surveillance, and survey or census data collected since 1980. Accordingly, we estimated the burden of DALYs attributed to risk factors in 2021. The GBD comparative risk assessment (CRA) framework was employed to assess the exposure of risk factors associated with digestive diseases and their consequent disease burden. The CRA comprised seven primary interrelated methodological components. The effect size was initially estimated by quantifying the relative risk (RR) of the designated health outcome of exposure to the identified risk factor. The population-attributable fraction of YLL and YLDs was calculated for each risk factor by considering the distribution of exposures across different ages, genders, locations, and years and the RR associated with each level of exposure. The sociodemographic index (SDI) was used to demonstrate variations in cancer burden attributed to different levels of socioeconomic development. It was determined by factors including the total fertility rate in women below 25 years, income per capita distribution over time, and average education levels for individuals aged ≥ 15 years¹³. The index ranged from 0 (low SDI) to 100 (high SDI), classifying countries in 2021 into five groups based on quintiles: low, low-middle, middle, high-middle, and high SDI.

Statistical analysis

Based on the GBD framework, 95% uncertainty intervals (UIs) for all estimates were calculated by averaging the data from 1,000 draws, with the lower and upper bounds of the 95% UIs established by the 25th and 975th ranked values among all 1,000 draws. R software (version 4.2.3) was used for data analysis. This study utilized data from the GBD study, which was approved by the Institutional Review Board of the University of Washington and is publicly accessible. The GBD study analyses adhered to the Guidelines for Accurate and Transparent Health Estimates Reporting¹³.

The burden of cancers in theglobal

In 2021, cancer accounted for 14.57% (95% UI, 13.65–15.28) of total mortality and 8.8% (7.99–9.67) of total DALYs across both sexes globally. During the same period, the ASIR and ASDR were 790.33 (694.43–893.01) and 116.49 (107.28–124.69), respectively (Table1). Figure1 depicts the disparities in the incidence rates and proportion of cancer cases between males and females. In 2021, females exhibited a higher ASIR than males (923.44 versus 673.09), while males exhibited a higher ASDR than females (145.69 versus 93.60). In both sexes, non-melanoma skin cancer exhibited the highest ASIR (74.10), followed by tracheal, bronchial, and lung (TBL) cancer (26.43), colon and rectal cancer (25.61), breast cancer (24.56), prostate cancer (15.37), and stomach cancer (14.33). TBL cancer exhibited the highest ASDR (23.50), followed by colon and rectal cancer (12.40), stomach cancer (11.20), breast cancer (7.90), and esophageal cancer (6.25). In females, breast cancer exhibited the highest ASIR (46.40) and ASDR (14.55). In males, TBL cancer exhibited the highest ASIR (37.85) and ASDR (34.32). Digestive cancer accounted for 39.29% of all cancer-related deaths (Figure S1).

Age-related sex-specific patterns exhibited some variation. Between 1990 and 2021, females exhibited a higher cancer incidence and ASIR than males, and ASIR demonstrated a stable trend. Between 1980 and 2021, males exhibited a higher rate of cancer deaths and ASDR than females, and ASDR demonstrated a decreased trend. The ASDR of cancer decreased by approximately 24.81% in males and 24.47% in females in the past 40 years globally (Fig.2). In 2021, breast cancer accounted for 5.28% of all cancer incidence and 15.29% of cancer-related deaths in females. Prostate cancer accounted for 4.89% of all cancer incidence and 7.72% of cancer-related deaths in males. The ASIR of breast cancer in females was 46.40 (43.26–49.56), and the ASDR was 14.54 (13.45–15.56). The ASIR of prostate cancer in males was 34.05 (31.27–36.00), and the ASDR was 12.63 (11.16–13.55). From 1990 to 2021, the percentage change in ASIR was 0.04% (0.01–0.07), while the percentage change in ASIR was –0.02% (–0.04, 0) from 2019 to 2021. The percentage change in ASDR decreased from 1990 to 2021 and from 2019 to 2021 (Table S1). In 2021, the incidence rates were highest among women aged 60 to 64 years and men aged 65–69 years. Before the age of 55–59, the incidence rate in females was higher than that in males, while from age 65 to 69, the incidence rate in males was higher than that in females (Fig.3A). Cancer incidence is increasing among younger individuals, particularly among women under the age of 50. The death rate was highest among individuals aged 70–74 years for males and females, and before the age of 40–44, the death rate in females was higher than that in males (Fig.3B).

