Analysis of the disease burden of esophageal cancer and gastric cancer in China from 1990 to 2021_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Chongrui ¹ , HU Shoucai ² ,  LI Bin ¹ , LIN Mingzhi ¹ , HUI Yiming ¹ , LI Haitian ¹

1. Department of Thoracic Surgery, The Second Hospital & Clinical Medical School, Lanzhou University/Gansu Province Key Laboratory of Environmental Oncology/Cuiying Biomedical Research Center, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, 730030, P. R. China;
2. Department of Thoracic Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou, 730030, P. R. China;

Corresponding?author：

LI Bin, Email: leebin@lzu.edu.cn

Keywords：

Esophageal cancer; gastric cancer; disease burden; trend of change; China; gender differences

DOI：

10.7507/1007-4848.202504016

Video：

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Objective To assess the evolving disease burden of esophageal and gastric cancers in China from 1990 to 2021, with a focus on gender disparities, and construct a predictive model to forecast disease trends from 2022 to 2031, aiming to optimize targeted prevention strategies. Methods Epidemiological data for esophageal and gastric cancers in China (1990-2021) were extracted from the Global Burden of Disease (GBD) 2021 database. Temporal trends were analyzed using Joinpoint regression (version 4.9.1.0), and future trends were predicted via the GM (1, 1) model under grey system theory. Results From 1990 to 2021, tobacco- and alcohol-attributable burdens of esophageal cancer increased, while tobacco- and diet-related burdens of gastric cancer showed no significant change. Deaths and disability-adjusted life years (DALY) for esophageal cancer rose by 40.61% and 17.89%, respectively; gastric cancer deaths increased by 18.95%, though DALY decreased by 1.22%. Both cancers exhibited significant declines in age-standardized mortality rates (?45.78% for esophageal cancer, ?53.29% for gastric cancer) and age-standardized DALY rates (?51.45% for esophageal cancer, ?57.58% for gastric cancer). China’s age-standardized mortality and DALY rates for both cancers remained consistently higher than global averages. Males exhibited disproportionately higher burdens than females. Predictive modeling projected continued but decelerating declines in disease burdens for both cancers by 2031. Conclusion Over three decades, China achieves measurable reductions in esophageal and gastric cancer burdens, though gastric cancer burdens remain higher than esophageal cancer. Persistent disparities relative to global levels, elevated male burdens, and aging demographics highlight the urgency for prioritized interventions targeting high-risk populations.

Citation： LI Chongrui, HU Shoucai, LI Bin, LIN Mingzhi, HUI Yiming, LI Haitian. Analysis of the disease burden of esophageal cancer and gastric cancer in China from 1990 to 2021. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(10): 1438-1446. doi: 10.7507/1007-4848.202504016 Copy

