Yunhao Li, Yanyan Guo, Man Ping Wang, Wen-Qing Li, Wai K Leung
Despite declining mortality rates, the absolute number of smoking-related UGIC deaths remains substantial and is rising in China due to demographic momentum. Greater reductions were seen among young individuals and females. These ecological findings underscore the importance of strengthening tobacco-control policies to mitigate the population-level burden attributable to smoking, particularly within high-risk populations.
BACKGROUND AND OBJECTIVES: Smoking is a major modifiable risk factor for upper gastrointestinal cancers (UGIC), particularly in China. This study investigated temporal trends, demographic patterns, and future projections of smoking-attributable UGIC mortality globally and nationally.
METHODS: We extracted data from the Global Burden of Disease 2021. Joinpoint regression was used to assess trends in smoking-attributable UGIC mortality rates and absolute deaths. Age-period-cohort (APC) model was applied to evaluate effects brought by age groups and birth cohort. Decomposition analysis quantified contributions of aging, population growth, and epidemiologic shifts to mortality changes. Bayesian APC (BAPC) model projected mortality trends to 2030.
RESULTS: At the population level, smoking is more strongly associated with esophageal cancer than gastric cancer. Although smoking-attributable mortality rates of both esophageal and gastric cancers declined globally and in China, the decline was more pronounced for gastric cancer than for esophageal cancer (AAPC: -2.594 vs. -1.229 globally; -2.297 vs. -1.491 in China; both p < 0.001). However, trends in absolute deaths differed by cancer type and geography: smoking-attributable esophageal cancer deaths increased globally and in China, whereas smoking-attributable gastric cancer deaths increased in China but remained stable globally. APC analysis revealed the most significant drop among young adults aged 35-44, but mortality trends plateaued or increased in older individuals. In contrast, esophageal cancer mortality is expected to remain elevated through 2030, with an estimated 263,219 deaths globally including 187,567 in China.
CONCLUSIONS: Despite declining mortality rates, the absolute number of smoking-related UGIC deaths remains substantial and is rising in China due to demographic momentum. Greater reductions were seen among young individuals and females. These ecological findings underscore the importance of strengthening tobacco-control policies to mitigate the population-level burden attributable to smoking, particularly within high-risk populations.