Burden of cancers in countries

Across the 21 GBD regions, high-income North America exhibited the highest observed ASIR: 3138.73 (2786.29–3519.73), followed by Central Europe: 1308.53 (1147.64–1501.09) and high-income Asia Pacific: 1253.28 (1092.47–1,462.55) (Figure S2). Eastern Sub-Saharan Africa exhibited the lowest observed ASIR: 268.54 (238.04–300.85), followed by Western and Central Sub-Saharan Africa. Central Europe exhibited the highest observed ASDR: 157.77 (146.33–167.79), followed by Southern Sub-Saharan Africa: (144.19 (132.84–154.13) and East Asia: 137.08 (115.32–162.11). Furthermore, South Asia exhibited the lowest observed ASDR: 74.73 (68.77–81.23), followed by Western Sub-Saharan Africa: 89.08 (72.14–103.40), and North Africa and the Middle East: 90.11 (80.96–99.52) (Figure S3). From 1990 to 2021, Southern Sub-Saharan Africa exhibited the largest percentage increase in the rates of cancer deaths: 22% (11%–35%), while Australasia exhibited the biggest percentage decline in the rates of cancer deaths (–30%, –34% to –27%) (Table S1).

In 2021, the ASIR exhibited variations globally. Across the 204 countries, theUnited States of America exhibited the highest ASIR: 3,304.9 (2941.64–3699.14), followed by Canada: 1,758.48 (1470.8–2062.1) and Greenland: 1,751.13 (1468.51–2039.7). Meanwhile, Burundi exhibited the lowest observed ASIR: 243.71 (206.6–285.36), followed by Madagascar: 243.88 (207.76–281.58) and Kenya: 251.15 (218.01–287.69) (Figs.4A and S4). Mongolia exhibited the highest observed ASDR: 214.81 (188.01, 243.86), followed by Monaco: 207.69 (173.54–245.45) and Zimbabwe: 201.33 (162.95–246.3). Furthermore, Oman exhibited the lowest observed ASDR: 44.21 (36.51–52.81), followed by the Maldives: 47.86 (39.57–56.19) and Algeria: 51.51 (43.01–61.21) (Figs.4B and S5). Between 1990 and 2021, the United States of America exhibited the largest percentage increase in cancer incidence: 88% (78%–97%), while Burundi exhibited the biggest percentage decline in cancer incidence (–15%, –26% to –1%). Additionally, between 1990 and 2021, Lesotho (80%, 32% to 140%) exhibited the largest percentage increase in cancer-related deaths, while Kazakhstan (–50%, –56% to –44%) exhibited the biggest percentage decline in cancer-related deaths (Table S2).

SDI and cancer burden

In 2021, the high SDI quintile exhibited the highest ASIR: 1671.46 (95% UI: 1484.99–1875.02) and ASDR 123.22 (95% UI: 113.06–128.96), while the low SDI exhibited the lowest ASIR: 336.09 (95% UI: 288.48–385.96) and ASDR: 90.64 (95% UI: 79.86–102.00). Figure5 depicts the changes in age-standardized incidence and death rates across five SDIs from 1990/1980 to 2021. The findings suggest a significant increase of ASIR and ASDR in high-SDI and high-middle SDI regions. However, low, middle, and low-middle SDIs exhibited a stable trend in ASIR and ASDR. Based on the changes in age-standardized death rates by region, thehigh-income North Pacific exhibited an increase in ASIR among the four regions with the highest SDI. The ASIR increased gradually as the SDI increased until it reached approximately 0.65, after which it increased significantly. However, the United States ofAmerica experienced unexpectedly high ASIR based on SDI levels (Figure S6). The ASDR value in the region level decreased as the SDI increased to approximately 0.34. Subsequently, it increased until it reached approximately 0.75, after which it decreased significantly (Figure S7).

Burden of cancer attributable to risk factors

In 2021, 4.06 million (95% UI: 3.46–4.75) global cancer-related deaths were caused by all estimated risk factors, representing 41.07% (35.24–46.64) of all cancer-related deaths for both sexes. Risk factors caused 2.56 million (95% UI: 2.20–2.99) cancer-related deaths in males and 1.50 million (95% UI: 1.16–1.83) in females, accounting for 45.65% (40.72–50.77) of all male cancer-related deaths and 35.08% (27.38–42.23) of all female cancer-related deaths. The global overall cancer DALYs attributed to estimated risk factors were 100.30 million (95% UI: 86.19–116.72) for both sexes, representing 39.59% (34.18–44.88) of all cancer DALYs. Males accounted for 62.09 million (95% UI: 53.92–72.60) cancer DALYs due to risk factors, representing 43.81% (29.81–46.07) of all cancer DALYs, while females accounted for an estimated 38.21 million (95% UI: 32.8–43.1) cancer DALYs attributable to risk factors, representing 34.21% (27.05–40.69) of all cancer DALYs in females. Global geographical pattern variations were observed for cancer age-standardized DALY rates caused by environmental and occupational, behavioral, and metabolic risks across different regions. Higher age-standardized DALY rates were observed in central Europe within these level 1 risk factor categories (Figure S8).