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2.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
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10.	李輝章, 杜靈彬. Joinpoint回歸模型在腫瘤流行病學時間趨勢分析中的應用. 中華預防醫學雜志, 2020, 54(8): 808-813.Li HZ, Du LB. Application of Joinpoint regression model in cancer epidemiological time trend analysis. Chin J Prev Med, 2020, 54(8): 808-813.
11.	Danpanichkul P, Suparan K, Tothanarungroj P, et al. Epidemiology of gastrointestinal cancers: a systematic analysis from the Global Burden of Disease Study 2021. J Gastroenterol Hepatol, 2025, 74(1): 26-34.
12.	Hemminki K, Zitricky F, F?rsti A, et al. Survival improvements in esophageal and gastric cancers in the Nordic countries favor younger patients. Cancer Med, 2024, 13(15): e7365.
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14.	Ren F, Shi Z, Shen X, et al. The global, regional, and national burden of stomach cancer attributed to smoking in 204 countries, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Tob Induc Dis, 2024, 22: 1-10.
15.	Qin N, Fan Y, Yang T, et al. The burden of gastric cancer and possible risk factors from 1990 to 2021, and projections until 2035: findings from the Global Burden of Disease Study 2021. Biomark Res, 2025, 13: 5.
16.	Hu J, Dong H, Dong Y, et al. Cancer burden attributable to risk factors, 1990-2019: a comparative risk assessment. iScience, 2024, 27(4): 109430.
17.	Etemadi A, Poustchi H, Chang CM, et al. Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer. J Natl Cancer Inst, 2023, 116(3): 379-388.
18.	Wu S, Chen Y, Chen Z, et al. Reactive oxygen species and gastric carcinogenesis: the complex interaction between Helicobacter pylori and host. Helicobacter, 2023, 28(6): e13024.
19.	Duan Y, Xu Y, Dou Y, et al. Helicobacter pylori and gastric cancer: mechanisms and new perspectives. J Hematol Oncol, 2025, 18: 10.
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21.	Jiang Y, Lin Y, Wen Y, et al. Global trends in the burden of esophageal cancer, 1990-2019: results from the Global Burden of Disease Study 2019. Ann Transl Med, 2023, 15(2): 348-364.
22.	谷變利, 馬麗霞, 石林林, 等. 食管癌流行病學研究現狀及展望. 食管疾病, 2024, 6(2): 148-151.Gu BL, Ma LX, Shi LL, et al. Advances and prospects in epidemiological research on esophageal cancer. J Esophageal Dis, 2024, 6(2): 148-151.
23.	Lowe KA, Katz A, Kelsh MA, et al. A multinational assessment of gastric and esophageal cancer burden by age, gender, and disease characteristics. J Clin Oncol, 2015, 33(3_suppl): 29.
24.	Zhang T, Zhang Y, Leng X. Global, regional, and national trends in gastric cancer burden: 1990-2021 and projections to 2040. Gastric Cancer, 2024, 14: 1-14.
25.	胡守財, 楊成龍, 馬浩天, 等. 1990—2019年中國飲酒所致的食管癌疾病負擔趨勢及男女對比分析. 中國胸心血管外科臨床雜志, 2025, 32(4): 500-507.Hu SC, Yang CL, Ma HT, et al. Trends in Chinese esophageal cancer burden of disease due to high alcohol use and comparative analysis of males and females from 1990 to 2019. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(4): 500-507.
26.	Jackson SS, Marks MA, Katki HA, et al. Sex disparities in the incidence of 21 cancer types: quantification of the contribution of risk factors. Cancer, 2022, 128(19): 3531-3540.
27.	Sun LP, Yan LB, Liu ZZ, et al. Dietary factors and risk of mortality among patients with esophageal cancer: a systematic review. BMC Cancer, 2020, 20: 287.
28.	Uhlenhopp DJ, Then EO, Sunkara T, et al. Epidemiology of esophageal cancer: update in global trends, etiology and risk factors. Clin J Gastroenterol, 2020, 13(6): 1010-1021.
29.	Inoue M. Epidemiology of gastric cancer: changing trends and global disparities. Cancers (Basel), 2024, 16(17): 2948.
30.	Zhang L, Dong Q, Wang Y, et al. Global trends and risk factors in gastric cancer: a comprehensive analysis of the Global Burden of Disease Study 2021 and multi-omics data. Int J Med Sci, 2025, 22(2): 341-356.

