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Abstract：
BACKGROUND: In this study we estimate the burden of esophageal cancer (EC) in China and globally from 1990 to 2021, with a forecast to 2035, using Global Burden of Disease (GBD) data. We also analyze the related risk factors to investigate burden trends.
METHODS: Mortality, disability-adjusted life years (DALYs), crude rates, and age-standardized rates of EC were analyzed in China and globally from 1990 to 2035, utilizing GBD open data as a secondary dataset analysis of GBD data. Temporal change trends of EC risk factors were analyzed from 1990 to 2021. Joinpoint regression determined average annual percentage change (AAPC) of age-standardized rates. Descriptive analysis compared mortality and DALYs by age groups. Bayesian age-period-cohort (BAPC) predicted age-standardized mortality and DALYs rates for the next 14 years.
RESULTS: The ASMR and ASDR fluctuations in EC were significant in China, showing an overall downward trend. Globally, although there was also a downward trend, the fluctuations were relatively mild. The number of deaths and DALYs related to EC in China and globally showed a significant upward trend. Age-specific burden trends in China for EC indicated that the age group with the peak number of EC deaths shifted to the 70-74 years age group in 2021, while DALYs peaked in the 65-69 years age group. The crude mortality rate (CMR) peaked consistently in 1990 and 2021, both within the 90-94 years age range, while the crude DALY rate (CDR) shifted to the 85-89 years age group. Overall, the burden of EC deaths and DALYs in the population aged <40 years was relatively low, increasing rapidly after the age of 40 years, reaching a peak and gradually declining, and reaching a lower level after the age of 85 years. The predictive results of the BAPC model indicated that over the next 14 years, both ASMR and ASDR for EC in China and globally would show a slight overall increase. The GBD 2021 study identified smoking, high alcohol use, chewing tobacco, and diet low in vegetables as the main risk factors affecting EC mortality rate and DALYs. Among these, smoking and alcohol use were the most significant risk factors, with a higher impact on EC in China compared to the global level. From 1990 to 2021, the overall changes in ASMR and ASDR indicate a decreasing trend in the impact of these four risk factors on EC mortality rate and DALYs.
CONCLUSIONS: The burden of EC is expected to steadily increase in China and globally until 2035, posing a significant challenge. Targeted prevention and control policies, such as calling on people to quit smoking and reduce alcohol use, may help curb this upward trend.
METHODS: Mortality, disability-adjusted life years (DALYs), crude rates, and age-standardized rates of EC were analyzed in China and globally from 1990 to 2035, utilizing GBD open data as a secondary dataset analysis of GBD data. Temporal change trends of EC risk factors were analyzed from 1990 to 2021. Joinpoint regression determined average annual percentage change (AAPC) of age-standardized rates. Descriptive analysis compared mortality and DALYs by age groups. Bayesian age-period-cohort (BAPC) predicted age-standardized mortality and DALYs rates for the next 14 years.
RESULTS: The ASMR and ASDR fluctuations in EC were significant in China, showing an overall downward trend. Globally, although there was also a downward trend, the fluctuations were relatively mild. The number of deaths and DALYs related to EC in China and globally showed a significant upward trend. Age-specific burden trends in China for EC indicated that the age group with the peak number of EC deaths shifted to the 70-74 years age group in 2021, while DALYs peaked in the 65-69 years age group. The crude mortality rate (CMR) peaked consistently in 1990 and 2021, both within the 90-94 years age range, while the crude DALY rate (CDR) shifted to the 85-89 years age group. Overall, the burden of EC deaths and DALYs in the population aged <40 years was relatively low, increasing rapidly after the age of 40 years, reaching a peak and gradually declining, and reaching a lower level after the age of 85 years. The predictive results of the BAPC model indicated that over the next 14 years, both ASMR and ASDR for EC in China and globally would show a slight overall increase. The GBD 2021 study identified smoking, high alcohol use, chewing tobacco, and diet low in vegetables as the main risk factors affecting EC mortality rate and DALYs. Among these, smoking and alcohol use were the most significant risk factors, with a higher impact on EC in China compared to the global level. From 1990 to 2021, the overall changes in ASMR and ASDR indicate a decreasing trend in the impact of these four risk factors on EC mortality rate and DALYs.
CONCLUSIONS: The burden of EC is expected to steadily increase in China and globally until 2035, posing a significant challenge. Targeted prevention and control policies, such as calling on people to quit smoking and reduce alcohol use, may help curb this upward trend.