Tobacco was the primary level 2 risk factor for cancer DALYs in males, contributing to 29.32% (25.32–33.14) of all cancer DALYs, followed by dietary risks, alcohol use, and air pollution, which accounted for 5.89% (2.01–10.73), 5.48% (4.83–6.11), and 4.30% (2.77–5.95) of male cancer DALYs in 2021, respectively. Additionally, unsafe sex was the primary level 2 risk factor for females based on cancer DALYs. It comprised 8.88% (8.40–9.49) of all female cancer DALYs, followed by tobacco: 8.09% (6.12–10.05), dietary risks 7.21% (1.96–12.92), and high BMI 4.72% (1.86–7.59) (Figure S9).

This study provided a comprehensive overview of the global cancer burden and demonstrated significant trends and disparities in cancer incidence and mortality across genders, age groups, and geographical regions. The ASDR for cancer decreased by approximately 24.81% in males and 24.47% in females globally in the past 40 years. In 2021, digestive cancer accounted for 39.29% of all cancer-related deaths; thus, interventions aimed at promoting healthy diets and early screening for early signs of these cancers could potentially alleviate their burden. Significantly, TBL cancer exhibited the highest cancer burden, emphasizing the urgent need for targeted tobacco control measures. We demonstrated the significant impact of cancer on global health and highlighted the need for targeted interventions to alleviate this burden.

Data from 2021 reveal that cancers accounted for a significant percentage of global total deaths (14.57%) and DALYs (8.8%), indicating their critical role as an essential contributor to the GDB. The observed ASIR of 790.33 per 100,000 individuals and ASDR of 116.49 per 100,000 individuals signify the ubiquitous nature of cancer as a public health issue. Although the ASIR for females exceeded that of males, the ASDR was higher among males, indicating an increasing incidence of cancer among women while mortality is disproportionately high among men. This gender disparity illustrates variations in risk factors, including smoking and alcohol consumption, which are more common among men, and gender-specific cancers, including breast cancer in women and prostate cancer in men. Globally, the incidence of female breast cancer is continuously increasing in regions including North America, Australasia, and Africa, indicating the impact of social and economic development on the disease. Factors including age, sex, estrogen levels, family history, an unhealthy lifestyle, and gene mutations can all increase the risk of developing breast cancer¹⁴. The 5-year relative survival rates for breast cancer exhibit significant disparity between developed and developing countries. The rates exceed 90% in North America and Japan but fall below 40% in African countries such as Algeria¹⁵. Breast cancer is preventable, and developed countries have sufficient medical resources, including annual mammography screenings or daily chemopreventative drugs, to mitigate the risk of the disease. The strategy for breast cancer prevention involves enhancing primary prevention measures, including the avoidance of alcohol and excess dietary fat consumption, adoption of a healthy lifestyle, timely childbirth, and breastfeeding. Breast and prostate cancer are generally hormone-dependent and exhibit significant biological similarities. The high prevalence of breast cancer in females significantly affects the overall female ASIR and ASDR. This highlights the importance of breast cancer prevention, early detection, and treatment strategies in reducing the female cancer burden. Although prostate cancer is not the primary cause of cancer deaths among males, it significantly affects the male ASDR. Enhanced treatment options and screening strategies for prostate cancer may contribute to a decrease in male cancer mortality rates. Since the mid-2000s, the incidence rates of female breast cancer have gradually increased by approximately 0.5% annually, which can be partially attributed to the continuing decline in fertility rates and the increase in excess body weight¹⁶. The rapidly growing population and the significant number of men reaching the age of ≥ 65 contribute to a higher ASIR of prostate cancer¹⁷. The incidence rates of prostate cancer are highest in developed countries where there is increased awareness of the disease and widespread use of prostate-specific antigen tests for screening¹⁸. Although breast and prostate cancers significantly influence the overall gender disparities in cancer incidence and mortality, these disparities cannot be ascribed to these two cancers. Additional research and customized strategies are required to address the broader issue of gender disparities in cancer.