1. Cui Z, Suo C, Zhao Y, et al. Spatiotemporal correlation analysis for the incidence of esophageal and gastric cancer from 2010 to 2019: ecological study. JMIR Cancer, 2025, 11: e66655.
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
3. Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Zhonghua Zhong Liu Za Zhi, 2024, 46(3): 221-231.
4. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
5. Jiang Q, Shu Y, Jiang Z, et al. Burdens of stomach and esophageal cancer from 1990 to 2019 and projection to 2030 in China: findings from the 2019 Global Burden of Disease Study. J Glob Health, 2024, 14: 04025.
6. 王雪婷, 姚衛光. 2010-2021年中國食管癌死亡率變化趨勢分析及預測研究. 中國全科醫學, 2024, 27(1): 1-10.Wang XT, Yao WG. Trend analysis and forecasting study of esophageal cancer mortality rate change in China from 2010 to 2021. Chin Gen Pract, 2024, 27(1): 1-10.
7. 曹毛毛, 李賀, 孫殿欽, 等. 2000—2019年中國胃癌流行病學趨勢分析. 中華消化外科雜志, 2021, 20(1): 102-109.Cao MM, Li H, Sun DQ, et al. Epidemiological trend analysis of gastric cancer in China from 2000 to 2019. Chin J Dig Surg, 2021, 20(1): 102-109.
8. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
9. 胡守財, 陶堰成, 馬浩天, 等. 1990-2019年中國非風濕性瓣膜性心臟病疾病負擔及變化趨勢分析. 中國循環雜志, 2024, 39(8): 806-812.Hu SC, Tao YC, Ma HT, et al. Disease burden and changing trend of non-rheumatic valvular heart disease from 1990 to 2019 in China. Chin Circ J, 2024, 39(8): 806-812.
10. 李輝章, 杜靈彬. Joinpoint回歸模型在腫瘤流行病學時間趨勢分析中的應用. 中華預防醫學雜志, 2020, 54(8): 808-813.Li HZ, Du LB. Application of Joinpoint regression model in cancer epidemiological time trend analysis. Chin J Prev Med, 2020, 54(8): 808-813.
11. Danpanichkul P, Suparan K, Tothanarungroj P, et al. Epidemiology of gastrointestinal cancers: a systematic analysis from the Global Burden of Disease Study 2021. J Gastroenterol Hepatol, 2025, 74(1): 26-34.
12. Hemminki K, Zitricky F, F?rsti A, et al. Survival improvements in esophageal and gastric cancers in the Nordic countries favor younger patients. Cancer Med, 2024, 13(15): e7365.
13. Ilic I, Zivanovic Macuzic I, Ravic-Nikolic A, et al. Global burden of esophageal cancer and its risk factors: a systematic analysis of the Global Burden of Disease Study 2019. Front Oncol, 2025, 15: 24.
14. Ren F, Shi Z, Shen X, et al. The global, regional, and national burden of stomach cancer attributed to smoking in 204 countries, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Tob Induc Dis, 2024, 22: 1-10.
15. Qin N, Fan Y, Yang T, et al. The burden of gastric cancer and possible risk factors from 1990 to 2021, and projections until 2035: findings from the Global Burden of Disease Study 2021. Biomark Res, 2025, 13: 5.
16. Hu J, Dong H, Dong Y, et al. Cancer burden attributable to risk factors, 1990-2019: a comparative risk assessment. iScience, 2024, 27(4): 109430.
17. Etemadi A, Poustchi H, Chang CM, et al. Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer. J Natl Cancer Inst, 2023, 116(3): 379-388.
18. Wu S, Chen Y, Chen Z, et al. Reactive oxygen species and gastric carcinogenesis: the complex interaction between Helicobacter pylori and host. Helicobacter, 2023, 28(6): e13024.
19. Duan Y, Xu Y, Dou Y, et al. Helicobacter pylori and gastric cancer: mechanisms and new perspectives. J Hematol Oncol, 2025, 18: 10.
20. Zhu H, Wang Z, Deng B, et al. Epidemiological landscape of esophageal cancer in Asia: results from GLOBOCAN 2020. Esophagus, 2023, 14(11): 992-1003.
21. Jiang Y, Lin Y, Wen Y, et al. Global trends in the burden of esophageal cancer, 1990-2019: results from the Global Burden of Disease Study 2019. Ann Transl Med, 2023, 15(2): 348-364.
22. 谷變利, 馬麗霞, 石林林, 等. 食管癌流行病學研究現狀及展望. 食管疾病, 2024, 6(2): 148-151.Gu BL, Ma LX, Shi LL, et al. Advances and prospects in epidemiological research on esophageal cancer. J Esophageal Dis, 2024, 6(2): 148-151.
23. Lowe KA, Katz A, Kelsh MA, et al. A multinational assessment of gastric and esophageal cancer burden by age, gender, and disease characteristics. J Clin Oncol, 2015, 33(3_suppl): 29.
24. Zhang T, Zhang Y, Leng X. Global, regional, and national trends in gastric cancer burden: 1990-2021 and projections to 2040. Gastric Cancer, 2024, 14: 1-14.
25. 胡守財, 楊成龍, 馬浩天, 等. 1990—2019年中國飲酒所致的食管癌疾病負擔趨勢及男女對比分析. 中國胸心血管外科臨床雜志, 2025, 32(4): 500-507.Hu SC, Yang CL, Ma HT, et al. Trends in Chinese esophageal cancer burden of disease due to high alcohol use and comparative analysis of males and females from 1990 to 2019. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(4): 500-507.
26. Jackson SS, Marks MA, Katki HA, et al. Sex disparities in the incidence of 21 cancer types: quantification of the contribution of risk factors. Cancer, 2022, 128(19): 3531-3540.
27. Sun LP, Yan LB, Liu ZZ, et al. Dietary factors and risk of mortality among patients with esophageal cancer: a systematic review. BMC Cancer, 2020, 20: 287.
28. Uhlenhopp DJ, Then EO, Sunkara T, et al. Epidemiology of esophageal cancer: update in global trends, etiology and risk factors. Clin J Gastroenterol, 2020, 13(6): 1010-1021.
29. Inoue M. Epidemiology of gastric cancer: changing trends and global disparities. Cancers (Basel), 2024, 16(17): 2948.
30. Zhang L, Dong Q, Wang Y, et al. Global trends and risk factors in gastric cancer: a comprehensive analysis of the Global Burden of Disease Study 2021 and multi-omics data. Int J Med Sci, 2025, 22(2): 341-356.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of the disease burden of esophageal cancer and gastric cancer in China from 1990 to 2021

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