JMIR Publications

ABSTRACT

Background:

Little is known about trends and projections of disease burden of dietary gastric and esophageal cancer (GEC) in China.

Objective:

We aim to report GEC death and DALYs in 1990 - 2019 and their predictions to 2044, and decompose changes in terms of population growth, population aging, and epidemiological changes.

Methods:

We retrieved dietary GEC data from the Global Burden of Disease (GBD) online database. The models of Joinpoint regression and an age-period-cohort (APC) were conducted to analyze the trend of death and disability-adjusted life years (DALYs) of dietary GEC from 1990 to 2019 in China. A Bayesian APC model of integrated nested Laplace approximations was used to predict disease burden of GEC through 2044, and we obtained the estimated population of China from 2020 to 2050 from the Global Health Data Exchange website. Finally, a recently developed decomposition method was applied to attribute changes between 2019 and 2044 to population growth, population aging, and epidemiological changes.

Results:

The summary exposure values and age-standardized rates decreased significantly from 1990 to 1999, with a percentage change of -0.06 (95% CI: -0.11 – -0.02) and -0.05 (95% CI: -0.10 – -0.02), respectively. From 1990 to 2019, for dietary esophageal cancer, percentage change of age-standardized mortality rate (ASMR) (-0.79, 95% CI: -0.93 – -0.58) and percentage change of age-standardized DALYs rate (ASDR) (-0.81, 95% CI: -0.94 – -0.61) showed significantly decreased trends; And for dietary stomach cancer, significant decreases were also observed for percentage change of ASMR (-0.43, 95% CI: -0.55 – -0.31) and percentage change of ASDR (-0.47, 95% CI: -0.58 – -0.35). In addition, both data from Joinpoint regression and annual percent change analysis demonstrated significantly decreased trends for annual percent change of ASMR and ASDR of GEC attributable to dietary carcinogens. The overall annual percentage change (net drift) was -5.95 (95% CI: -6.25 – -5.65) for dietary esophageal cancer mortality and -1.97 (95% CI: -2.11 – -1.83) for dietary stomach cancer mortality, respectively. Lastly, in 2044, dietary esophageal cancer death numbers and DALYs would increased by 192.62% and 170.28%, which was due to age structure (121.58% and 83.29%), mortality change (76.81% and 92.43%), and population size (-5.77% and -5.44%), respectively. In addition, dietary stomach cancer death number and DALYs would increased by 118.10% and 54.08%, with age structure, mortality rate changes, and population size accounting for 96.71% and 53.99%, 26.17% and 3.97%, -4.78% and -3.88%, respectively.

Conclusions:

Although the predicted age-standardized rates of mortality and DALYs of dietary GEC show downward trends, the absolute number would still increase in the next 25 years due to the rapid population aging seen in China.