Analysis of the Global and Chinese Esophageal Cancer Burden Trends from 1990 to 2021 and Projections from 2022 to 2050: Based on GBD 2021 Data

Background: Esophageal cancer is one of the common cancers worldwide, imposing a substantial disease burden on all countries. It constitutes a critical public health issue globally, particularly in developing nations.Objective: This study aims to analyze the trends of esophageal cancer burden in China from 1990 to 2021, further project the burden from 2022 to 2040, and provide scientific evidence for the prevention of esophageal cancer.Methods: Data from the 2021 Global Burden of Disease (GBD) study were utilized. The Annual Percentage Change (EAPC) was employed to analyze the temporal trends of age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate of esophageal cancer in China from 1990 to 2021. Additionally, the Bayesian Age-Period-Cohort (BAPC) model was used to project the esophageal cancer burden in China from 2022 to 2040.Results: In China, the ASIR of esophageal cancer increased from 17.637 per 100, 000 in 1990 to 22.548 per 100, 000 in 2021 (EAPC = 0.55, 95% Confidence Interval CI = 0.38–0.71). The ASMR rose from 17.920 per 100, 000 in 1990 to 20.836 per 100, 000 in 2021 (EAPC = 0.21, 95% CI = 0.02–0.39). In contrast, the age-standardized DALYs rate decreased from 497.437 per 100, 000 in 1990 to 484.884 per 100, 000 in 2021 (EAPC = -0.39, 95% CI = -0.59 to -0.2).The proportion of esophageal cancer cases among individuals aged 45 years and above increased from 93.32% in 1990 to 97.56% in 2021, while the proportion of deaths in this age group rose from 90.44% in 1990 to 98.22% in 2021. For individuals aged 40 years and above, the proportion of DALYs attributed to esophageal cancer increased from 95.29% in 1990 to 98.29% in 2021.Among people aged 20 years and above, the incidence rate of esophageal cancer showed a downward trend in all age groups. Specifically, the 35–39 years age group exhibited the most significant decline (EAPC = -3.74, 95% CI = -4.22 to -3.25). On the other hand, the 70+ years age group had the smallest decrease in ASMR and age-standardized DALYs rate among those aged 20 years and above.Projections indicate that by 2050, the age-standardized prevalence rate, ASIR, ASMR, and age-standardized DALYs rate of esophageal cancer in China will decrease to 25.1 per 100, 000, 6.4 per 100, 000, 14.2 per 100, 000, and 12.0 per 100, 000, respectively.Conclusion: From 1990 to 2021, the ASIR and ASMR of esophageal cancer in China showed an upward trend, while the age-standardized DALYs rate exhibited a slow downward trend. Projections suggest that by 2050, the burden of esophageal cancer in China (in terms of prevalence, incidence, mortality, and DALYs) will present a downward trajectory.