Global burden of gastric cancer from1990 to 2021: A systematic analysis for the Global Burden of Disease study 2021

BACKGROUND: Gastric cancer (GC) represents a major global health issue. Understanding its current burden and divergent regional trends is critical for formulating effective prevention strategies. We report on the incidence, mortality, and disability-adjusted life-years (DALYs) due to gastric cancer in 204 countries and territories from 21 regions between 1990 and 2021 and provide projections of future trends. METHODS: Using Global Burden of Disease 2021 data, we evaluated GC age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), DALYs, and age-standardized DALY rates (ASDR) across 204 countries and territories from 1990 to 2021. Metrics were stratified by region, country, sociodemographic index (SDI), age, and sex. Trends were evaluated through joinpoint regression, and Bayesian age-period-cohort (BAPC) model was used to project incidence, mortality, and DALYs to 2045. RESULTS: In 2021, the global count estimated of GC-related deaths was 954,373.60, while the incidence exceeded 1.23 million cases. Notably, China alone accounted for 611,799 GC cases and 445,013 GC-related deaths in 2021. Global ASIR, ASDR, and ASR of GC declined annually by 1.77%, 2.18%, and 2.44%, respectively from 1990 to 2021. Males exhibit a higher ASIR, ASDR, and ASR. Andean Latin America and East Asia carry the heaviest burden of GC. The population aged 70-74 years has the highest number of incident cases and deaths. Higher-SDI regions demonstrated more rapid declines in mortality, incidence, and ASR than lower-SDI regions. Smoking and high-sodium diet were the primary risk factors for GC burden. Projections for 2045 suggest a continued decrease in GC burden. CONCLUSIONS: Since 1990, the global ASDR, ASIR, and ASR for GC have consistently declined. However, substantial disparities persist across regions, countries, age groups, and sexes. Tailored prevention and intervention strategies, informed by regional characteristics and risk factors, are essential to effectively reduce the global GC burden.