Epidemiological trends and burden of esophageal cancer mortality in South Asia: A retrospective analysis from 1990 to 2023 with advanced machine learning forecasting to 2050.

e16055 Background: Esophageal cancer remains a major cause of cancer mortality in South Asia, with marked geographic and sex-specific heterogeneity. Comprehensive evaluations integrating long-term trends with advanced forecasting are scarce. We examined temporal patterns of esophageal cancer mortality across South Asia from 1990–2023 and projected future burden through 2050. Methods: Age-standardized mortality rates (ASMRs) were analyzed using population-based estimates for South Asia and individual countries from 1990–2023, using the Global Burden of Disease 2023 database. Temporal trends were quantified using estimated annual percentage change (EAPC) with 95% confidence intervals (CIs), stratified by sex. Machine learning–based ARIMA time-series models were applied to forecast ASMRs to 2050 with uncertainty intervals (UI). Results: At the regional level, esophageal cancer mortality increased significantly from 1990–2023 (both sexes EAPC 1.80; 95% CI 1.35–2.25), with faster rises among males (EAPC 2.09; 1.69–2.49) than females (1.49; 0.99–2.01). South Asian ASMRs (both sexes) rose from 4.35 per 100,000 in 1990 to 8.14 in 2023. Male ASMRs increased from 4.44 to 8.79, while female ASMRs rose from 4.24 to 7.51. India demonstrated the steepest increase in mortality (both sexes EAPC 2.25; 1.71–2.81), with parallel rises in males (2.42; 1.92–2.92) and females (2.13; 1.51–2.76). Bangladesh showed a pronounced male predominance (male EAPC 1.59; 1.42–1.76 vs female 0.71; 0.43–0.99). Bhutan exhibited divergent trends, with declining female mortality but increasing male mortality. Nepal showed near-stable overall trends, and Pakistan experienced modest overall increases. Forecasts indicate continued increases across South Asia, with both-sex ASMRs projected to reach 15.60 by 2050. Male ASMRs are projected to rise to 14.49 (95% UI 1.93–27.04) and female ASMRs to 24.05 (6.90–41.19), reflecting widening sex disparities and increasing uncertainty. Conclusions: Esophageal cancer mortality has increased substantially across South Asia over the past three decades, with pronounced male predominance and striking inter-country heterogeneity. Projections suggest a rapidly escalating future burden, underscoring the urgent need for targeted prevention, and early detection. Location Sex EAPC Lower 95%CI Upper 95%CI Bangladesh Both 1.19 0.98 1.40 Bangladesh Female 0.71 0.43 0.99 Bangladesh Male 1.59 1.42 1.76 Bhutan Both 0.32 0.20 0.44 Bhutan Female -0.34 -0.53 -0.15 Bhutan Male 1.08 1.01 1.16 India Both 2.25 1.71 2.81 India Female 2.13 1.51 2.76 India Male 2.42 1.92 2.92 Nepal Both 0.00 -0.20 0.19 Nepal Female -0.38 -0.60 -0.17 Nepal Male 0.36 0.18 0.55 Pakistan Both 0.26 0.15 0.37 Pakistan