Burden profiles and mortality-attributable risk factors for gastrointestinal cancers: A comprehensive analysis, 1990–2021

Burden profiles and attributable risk factors for gastrointestinal cancers, 1990–2021. • Regionally, nearly half of the cases and deaths occurred in East Asia and high-income Asia Pacific. • Older adults (>65 years) and males bore a significantly greater burden across most GI cancer types. • Colorectal cancer and stomach cancer were the major contributors to the burden of GI cancer. • Risk-attributable mortality varied by cancer type, region, SDI level, sex, and age. • Tobacco use and high body mass index (BMI) were pervasive cross-cancer risk factors. Gastrointestinal (GI) cancers accounted for 23.6% of new cancer cases and 34.2% of cancer-related deaths globally. A comprehensive understanding of GI cancer burden and mortality-attributable risk factors is urgently needed. We aim to identify high-risk regions and populations to inform targeted interventions and evidence-based policies for global GI cancer control. Cases, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) were obtained from the Global Burden of Disease Study (GBD) 2021. The socio-demographic index (SDI) was employed to categorize regions. Joinpoint regression was used to assess temporal trends. Risk factor contributions were calculated via the comparative risk assessment framework. In 2021, GI cancers caused an estimated 5,255,409 (95 % UI: 4,687,432–5,801,303) new cases, 3,698,636 (95 % UI: 3,291,859–4,091,466) deaths, and 88,123,735 (95 % UI: 79,029,696–97,844,204) DALYs. Regionally, nearly half of the cases and deaths occurred in East Asia and high-income Asia Pacific. Older adults (>65 years) and males bore a significantly greater burden across most GI cancer types. Colorectal cancer and stomach cancer were the major contributors to the burden of GI cancer. Risk-attributable mortality varied by cancer type, region, SDI level, sex, and age. Tobacco use and high body mass index (BMI) were pervasive cross-cancer risk factors. Tobacco use accounted for 11.29 % (95 % UI: 9.36–13.28) of stomach cancer deaths and 40.64 % (95 % UI: 33.64–47.05) of esophageal cancer deaths, whereas high BMI contributed to 9.51 % (95 % UI: 4.07–14.81) of colorectal cancer deaths and 11.69 % (95 % UI: 8.27–15.59) of gallbladder and biliary tract cancer deaths. GI cancers impose a major yet unequal global burden, disproportionately affecting males, older adults, and populations in East Asia. The varying risk patterns underscore the necessity of targeted, region-specific public health interventions.