Global, Regional, and National Burden of Gastric Cancer and its Risk Factors from 1990 to 2021: Findings from the Global Burden of Disease Study 2021

Abstract

Background: Studies from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021 offered valuable insights to inform screening and prevention strategies for gastric cancer (GC). This research aimed to provide comprehensive global, regional, and national estimates of GC burden and attributable risks from 1990 to 2021, with analysis stratified by sex.

Methods: we reported on the incidence, age-standardized incidence rate (ASIR), prevalence, age-standardized prevalence rate (ASPR), mortality, age-standardized mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardized DALYs rate (ASDALR), and the burden attribute to risk factors associated with GC by sex. Further inequality, predictive, and frontier analyses were conducted to comprehensively understand the global burden of GC.

Findings: From 1990 to 2021, global GC incidence, prevalence, mortality, and DALYs number increased, while ASIR (Average Annual Percent Change [AAPC], −1.77 [−1.88 to −1.65]), ASPR (AAPC, −1.26 [−1.34 to −1.17]), ASMR (AAPC, −2.19 [−2.34 to −2.03]), and ASDALR (AAPC, −2.45 [−2.58 to −2.31]) significantly decreased. In 2021, high-middle socio-demographic index (SDI) countries bore the largest GC burden, with the most affected regions being East Asia, High-income Asia Pacific, Andean Latin America, and Eastern Europe. Mongolia had the highest ASIR, ASMR, and ASDALR. Northern Africa was the only region with an ASR increase over the past 30 years, particularly among female. During the COVID-19 pandemic, 17 countries exhibited a reverse trend in ASMR of GC. Globally, DALYs from GC attributable to smoking and high-sodium diets showed a downward trend, although some countries experienced increases. The GC burden showed clear regional and sex-specific heterogeneity. Inequalities in GC burden related to SDI intensified over time. Although ASR of GC was projected to decline further by 2040, case number was expected to rise, with a marked shift toward an older population.

Interpretation: This study emphasizes the regional and gender differences in the epidemiological burden and trends of GC, highlighting the need for targeted prevention and screening strategies, particularly in high-burden regions.

Funding: This work was supported by the Capital Health Development Research Fund (grant number: 2024-2-4194); the Fundamental Research Funds for the Central Universities (grant number: 2024-JYB-JBZD-012); the Clinical Research Operations of Centralized High-level Chinese Medicine Hospitals (grant number: CZ015).

Declaration of Interest: All authors declare no competing interests.

Keywords: Gastric cancer, Epidemiology, COVID-19, Risk factors, Global burden of disease