Global Burden, Risk Factors, and Trends of Esophageal Cancer: An Analysis of Cancer Registries from 48 Countries

Abstract

This study aimed to examine the global burden, risk factors, and trends of esophageal cancer based on age, sex, and histological subtype. The data were retrieved from cancer registries database from 48 countries in the period 1980-2017. Temporal patterns of incidence and mortality were evaluated by average annual percent change (AAPC) using joinpoint regression. Associations with risk factors were examined by linear regression. The highest incidence of esophageal cancer was observed in Eastern Asia. The highest incidence of adenocarcinoma (AC) was found in the Netherlands, the United Kingdom, and Ireland. A higher AC/squamous cell carcinoma (SCC) incidence ratio was associated with a higher prevalence of obesity and elevated cholesterol. We observed an incidence increase (including AC and SCC) in some countries, with the Czech Republic (female: AAPC 4.66), Spain (female: 3.41), Norway (male: 3.10), Japan (female: 2.18), Thailand (male: 2.17), the Netherlands (male: 2.11; female: 1.88), and Canada (male: 1.51) showing the most significant increase. Countries with increasing mortality included Thailand (male: 5.24), Austria (female: 3.67), Latvia (male: 2.33), and Portugal (male: 1.12). Although the incidence of esophageal cancer showed an overall decreasing trend, an increasing trend was observed in some countries with high AC/SCC incidence ratios. More preventive measures are needed for these countries.

Keywords: esophageal cancer; histological subtypes; incidence; mortality; risk factors.

Figure 1

The global estimated incidence of esophageal cancer in 2018, both sexes, all ages: (A) male incidence; (B) female incidence. ASR, age-standardized rate. Data source: GLOBOCAN 2018, IARC (http://gco.iarc.fr/today), World Health Organization.

Figure 2

The global estimated mortality of esophageal cancer in 2018, both sexes, all ages: (A) male mortality; (B) female mortality. ASR, age-standardized rate. Data source: GLOBOCAN 2018, IARC (http://gco.iarc.fr/today), World Health Organization.

Figure 3

The risk factors associated with histological subtype ratio of esophageal cancer. These added-variable plots were generated using multi-variable linear regression models. ^e, residuals; AC, adenocarcinoma; SCC, squamous cell carcinoma; β, β coefficient in the linear regression.

Figure 4

The AAPC of the incidence of esophageal cancer in individuals aged 0–85+ years. AAPC, annual percentage change; * p values less than 0.05; ^ AAPC for these countries could not be generated, as zero or missing values were identified in any year of trend analysis; the 95% confidence intervals and p values for the tests of AAPC are presented in Table S5.

Figure 5

The AAPC of the mortality of esophageal cancer in individuals aged 0–85+ years. AAPC, annual percentage change; * p values less than 0.05; ^ AAPC for these countries could not be generated, as zero or missing values were identified in any year of trend analysis; the 95% confidence intervals and p values for the tests of AAPC are presented in Table S5.

Figure 6

The AAPC of the incidence of esophageal cancer in individuals aged ≥50 years. AAPC, annual percentage change; * p values less than 0.05; ^ AAPC for these countries could not be generated, as zero or missing values were identified in any year of trend analysis; the 95% confidence intervals and p values for the tests of AAPC are presented in Table S5.