Upper gastrointestinal (GI) cancers, comprising esophageal cancer (EC) and gastric cancer (GC), remain a significant global health burden with disproportionate geographic distribution of incidence and mortality. A comprehensive assessment of global and regional patterns and trends of upper GI cancer burden is essential to inform targeted prevention strategies. Data were sourced from the Global Burden of Disease (GBD) study 2021. We examined the incidence, mortality, and life expectancy (LE) impacts of upper GI cancers from 1990 to 2021 across 21 GBD world regions. Trends were assessed using age-standardized rates and average annual percentage change (AAPC). Non-modifiable demographic factors and modifiable risk-attributable burdens were analyzed. A three-step decomposition method was applied to quantify the contribution of upper GI cancer to changes in LE. In 2021, upper GI cancers accounted for 1.80 million new cases and 1.49 million deaths globally, with Asia contributing over 70% of the burden. Global age-standardized incidence and mortality rates for upper GI cancers declined from 1990 to 2021, with AAPC of -1.53% and -1.87%, respectively, although absolute incidence and deaths increased due to population growth and ageing, contributing to 1.13 million deaths for upper GI cancers. Population expansion and ageing drove increases in age-related deaths during the study period and were offset by reduced incidence and case fatality. Risk-attributable deaths declined for most modifiable factors, with tobacco remaining the leading risk, responsible for 21.9% of all deaths. A total of 0.24 year of LE gained was attributable to upper GI cancers from 1990 to 2021. Regionally, high-income Asia Pacific achieved the greatest gains in LE (0.67 years). GC predominantly contributed to the most gains, whereas EC mostly contributed to LE changes in Central and East Asia (0.27 years and 0.19 years, respectively). Although the burden of upper GI cancers has declined, progress is uneven, and the absolute burden remains high in Asia. Continued region-specific prevention, risk factor control, and equitable access to early detection and treatment are essential to further reduce the disease burden and close global disparities.
Teng et al. (Sun,) studied this question.