Trends and cross-country inequalities in the global burden of gastrointestinal cancers attributable to smoking, 1990–2021: A secondary dataset analysis of GBD Study 2021

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INTRODUCTION: Gastrointestinal (GI) cancers, including esophageal, gastric, and colorectal cancers, are major contributors to the global cancer burden. Epidemiological trends of GI cancers attributable to smoking have not been comprehensively examined. We aim to evaluate the burden of GI cancers attributable to smoking and its cross-country inequalities from 1990 to 2021. METHODS: A secondary assessment of Global Burden of Disease (GBD) datasets was conducted. Deaths, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardized rate of DALYs (ASDR), and estimated annual percentage changes (EAPCs) were obtained from the GBD 2021. Spearman's rank test and a locally weighted regression (LOESS) model were utilized as analytical models. We quantified the inequalities using the slope index of inequality (SII) and the concentration index (Crl) associated with the national sociodemographic index. RESULTS: In 2021, the ASMR for smoking-attributable esophageal, gastric, and colorectal cancers was 2.38 (95% UI: 1.81-2.98), 1.25 (95% UI: 0.98-1.61), and 0.55 (95% UI: 0.34-0.77) per 100000 persons, respectively. From 1990 to 2021, there was a downward trend in the ASMRs and ASDRs for all three GI cancers attributed to smoking. The distribution and trajectory of the burden of disease exhibits considerable variation across regions. The three GI cancers had positive SIIs and Crls, with their Crls changing from 0.03 to 0.21 (esophageal cancer), 0.12 to 0.19 (gastric cancer), and 0.32 to 0.28 (colorectal cancer) between 1990 and 2021, suggesting that the disease burden is more prevalent and concentrated in countries with higher SDIs. However, heterogeneity was observed in the changes of absolute and relative inequality of the three GI cancers attributable to smoking between 1990 and 2021. CONCLUSIONS: The burden of GI cancer associated with smoking has increased in some regions from 1990 to 2021. These differing regional patterns may suggest a potential need for further assessment or targeted interventions in some areas.