Global, regional, and national trends in gastric cancer burden: 1990-2021 and projections to 2040

Abstract

Background: Gastric cancer (GC) is a common malignancy of the digestive system, with significant geographical variation in its disease burden.

Methods: This study used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to analyze three key indicators: incidence, mortality, and disability-adjusted life years (DALYs). Initially, a detailed analysis of the GC burden was conducted from global, regional, national, gender, and age perspectives. Subsequently, the percentage change and average annual percent change (AAPC) of GC were calculated to understand the trends in disease burden. Decomposition analysis and frontier analysis were then performed. Finally, the Bayesian age-period-cohort model was used to predict the trends in age-standardized rates (ASRs) of GC up to 2040.

Results: In 2021, there were 1.23 million (95% UI: 1.05-1.41 million) new cases of GC globally, with 0.95 million (95% UI: 0.82-1.10million) deaths and 22.79 million (95% UI: 19.58-26.12 million) DALYs. Compared to 1990, the global ASRs of GC has declined, but new cases and deaths have increased. For females, age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALYs rate were 8.6, 7.1, and 165.6 per 100,000, with AAPCs of -2.1, -2.4, and -2.6. For males, they were 20.9, 16.0, and 371.2 per 100,000, with AAPCs of -1.6, -2.1, and -2.3. ASRs fluctuated with increasing Socio-demographic Index (SDI), being higher in middle and high-middle SDI regions. Decomposition analysis indicated negative effects from epidemiological trends on GC burden, while population growth and aging had positive effects. Frontier analysis showed that middle and high-middle SDI regions had more potential for reducing ASRs. Predictions indicate a continued decline in ASRs for both genders by 2040.

Conclusion: Despite progress in controlling GC, the number of new cases and deaths globally is rising due to population growth and aging. This highlights the need for effective prevention and control strategies.

Keywords: disability-adjusted life years; gastric cancer; global burden of disease; incidence; mortality.

Figure 1

ASRs of GC by gender across continents from 1990 to 2021. (A–C) ASIR for both sexes, female, and male; (D–F) ASMR for both sexes, female, and male; (G–I) age-standardized DALYs rate for both sexes, female, and male. ASR, age-standardized rate; GC, gastric cancer; DALYs, disability-adjusted life years. ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate.

Figure 2

AAPC of GC by gender across continents from 1990 to 2021. (A) ASIR; (B) ASMR; (C) age-standardized DALYs rate. AAPC, average annual percentage change; GC, gastric cancer; DALYs, disability-adjusted life years; ASMR, age-standardized mortality rate; ASIR, age-standardized incidence rate.

Figure 3

Distribution of ASIR for GC across different SDI levels. (A) Global and 21 GBD regions from 1990 to 2021; (B) 204 countries and territories in 2021. ASIR, age-standardized incidence rate; GC, gastric cancer; SDI, Socio-demographic Index; GBD, Global Burden of Diseases, Injuries, and Risk Factors Study.

Figure 4

Analysis of GC incidence using multiple indicators in 204 countries and territories. (A) ASIR per 100,000 population in 2021; (B) Percentage change in the number of incident cases from 1990 to 2021; (C) AAPC from 1990 to 2021. GC, gastric cancer; ASIR, age-standardized incidence rate; AAPC, average annual percentage change.

Figure 5

Visualization of decomposition analysis results. Black dots represent the overall changes in disease burden due to aging, epidemiological changes, and population growth. (A) incident cases from 1990 to 2021; (B) death cases from 1990 to 2021; (C) DALYs from 1990 to 2021. For each component, an increase in the disease burden of GC related to that component is indicated by positive values, whereas a decrease is indicated by negative values. SDI, Socio-demographic Index; DALYs, disability-adjusted life years; GC, gastric cancer.

Figure 6

Visualization of frontier analysis results. (A, B) Frontier analysis for ASIR; (C, D) Frontier analysis for ASMR; (E, F) Frontier analysis for age-standardized DALYs rate. Black lines represent the lower limits of ASR achievable at different SDI levels, with points representing different countries and regions. The 15 countries and regions with the largest effective differences globally are labeled in black font, the 5 countries and regions with the smallest effective differences among low SDI countries are labeled in blue font, and the 5 countries and regions with the largest effective differences among high SDI countries are labeled in red font. In Figures (A, C, E), the blue dots represent the ASRs of GC from 1990 to 2021, with darker shades indicating later years. In Figures (B, D, F), the dots represent changes in GC ASR from 1990 to 2021. Blue dots indicate countries and territories where the ASR increased from 1990 to 2021, while red dots indicate countries and territories where the ASR decreased. ASIR, age-standardized incidence rate; SDI, Socio-demographic Index; ASMR, age-standardized mortality rate; DALYs, disability-adjusted life years; ASR, age-standardized rate; GC, gastric cancer.

Figure 7

Visualization of BAPC predicted results. DALYs, disability-adjusted life years; BAPC, Bayesian Age-Period-Cohort model.