Burden of esophageal cancer in China and Asia: A systematic analysis for the Global Burden of Disease Study 2023

BACKGROUND: Esophageal cancer (EC) is the eighth most common cancer and fifth leading cause of cancer death globally. Asia bears a disproportionate burden, accounting for approximately 80% of cases, yet comprehensive regional assessments remain limited. METHODS: Using data from the Global Burden of Disease (GBD) 2023 study, we systematically analyzed EC incidence, mortality, and disability-adjusted life years (DALYs)-along with their corresponding 95% uncertainty intervals (UIs)-by sex and age groups across five Asian subregions and 33 countries and territories from 1990 to 2023. The quantification of trends was achieved through the utilization of age-standardized rates (ASRs) and estimated annual percentage change (EAPC). Additionally, risk attribution and decomposition analyses were conducted. Besides, we focused on China and analyzed the burden of EC there. RESULTS: In 2023, East Asia remained the region with the heaviest burden of EC, with 261,367.96 (95% UI: 223,690.57, 299,941.44) deaths and an age-standardized mortality rate (ASMR) of 10.88 (95% UI: 9.34, 12.43) per 100,000 population. Central Asia demonstrated the most significant decline in burden (EAPC for ASMR = -3.67% [95% CI: -3.86%, -3.47%]), while South Asia was the only region with an increasing trend (EAPC for ASMR = 1.80% [95% CI: 1.34%, 2.27%]), primarily linked to chewing tobacco and diet low in vegetables. Smoking and high alcohol use remained the dominant risk factors in East Asia and the high-income Asia-Pacific region. The burden of EC among males was found to be considerably higher than among females. Decomposition analysis identified population aging and growth as key drivers of death increases, despite mitigating epidemiological improvements. China accounted for approximately 59.1% of Asia's total incident cases (267,431.62 out of 452,378.59), approximately 59.8% of deaths (254,462.56 out of 425,429.23), and 55.7% of DALYs (5,734,333.60 out of 10,295,667.36) in 2023, making it the dominant contributor to the overall Asian EC burden. Although the EC burden remains substantial in China, the ASRs have shown a particularly pronounced reduction, with the EAPC values were -3.42% (95% CI: -3.75%, -3.09%) for ASIR, -3.58% (95% CI: -3.92%, -3.24%) for ASMR, and -3.96% (95% CI: -4.31%, -3.60%) for ASDR. Smoking and high alcohol use remained the two leading risk factors for EC in China. CONCLUSION: Disease burden of EC in Asia remains substantial and heterogeneous, with China contributing the largest share of cases, deaths, and DALYs in the region. Targeted prevention, lifestyle modification, and advanced screening for high-risk populations are crucial to reduce future burden.