Age-period-cohort analysis of incidence, mortality and disability-adjusted life years of esophageal cancer in global, regional and national regions from 1990 to 2019
Authors: Li Huiying , Yang Xianzhi , Zhang Aiqi , Liang Guanying , Sun Yue , Zhang Jian 
Published: August 2023

Abstract
Objective
Esophageal cancer is one of the most deadly cancers in the world. In view of the high incidence and mortality of esophageal cancer, the latest statistical data on the disease burden of esophageal cancer can provide strategies for cancer screening, early detection and treatment, and help to rationally allocate health resources. This study analyzed the disease burden of esophageal cancer in 204 countries in 21 regions around the world from 1990 to 2019, and evaluated the relationship between regions with different socio-demographic indexes and risk factors of esophageal cancer.
Methods
The incidence, mortality and disability-adjusted life years of esophageal cancer in 21 regions and 204 countries were estimated according to the age, gender and geographical location from 1990 to 2019, and the disease burden of esophageal cancer in different genders was measured according to the socio-demographic index (SDI). The age-period-cohort model was used to estimate the age, period and cohort trend of esophageal cancer in different SDI regions.
Results
From 1990 to 2019, the number of new cases of esophageal cancer increased from 319,969 (351,210 -253,395) to 534,563 (595,342 -466,513), the number of deaths of esophageal cancer increased from 319,332 (350,802-248,666) to 498,067 (551,462-438411), the disability adjusted life years increased from 8,208,267 (9,075,711-6,334,289) to 11,666,017 (12,938,949-10,378,747), The age standardized incidence rate of esophageal cancer worldwide decreased from 8.06 (8.83-6.41) per 100 000 to 6.51 (7.25-5.69) per 100 000, a decrease of 19.28%, the age standardized mortality rate decreased from 8.18 (8.97-6.40) per 100 000 to 6.11 (6.76-5.38) per 100000, a decrease of 25.32%, and the age standardized DALY rate decreased from 199.28 (219.99-154.25) per 100 000 to 33.43 (41.96-26.85) per 100 000, a decrease of 88.22%. On the whole, countries and regions with higher SDI levels usually have lower incidence, mortality and DALY rates. On the contrary, countries and regions with lower SDI levels have higher incidence and mortality, while countries and regions with medium SDI levels have significantly higher incidence, mortality and DALY rates. In the past 30 years, the incidence and death of esophageal cancer in the world has gradually changed to people over 80 years old, but the population aged 60-79 still accounts for the largest proportion. The incidence, mortality and DALY rate in all areas showed a trend of increasing first and then decreasing with age. The period effect and birth cohort effect of incidence, mortality and DALY rate gradually decreased over time, especially in high SDI areas and high -middle SDI areas.
Conclusions
Although the age-standardized incidence, mortality and disability-adjusted life years have decreased significantly, esophageal cancer is still the main factor causing the disease burden worldwide. There are differences in the disease burden of esophageal cancer among different regions, so we should focus on the regions with low SDI, because countries with low SDI are facing more serious disease burden. In addition, in high-risk areas of esophageal cancer, public health managers should implement prevention and control measures, raise awareness and cost-effective screening and treatment of esophageal cancer in these areas to reduce the death caused by esophageal cancer in high-risk areas.