Currently submitted to: JMIR Cancer
Date Submitted: Jun 7, 2026
Open Peer Review Period: Jun 11, 2026 - Aug 6, 2026
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Regional Disparities, Risk Profiles, and Future Trajectories of Digestive System Cancers in East Asia: An Analysis of the Global Burden of Disease Study 2023
ABSTRACT
Background:
East Asia is the global epicenter of digestive system cancers (DSCs), yet location-specific evidence on regional burden and differentiated risk etiologies remains limited.
Objective:
This study aimed to evaluate the burden, risk profiles, and trajectories through 2050 for six DSCs across five East Asian locations, including China mainland, North Korea, South Korea, Japan and Taiwan.
Methods:
Incidence, prevalence, mortality, and disability-adjusted life years were extracted from the Global Burden of Disease (GBD) 2023 study. Trends were quantified via average annual percent changes (AAPCs). Random Forest and Gamma regression analyzed data from 204 countries to derive relative risks (RRs). Region-specific SHAP values were subsequently extracted to rank local risk contributions. Bayesian models projected incidence to 2050.
Results:
A sub-regional divide emerged. Infection-associated esophageal cancer mortality in China mainland (AAPC -3.59) and stomach cancer mortality in South Korea (AAPC -5.15) fell. Conversely, geriatric colorectal and pancreatic cancers surged in industrialized zones, with Taiwan recording the highest colorectal incidence (ASIR 373.96). Regional SHAP rankings revealed marked etiologic heterogeneity. High trans-fatty acids (RR 1.216, 95% CI 1.102–1.346; P < 0.001) constituted the leading gallbladder cancer contributor in South Korea. Alcohol (RR 1.143, 95% CI 1.059–1.235; P < 0.001) predominantly impacted colorectal cancer across China mainland, Japan, and South Korea. Additionally, red meat (RR 1.135, 95% CI 1.029–1.253; P = 0.01) and BMI (RR 1.103, 95% CI 1.016–1.199; P = 0.03) primarily contributed to stomach cancer in China mainland. By 2050, pancreatic cancer escalates universally, whereas colorectal cancer trajectories diverge regionally.
Conclusions:
East Asia faces individualized DSC imbalances. This dual burden of persistent infection-driven reservoirs and surging geriatric metabolic malignancies highlights the potential need for location-specific screening and precision prevention.
Citation
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