摘要：
背景：在这项研究中，我们使用全球疾病负担（GBD）数据估算了1990年至2021年中国和全球食管癌（EC）的负担，并预测到2035年。我们还分析了相关的风险因素，以调查负担趋势。
方法：死亡率，残疾调整寿命年(DALYs)，原油利率，从1990年到2035年，利用GBD开放数据作为GBD数据的辅助数据集分析，分析了中国和全球的年龄标准化的EC率。分析了1990-2021年EC危险因素的时间变化趋势。Joinpoint回归确定了年龄标准化率的平均年百分比变化（AAPC）。描述性分析比较了按年龄组划分的死亡率和DALY。贝叶斯年龄周期队列（BAPC）预测了未来14年的年龄标准化死亡率和DALY率。
结果：中国EC的ASMR和ASDR波动显著，总体呈下降趋势。全球范围内,尽管也有下降趋势，波动相对温和。中国和全球与EC相关的死亡人数和DALY人数呈显著上升趋势。中国EC的特定年龄负担趋势表明，EC死亡人数高峰的年龄组在2021年转移到70-74岁年龄组，而DALYs在65-69岁年龄组达到峰值。粗死亡率（CMR）在1990年和2021年一直达到峰值，都在90-94岁的年龄范围内，而粗DALY率（CDR）转移到85-89岁年龄组。总的来说,40岁以下人群的EC死亡和DALYs负担相对较低，在40岁后迅速增加，达到顶峰并逐渐下降，85岁后达到较低水平。BAPC模型的预测结果表明，在接下来的14年里，中国和全球电子商务的ASMR和ASDR都将显示出轻微的整体增长。GBD2021年的研究确定了吸烟，大量饮酒,咀嚼烟草，和低蔬菜饮食是影响EC死亡率和DALYs的主要危险因素。其中,吸烟和饮酒是最重要的危险因素，与全球水平相比，中国对电子商务的影响更大。从1990年到2021年，ASMR和ASDR的总体变化表明，这四个风险因素对EC死亡率和DALY的影响呈下降趋势。
结论：预计到2035年，中国和全球的欧共体负担将稳步增加，这构成了重大挑战。有针对性的防控政策,比如呼吁人们戒烟，减少饮酒，可能有助于遏制这种上升趋势。
方法：死亡率，残疾调整寿命年(DALYs)，原油利率，从1990年到2035年，利用GBD开放数据作为GBD数据的辅助数据集分析，分析了中国和全球的年龄标准化的EC率。分析了1990-2021年EC危险因素的时间变化趋势。Joinpoint回归确定了年龄标准化率的平均年百分比变化（AAPC）。描述性分析比较了按年龄组划分的死亡率和DALY。贝叶斯年龄周期队列（BAPC）预测了未来14年的年龄标准化死亡率和DALY率。
结果：中国EC的ASMR和ASDR波动显著，总体呈下降趋势。全球范围内,尽管也有下降趋势，波动相对温和。中国和全球与EC相关的死亡人数和DALY人数呈显著上升趋势。中国EC的特定年龄负担趋势表明，EC死亡人数高峰的年龄组在2021年转移到70-74岁年龄组，而DALYs在65-69岁年龄组达到峰值。粗死亡率（CMR）在1990年和2021年一直达到峰值，都在90-94岁的年龄范围内，而粗DALY率（CDR）转移到85-89岁年龄组。总的来说,40岁以下人群的EC死亡和DALYs负担相对较低，在40岁后迅速增加，达到顶峰并逐渐下降，85岁后达到较低水平。BAPC模型的预测结果表明，在接下来的14年里，中国和全球电子商务的ASMR和ASDR都将显示出轻微的整体增长。GBD2021年的研究确定了吸烟，大量饮酒,咀嚼烟草，和低蔬菜饮食是影响EC死亡率和DALYs的主要危险因素。其中,吸烟和饮酒是最重要的危险因素，与全球水平相比，中国对电子商务的影响更大。从1990年到2021年，ASMR和ASDR的总体变化表明，这四个风险因素对EC死亡率和DALY的影响呈下降趋势。
结论：预计到2035年，中国和全球的欧共体负担将稳步增加，这构成了重大挑战。有针对性的防控政策,比如呼吁人们戒烟，减少饮酒，可能有助于遏制这种上升趋势。
