Burden, trends, driving factors, and predictions of gastric cancer: a cross-national comparative analysis of China, Japan, and South Korea

BACKGROUND: Gastric cancer (GC) is one of the most common malignancies globally. Despite advances in early screening and treatment, the burden of GC has decreased. But, its incidence and mortality rates remain high in East Asia, particularly in China, Japan, and South Korea. METHODS: This study based on the Global Burden of Disease (GBD) 2021 database, analyzes trends in GC burden from 1990 to 2021 and identifies key driving factors in China, Japan, South Korea, and globally. The Bayesian Age-Period-Cohort (BAPC) model was used for future predictions. RESULTS: From 1990 to 2021, the global GC burden showed a significant downward trend. The ge-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) decreased from 24.76/100,000 to 14.33/100,000 (EAPC=-1.81 95% CI: -1.88,-1.75) and 22.01/100,000 to 11.20/100,000 (EAPC=-2.26 95% CI: (-2.34,-2.18), respectively. China's ASIR decreased from 48.03/100,000 to 29.05/100,000 (EAPC=-1.64 95% CI: -1.82,-1.47). South Korea and Japan showed more significant reductions, with South Korea's ASIR dropping from 71.18/100,000 in 1990 to 25.76/100,000 in 2021 (EAPC=-3.54 95% CI: -3.68,-3.41), the fastest decline among all regions. Japan's ASIR decreased from 64.05/100,000 to 25.54/100,000 (EAPC=-2.98 95% CI: -3.05,-2.92). The decomposition analysis indicated that population aging was the major driver of the GC burden. Risk factors such as high-salt diet and smoking were strongly associated with GC. CONCLUSION: The findings emphasize the importance of early screening, health interventions, lifestyle changes and dietary adjustments in reducing GC burden, especially in high-risk countries.