The variation in the cancer types across regions is affected by the unique environmental characteristics, dietary habits, and lifestyles specific to each area. Our study revealed that South Asia exhibited the highest incidence and mortality rates for lip and oral cavity cancer. The risk factors include unhealthy lifestyle habits (betel quid consumption), poor oral hygiene, exposure to ultraviolet radiation, and limited medical resources¹⁹. Enhancing the quality of health education for residents, improving their oral hygiene awareness and living habits, and investing in and constructing medical resources are essential to reducing lip and mouth cancer incidence and mortality rates. Additionally, the highest incidence and mortality rates of liver cancer are predominantly concentrated in the Asia Pacific and sub–Saharan Africa, primarily attributable to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Liver cancer in China and Western Sub-Saharan Africa is caused mainly by chronic HBV infection, while in South Korea and Japan, HCV infection is the primary causative factor for liver cancer²⁰. Despite the ongoing increase in cancer cases, there has been a significant decline in the ASR of liver cancer in specific regions over the past few decades. The reduction in ASR is primarily attributable to the effective control of HBV infection through vaccination initiatives. Metabolic syndrome, obesity, and NAFLD are increasing and may collectively emerge as the leading cause of liver cancer²¹. Consequently, it is recommended that different countries re-evaluate their prevention strategies. The ASIR of malignant skin melanoma in New Zealand and Australasia exceeded the global average due to the proximity of Oceania to the ozone hole over the Antarctic, leading to increased UV exposure in the region. Meanwhile, the warm climate and favorable conditions for outdoor activities in the equatorial regions allow individuals to wear minimal clothing and experience increased exposure to UV radiation, thereby increasing the risk of skin cancer consistent with this geographical trend²². As a result, enhancing public awareness and attention to malignant melanoma is essential to mitigating its incidence risk. Public health policies must be tailored to specific environmental factors, dietary habits, and lifestyles in different regions.

TBL cancer was the most common and primary cause of death across all cancer types, particularly in East Asia and Central Europe. The global morbidity and mortality rates of TBL cancer in males were 2.2 times and 2.4 times higher than that in females, respectively, primarily attributed to the higher rate of smoking among males. Greenland and Monaco have the highest ASIR and ASDR observed in TBL. Smoking was identified as the primary risk factor contributing to the incidence of lung cancer in men, although air pollution and occupational exposure play a significant role. Smoking patterns were identified as the primary factor contributing to the incidence of lung cancer in women²³. A previous study reported that indoor air pollution from cooking and heating significantly contributes to lung cancer incidence, particularly in East Asia, where female smokers are uncommon²⁴. Over time, lung cancer rates decreased among male smokers in Europe, while the rates increased among women who smoke²⁵. Hence, initiatives to reduce both smoking prevalence and secondhand smoke exposure are essential. Regular screening with low-dose computed tomography of the chest resulted in a significant decrease in lung cancer mortality among heavy smokers, including nonsmokers²⁶. A comprehensive strategy for prevention is required; this includes enhancing tobacco control measures, reducing air pollution, and promoting healthy diets and lifestyles. Implementing comprehensive smoke-free policies, augmenting public awareness campaigns, and providing smoking cessation services can effectively reduce tobacco consumption and its detrimental health effects^27,28.

This study has some limitations. First, due to the extensive and complex nature of the data, caution should be exercised when interpreting the TBL cancer burden. Second, establishing a correlation between the COVID-19 pandemic and cancer incidence and mortality rates was difficult and thus resulted in erroneous data. Third, GBD estimates were based on covariates and modeling parameters in cases where data were unavailable, potentially leading to overestimating or underestimating the cancer burden.

Authors and Affiliations

1. Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

   Zenghong Wu&Rong Lin

2. Biomedical Materials Engineering Research Center, Hubei Key Laboratory of Polymer Materials, Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, School of Materials Science & Engineering, State Key Laboratory of Biocatalysis and Enzyme Engineering, Hubei University, Wuhan, China

   Fangnan Xia

Contributions

W.Z.H. designed and analyzed the research study; X.F.N. collected the data; W.Z.H. and L.R. wrote and revised the manuscript. All authors have read and approved the manuscript.

Corresponding authors

Correspondence to Zenghong Wu or Rong Lin.

Ethics approval and consent to participate

Lin rong acting as the submission's guarantor responsibility for the integrity of the work as a whole, from inception to published article. All authors approved the final version of the manuscript.

Conflict of interest

The authors declare no competing interests.

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