Comparison of Secular Trends in Esophageal Cancer Mortality in China and Japan during 1990-2019: An Age-Period-Cohort Analysis

Abstract

Esophageal cancer is a prevalent and often fatal malignancy all over the world, with China and Japan bearing a disproportionately high burden. Consequently, we explored and compared the long-term changes in esophageal cancer mortality in China and Japan from 1990 to 2019 to see if there were any etiological clues. From 1990 to 2019, data on mortality in China and Japan were gathered from the Global Burden of Disease Study 2019 (GBD 2019). The age-period-cohort (APC) model was utilized to evaluate the effects of age, period, and cohort. Between 1990 and 2019, the age-standardized mortality rates (ASMRs) for esophageal cancer fell in both nations, with China showing a tremendous reduction after 2005. The overall net drifts per year were more impressive in China (-5.22% [95% CI, -5.77 to -4.68] for females, -1.98% [-2.22 to -1.74] for males) than in Japan (-0.50% [-0.91 to -0.08] for females, -1.86% [-2.12 to -1.59] for males), and the local drift values in both countries were less than zero in all age groups for both sexes. The longitudinal age curves of esophageal cancer mortality increased as age advances and the sex disparity gradually exacerbates with age. The period and cohort effects were uncovered to have similar declining patterns for both sexes in both nations; however, the improvement of cohort effects for China's younger generation has stagnated. The ASMRs, period effects, and cohort effects have decreased for both countries and sexes over the 1990-2019 period. The decline in cohort effects for China's younger generation has plateaued, possibly due to the rising rates of smoking and obesity among Chinese youngsters. Comprehensive population-level treatments aimed at smoking cessation, obesity prevention, and gastrointestinal endoscopy screening should be carried out immediately, particularly for men and older birth cohorts at a higher risk of esophageal cancer.

Keywords: age-period-cohort model; esophageal cancer; mortality.

Figure 1

Trends in the ASMRs of esophageal cancer mortality by gender in China (A) and Japan (B) from 1990 to 2019, at all ages. ASMR: age-standardized mortality rate. Error bars represented the 95% CIs for esophageal cancer mortality.

Figure 2

Age-specific mortality rates of esophageal cancer by period and sex in China (A1,A2) and Japan (B1,B2), 1990 to 2019. The study period was organized into 5-year periods, namely, 1990–1994 (median, 1992), 1995–1999 (median, 1995), 2000–2004 (median, 2002), 2005–2009 (median, 2007), 2010–2014 (median, 2012), and 2015–2019 (median, 2017). Cross-sectional age curves present the expected age-specific rates in the reference period, i.e., 2000 to 2004, after adjusting for cohort effects (p < 0.01 for all).

Figure 3

Cohort-specific mortality rates of esophageal cancer by age and sex in China (A1,A2) and Japan (B1,B2), 1990 to 2019. Data on esophageal cancer mortality were arranged into 18 successive birth cohorts, which include those born between 1910–1914 (median, 1912) and 1990–1994 (median, 1992), and 12 age groups between 20–24 (median, 22 years) and 80–84 years of age (p < 0.01 for all).

Figure 4

The local drift with net drift values for esophageal cancer mortality for males and females in China (A) and Japan (B). Net drift values are depicted as solid lines with dashed lines representing their 95% CI. Error bars represent the 95% CI for the local drift values.

Figure 5

Longitudinal age curves of esophageal cancer mortality by genders in China (A) and Japan (B). Fitted longitudinal age-specific rates of esophageal cancer mortality rates (per 100,000 person-years) and the corresponding 95% CI.

Figure 6

Period effects of esophageal cancer mortality by genders in China (A) and Japan (B). The relative risk of each period compared with the reference period (2000–2004) adjusted for age and nonlinear cohort effects and the corresponding 95% CI.

Figure 7

Cohort effects of esophageal cancer mortality by genders in China (A) and Japan (B). The relative risk of each cohort compared with the reference cohort (the 1950s) adjusted for age and nonlinear period effects and the corresponding 95% CI.