Analysis of disease burden and attributable risk factors of esophageal cancer in countries with high incidence of esophageal cancer from 1990 to 2019 / 肿瘤研究与临床

ABSTRACT

Objective:To summarize the trend of disease burden of esophageal cancer in 4 countries with high incidence of esophageal cancer and analyse the proportion of death attribution of three common risk factors, which helps to provide reference for the prevention and control of esophageal cancer.Methods:Based on the 2019 Global Burden of Disease Study (GBD2019) database and visualization platform, the absolute number and age-standardized rates of incidence, mortality and disability adjusted life years (DALY) of esophageal cancer in 4 countries with high incidence of esophageal cancer (China, Iran, Russia and South Africa) from 1990 to 2019 were described. The Joinpoint regression model was used for time trend analysis, and the annual percentage change (APC) and average annual percentage change (AAPC) of age-standardized incidence, age-standardized mortality, and age-standardized DALY rate of esophageal cancer were calculated. The proportion of death attribution of three common risk factors (smoking, alcohol consumption and low fruit intake) in 2019 was compared, and the differences in the population attributable fraction (PAF) for risk factors globally and in 4 countries were analyzed. The incidence and mortality of esophageal cancer under different socio-demographic index (SDI) were analyzed by drawing fitting curves.Results:From 1990 to 2019, the age-standardized incidence, mortality and DALY rates of esophageal cancer showed an overall decreasing trend globally and in 4 countries with high incidence of esophageal cancer. The age-standardized incidence rate of esophageal cancer in China decreased from 21.0/100 000 to 13.9/100 000 (AAPC = -1.4%, 95% CI -1.3% - -1.1%), the age-standardized mortality rate decreased from 22.1/100 000 to 13.1/100 000 (AAPC = -1.8%, 95% CI -1.9% - -1.7%), and the age-standardized DALY rate decreased from 507.0/100 000 to 227.5/100 000 (AAPC = -2.1%, 95% CI -2.2% - -1.9%). These rates in China had been decreasing at a much faster rate than the other 3 countries. Both Chinese men and Russian men had higher rates of esophageal cancer deaths due to smoking and alcohol consumption than the global average (PAF smoking: 59.2%, 56.7% vs. 51.2%; PAF alcohol consumption: 29.7%, 38.3% vs. 28.4%). The proportion of alcohol-related esophageal cancer deaths in Russian women was higher than the global average for women (PAF: 14.9% vs. 7.3%). Attributing low fruit intake to esophageal cancer deaths in South African men and women were higher than the global average for men and women (PAF men: 20.8% vs. 9.8%; PAF women: 21.3% vs. 11.7%). The age-standardized incidence and mortality rates in China and South Africa were consistently higher than would be expected for the same level of SDI, while those in Iran were consistently lower than would be expected, and Russia was broadly in line with expectation. Conclusions:Although the disease burden of countries with high incidence of esophageal cancer in the world has been effectively controlled, the disease burden of esophageal cancer in China is still higher than that in other countries. Targeted prevention measures should be made according to the epidemiological characteristics of esophageal cancer in Chinese population.