Stomach cancer burden among older adults in aged and super-aged societies, 1990-2023: a global analysis: A short informative title: Elderly Stomach Cancer Burden in Aged and Super-Aged Countries, 1990-2023.

BACKGROUND: Population ageing is reshaping cancer burden in later life. For stomach cancer, declining age-standardised mortality may coexist with sustained or increasing absolute deaths as older populations expand. We assessed stomach cancer burden among adults aged 65 years or older in aged and super-aged societies from 1990 to 2023. METHODS: Using Global Burden of Disease Study 2023 estimates, we analysed deaths, disability-adjusted life-years (DALYs), age-standardised rates, age-specific mortality, sex-specific patterns, estimated annual percentage change, decomposition of changes in deaths, and trajectories around transition into super-aged status. Countries and territories were included if adults aged 65 years or older accounted for at least 14% of the population in 2023; super-aged societies were defined by a proportion of 21% or higher. RESULTS: Sixty countries and territories were included: 33 aged and 27 super-aged societies. In aged societies, deaths increased from 307,928 (95% UI 252,700-378,610) in 1990 to 336,454 (250,465-441,049) in 2023, despite a decline in the age-standardised death rate (ASDR) from 203.69 per 100,000 (166.46-251.77) to 90.12 (66.98-118.05). In super-aged societies, deaths decreased modestly from 105,330 (95,791-113,945) to 101,143 (81,472-116,462), while the ASDR declined from 162.13 (146.60-176.00) to 69.05 (57.17-78.77). ASDRs declined significantly in 59 of 60 countries and territories; Georgia showed a non-significant increase. Reductions were smaller at older ages, falling by 65% at ages 65-69 years but only 9% at ages 95 years or older. Decomposition showed that epidemiological improvements reduced deaths in nearly all countries, but population growth and ageing offset these gains in several settings, particularly China, Japan, and the Republic of Korea. CONCLUSIONS: Stomach cancer mortality rates declined substantially among adults aged 65 years or older, but absolute deaths declined less because demographic growth and ageing offset epidemiological gains, with burden increasingly concentrated at the oldest ages. Progress should therefore be assessed using both age-standardised rates and absolute burden.