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. 2020 Nov 2;13(1):146.
doi: 10.1186/s13045-020-00981-4.

Burden, trends, and risk factors of esophageal cancer in China from 1990 to 2017: an up-to-date overview and comparison with those in Japan and South Korea

Si Yang  1   2 , Shuai Lin  2 , Na Li  1   2 , Yujiao Deng  1   2 , Meng Wang  2 , Dong Xiang  3 , Grace Xiang  4 , Shuqian Wang  1 , Xianghua Ye  5 , Yi Zheng  1   2 , Jia Yao  1 , Zhen Zhai  1   2 , Ying Wu  1   2 , Jingjing Hu  6 , Huafeng Kang  7 , Zhijun Dai  8   9
Affiliations

Burden, trends, and risk factors of esophageal cancer in China from 1990 to 2017: an up-to-date overview and comparison with those in Japan and South Korea

Si Yang et al. J Hematol Oncol. .

Abstract

Background: The epidemiology of esophageal cancer (EC) can elucidate its causes and risk factors and help develop prevention strategies. We aimed to provide an overview of the burden, trends, and risk factors of EC in China from 1990 to 2017. We also investigated the differences between China, Japan, and South Korea and discussed the possible causes of the disparities.

Methods: We used the Global Burden of Disease Study 2017 to obtain data on incident cases, deaths, disability-adjusted life-year (DALY) cases, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALY rate of EC in China, Japan, and South Korea from 1990 to 2017. Trend analysis was performed using joinpoint analysis. We measured the associations between ASIR, ASDR, and age-standardized DALY rate and the socio-demographic index (SDI) for 1990-2017. We also analyzed the risk factors associated with EC deaths and DALYs.

Results: China recorded 234,624 (95% uncertainty intervals: 223,240-246,036) incident cases of and 212,586 (202,673-222,654) deaths from EC in 2017. The ASIR and ASDR declined from 1990 to 2017. Until 2017, the ASIR was 12.23, and ASDR was 11.25 per 100,000 persons. The DALYs were 4,464,980 (4,247,816-4,690,846) with an age-standardized rate of 222.58 per 100,000 persons in 2017. The ASIR, ASDR, and age-standardized DALY rate in China were twice those of Japan and South Korea. These three indicators showed a decreasing trend, whereas SDI increased, in all three countries from 1990 to 2017. Tobacco and alcohol use remained the major risk factors for EC death and DALYs, especially for men in China and women in Japan and South Korea. High body mass index (BMI) and low-fruit diet were the main risk factors for women in China.

Conclusions: The incident cases and deaths of EC in China, Japan, and South Korea increased from 1990 to 2017, whereas the ASIR, ASDR, and age-standardized DALY rate declined. China had the greatest burden of EC among three countries. SDI and aging along with tobacco use, alcohol use, high BMI, and low-fruit diet were the main risk factors of death and DALYs and should be paid more attention.

Keywords: Death; Disability-adjusted life years; Esophageal cancer; Incidence; Risk factor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trends for the ASIR (a), ASDR (b), and age-standardized DALY rate (c) of esophageal cancer in the world, East Asia and Pacific, China, Japan, and South Korea from 1990 to 2017. ASIR age-standardized incidence rate, ASDR age-standardized death rate, DALY disability-adjusted life-year
Fig. 2
Fig. 2
Trends for the ASIR and ASDR of esophageal cancer in the world, East Asia and Pacific, China, Japan, and South Korea from 1990 to 2017 calculated by joinpoint regression analyses. a ASIR in China; b ASDR in China; c ASIR in Japan; d ASDR in Japan; e ASIR in South Korea; f ASDR in South Korea; g ASIR in East Asia and Pacific; h ASDR in East Asia and Pacific; i ASIR in the world; j ASDR in the world. ASIR age-standardized incidence rate, ASDR age-standardized death rate
Fig. 3
Fig. 3
The trend in ASIR (a), ASDR (b), and age-standardized DALY rate (c) of esophageal cancer in the world, China, Japan, and South Korea by socio-demographic index for both sexes combined, 1990 to 2017. Expected values are shown as the black line. ASIR age-standardized incidence rate, ASDR age-standardized death rate, DALY disability-adjusted life-year
Fig. 4
Fig. 4
a The age-standardized DALY rate of esophageal cancer in the 34 provinces of China in 2017. b Age-standardized DALY rate and socio-demographic index in the 34 provinces of China in 2017. DALY disability-adjusted life-year
Fig. 5
Fig. 5
Percentage of esophageal cancer age-standardized death due to tobacco, alcohol use, high body-mass index, and diet low in fruits in the world, East Asia and Pacific, China, Japan, and South Korea in 1990 and 2017. a For men; b for women
Fig. 6
Fig. 6
Percentage of esophageal cancer age-standardized DALY rate due to tobacco, alcohol use, high body-mass index, and diet low in fruits in the world, East Asia and Pacific, China, Japan, and South Korea in 1990 and 2017. a For men; b for women. DALY disability-adjusted life-year
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