The Burden and Risk Factors of Gastric Cancer in Eastern Asia From 1990 to 2021: Longitudinal Observational Study of the Global Burden of Disease Study 2021

Abstract

Background: Eastern Asia has historically had the highest global incidence and mortality rates of gastric cancer (GC) while substantial disparities exist between countries. The overall burden of GC remains insufficiently explored.

Objective: Using the Global Burden of Disease Study 2021, this research aims to estimate the burden and risk factors of GC in Eastern Asia from 1990 to 2021.

Methods: Incidence, age-standardized incidence rate (ASIR), deaths, age-standardized mortality rate (ASMR), disability-adjusted life years, age-standardized disability-adjusted life year rate (ASDR), and risk factor burdens for GC were analyzed in Eastern Asia from 1990 to 2021. Joinpoint analysis determined average annual percent change (AAPC) and annual percent change, while age-period-cohort analysis assessed temporal trends. The Bayesian age-period-cohort model projected GC burden from 2021 to 2035. All analyses used R software (version 4.4.1; R Foundation for Statistical Computing).

Results: In 2021, Eastern Asia reported 748,235 new GC cases and 527,054 deaths, accounting for 60.8% (748,235/1,230,232) of new cases and 55.2% (527,054/954,373) of deaths reported globally. From 1990 to 2021, South Korea showed the largest declines in ASIR, ASMR, and ASDR, with ASMR decreasing from 55.4 per 100,000 to 13.3 per 100,000 (AAPC -4.5, 95% CI -4.8 to -4.3). ASIR, ASMR, and ASDR also showed a downward trend in Japan and China, with an AAPC of -3.0 (95% CI -3.2 to -2.8) for ASMR in Japan and -2.4 (95% CI -2.6 to -2.3) in China. The GC burden of North Korea was basically stable, with an AAPC of ASMR of -0.8 (95% CI -0.8 to -0.8). Mongolia showed a slight decline, with an AAPC of ASMR of -1.4 (95% CI -1.7 to -1.0), and the burden of GC was the highest. High-sodium diets and smoking were the main risk factors for disability-adjusted life years of GC in 2021. Smoking contributed to a decline in ASDR as the sociodemographic index increased. Projections suggest continued ASDR reductions across Eastern Asia from 2022 to 2035, though Mongolia will maintain the highest burden.

Conclusions: Despite a decrease from 1990 to 2021, GC remains a significant public health issue in Eastern Asia. Addressing it necessitates prioritizing primary and secondary prevention, including reducing risk factors and enhancing early screening.

Keywords: age-period-cohort analysis; gastric cancer; joinpoint analysis; mortality; risk factors.

Figure 1.. Age-standardized (A) incidence, (B) deaths, and (C) DALY rate of gastric cancer in Asia in 2021. DALY: disability-adjusted life year.

Figure 2.. The age-specific burden of gastric cancer, incidence number and rate, deaths number and rate, and DALY number and rate in 2021. DALY: disability-adjusted life year; UI: uncertainty interval.

Figure 3.. The age-standardized death trends of gastric cancer by sex in Eastern Asia, 1990-2021. APC: annual percent change; ASMR: age-standardized mortality rate.* indicates that 95% CI did not include 0.

Figure 4.. Age-specific mortality rates of gastric cancer (GC) by period and cohort-specific mortality rate of GC by age group in Eastern Asia, 1992‐2021. (A) Survey years were arranged into consecutive 5-year periods and describe the relationship between GC mortality rates and age group. (B) The GC mortality rates were arranged into 22 consecutive birth cohorts and describe the relationship between GC mortality rates and birth cohorts.

Figure 5.. ASDR per 100,000 population for gastric cancer attributable to each risk factor for Eastern Asia by SDI, 1990‐2021. Expected values based on SDI and ASDR in all locations are shown as the black line. For each region, points from left to right depict estimates from each year from 1990 to 2021. ASDR: age-standardized disability-adjusted life year rate; SDI: sociodemographic index.