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Background <p>Esophageal cancer (EC) represents a significant disease burden in China, exhibiting unique age distribution patterns. Previous research has primarily focused on overall epidemiological characteristics of EC, lacking systematic comparisons of the disease burden between early-onset esophageal cancer (EOEC) and late-onset esophageal cancer (LOEC).</p> Objective <p>The study aims to understand the trends in incidence and death rates of EOEC and LOEC in China from 1990 to 2021.</p> Methods <p>Data on incidence, mortality, and attributable risk factors for EOEC and LOEC in China were sourced from the 2021 Global Burden of Disease study. Joinpoint regression analysis was used to describe temporal trends over the past 32&#xa0;years. Bayesian Age-Period-Cohort (BAPC) modeling was employed to forecast both EOEC and LOEC’s trends for the next 14&#xa0;years.</p> Results <p>From 1990 to 2021, the age-standardized incidence rates (ASIRs) of EOEC and LOEC in China decreased by 55.52% and 65.16%, respectively, while their age-standardized death rates (ASDRs) fell by 37.65% and 44.06%. Compared to 1990, the peak age group for EC incident cases and deaths shifted to 70–74&#xa0;years in 2021. BAPC projections revealed that the burden of EOEC would continue to increase in the future, and the burden of LOEC would increase in males (ASIR<sub>2022-2035</sub> = 5.53%) but decrease in females (ASIR<sub>2022-2035</sub> = −&#xa0;9.93%). The male burden was projected to consistently exceed the female burden. Risk factor analysis showed that in LOEC, deaths attributed to chewing tobacco, high alcohol use, and smoking increased, but ASDR decreased. The burden attributable to a diet low in vegetables decreased for both EOEC and LOEC.</p> Conclusion <p>Despite the EC burden in China falling between 1990 and 2021, EOEC and male LOEC burdens will keep rising. Special attention should be given to elderly males as a key demographic, with effective primary prevention measures targeting critical behavioral risk factors such as smoking and alcohol consumption.</p>

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Comparative analysis of early-onset and late-onset esophageal cancer burden in China, 1990–2021: based on the 2021 Global Burden of Disease Study

  • 期刊论文

  • 发表日期：

    2026年3月16日

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  • Zhen Zhang,
  • Yingying Gong,
  • Lin Liu,
  • Yiyao Zhu,
  • Jintao Zhou,
  • Xingfeng Zhu

摘要

Background

Esophageal cancer (EC) represents a significant disease burden in China, exhibiting unique age distribution patterns. Previous research has primarily focused on overall epidemiological characteristics of EC, lacking systematic comparisons of the disease burden between early-onset esophageal cancer (EOEC) and late-onset esophageal cancer (LOEC).

Objective

The study aims to understand the trends in incidence and death rates of EOEC and LOEC in China from 1990 to 2021.

Methods

Data on incidence, mortality, and attributable risk factors for EOEC and LOEC in China were sourced from the 2021 Global Burden of Disease study. Joinpoint regression analysis was used to describe temporal trends over the past 32 years. Bayesian Age-Period-Cohort (BAPC) modeling was employed to forecast both EOEC and LOEC’s trends for the next 14 years.

Results

From 1990 to 2021, the age-standardized incidence rates (ASIRs) of EOEC and LOEC in China decreased by 55.52% and 65.16%, respectively, while their age-standardized death rates (ASDRs) fell by 37.65% and 44.06%. Compared to 1990, the peak age group for EC incident cases and deaths shifted to 70–74 years in 2021. BAPC projections revealed that the burden of EOEC would continue to increase in the future, and the burden of LOEC would increase in males (ASIR2022-2035 = 5.53%) but decrease in females (ASIR2022-2035 = − 9.93%). The male burden was projected to consistently exceed the female burden. Risk factor analysis showed that in LOEC, deaths attributed to chewing tobacco, high alcohol use, and smoking increased, but ASDR decreased. The burden attributable to a diet low in vegetables decreased for both EOEC and LOEC.

Conclusion

Despite the EC burden in China falling between 1990 and 2021, EOEC and male LOEC burdens will keep rising. Special attention should be given to elderly males as a key demographic, with effective primary prevention measures targeting critical behavioral risk factors such as smoking and alcohol consumption.