Age-standardized incidence, mortality, and premature-mortality burden of esophageal cancer in Brazil vs the United States.

BACKGROUND: Esophageal cancer is highly lethal, and its burden differs between high-income and middle-income countries. Because crude comparisons are confounded by age structure, we compared the age-standardized burden in Brazil and the United States and evaluated their temporal trends. METHODS: Using Global Burden of Disease 2023 estimates, we obtained incidence, prevalence, mortality, disability-adjusted life years, years of life lost, and years lived with disability for esophageal cancer in both countries, by sex, for 2013 to 2023. Counts, crude rates, and age-standardized rates per 100,000 are reported, with trends represented as the average annual percent change from log-linear regression of the age-standardized rate. RESULTS: In 2023, age-standardized incidence, mortality, disability-adjusted life years, and years of life lost were higher in Brazil than in the United States for both sexes. Among men, age-standardized disability-adjusted life years were 213.1 per 100,000 in Brazil vs 143.8 in the United States, approximately 1.5 times higher, with a similar ratio among women. Crude rates masked this difference, suggesting a United States excess because that population is older. Years of life lost accounted for approximately 99% of disability-adjusted life years in both countries, representing an almost entirely fatal burden, and the United States led only in prevalence, consistent with longer survival. From 2013 to 2023, the burden fell in both countries, more steeply in Brazil. CONCLUSION: After age standardization, Brazil has a higher premature-mortality burden from esophageal cancer than the United States, which has higher prevalence, a survival signature. These profiles support timely diagnosis and prevention in Brazil and survivorship-oriented care in the United States.