The global, regional, and national burden of stomach cancer in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease study 2017
Authors: Arash Etemadi, Saeid Safiri, Sadaf G Sepanlou, Kevin Ikuta, Catherine Bisignano, Ramin Shakeri, Mohammad Amani, Christina Fitzmaurice, Molly Nixon, Nooshin Abbasi, Hassan Abolhassani, Shailesh M Advani, Mohsen Afarideh, Tomi Akinyemiju, Tahiya Alam, Mahtab Alikhani, Vahid Alipour, Christine A Allen, Amir Almasi-Hashiani, Jalal Arabloo, Reza Assadi, Suleman Atique, Ashish Awasthi, Ahad Bakhtiari, Masoud Behzadifar, Kidanemaryam Berhe, Neeraj Bhala, Ali Bijani, Muhammad Shahdaat Bin Sayeed, Tone Bjørge, Antonio M Borzì, Dejana Braithwaite, Hermann Brenner, Giulia Carreras, Félix Carvalho, Carlos A Castañeda-Orjuela, Franz Castro, Dinh-Toi Chu, Vera M Costa, Ahmad Daryani, Dragos V Davitoiu, Gebre T Demoz, Asmamaw B Demis, Edgar Denova-Gutiérrez, Subhojit Dey, Mostafa Dianati Nasab, Shirin Djalalinia, Mohammad Hassan Emamian, Mohammad Farahmand, João C Fernandes, Florian Fischer, Masoud Foroutan, Mohamed M Gad, Silvano Gallus, Gebreamlak Gebremedhn Gebremeskel, Getnet A Gedefew, Fatemeh Ghaseni-Kebria, Giuseppe Gorini, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Josep M Haro, James D Harvey, Amir Hasanzadeh, Maryam Hashemian, Hamid Y Hassen, Simon I Hay, Hagos D Hidru, Mihaela Hostiuc, Mowafa Househ, Olayinka s Ilesanmi, Milena D. Ilic, Kaire Innos, Farhad Islami, Spencer L James, Ensiyeh Jenabi, Rohollah kalhor, Farin Kamangar, Amir Kasaeian, Andre P Kengne, Yousef S Khader, Rovshan Khalilov, Ejaz A Khan, Gulfaraz Khan, Maryam Khayamzadeh, Maryam Khazaee-Pool, Salman Khazaei, Abdullah T Khoja, Fatemah Khosravi Shadmani, Yun Jin Kim, Jonathan M Kocarnik, Hamidreza Komaki, Ai Koyanagi, Vivek Kumar, Carlo La Vecchia, Alan D Lopez, Raimundas Lunevicius, Navid Manafi, Ana-Laura Manda, Birhanu Geta, Hailemariam Meheretu, Getnet Mengistu, Bartosz Miazgowski, Seyed Mostafa Mir, Karzan A Mohammad, Naser Mohammad Gholi Mezerji, Mahdi Mohammadian, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Lorenzo Monasta, Mahmood Moosazadeh, Maryam Moossavi, Ghobad Moradi, Farhad Moradpour, Rahmatollah Moradzadeh, Ilais Moreno Vel squez, Abbas Mosapour, Mehdi Naderi, Gurudatta Naik, Farid Najafi, Azin Nahvijou, Ionut Negoi, Rajan Nikbakhsh, Marzieh Nojomi, Andrew T Olagunju, Tinuke O Olagunju, Eyal Oren, Hadi Parsian, Cristiano Piccinelli, Akram Pourshams, Hossein Poustchi, Navid Rabiee, Amir Radfar, Alireza Rafiei, Mahdi Rahimi, Marveh Rahmati, Andre M N Renzaho, Nima Rezaei, Ana Isabel Ribeiro, Gholamreza Roshandel, Anas M Saad, Seyedmohammad Saadatagah, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Milena M Santric Milicevic, Arash Sarveazad, Monika Sawhney, Faramarz Shaahmadi, Mario Sekerija, Masood A Shaikh, Amir Shamshirian, Sudeep K Siddappa Malleshappa, Jasvinder A Singh, Catalin-Gabriel Smarandache, Moslem Soofi, Takahiro Tabuchi, Degena B Tadesse, Leili Tapak, Berhe E Tesfay, Eugenio Traini, Bach Tran, Khanh B Tran, Marco Vacante, Amir Vahedian-Azimi, Yousef Veisani, Kia Vosoughi, Isidora S Vujcic, Ronny Westerman, Adam B Wondmieneh, Rixing Xu, Sanni Yaya, Vahid Yazdi-Feyzabadi, Zabihollah Yousefi, Bhaman Yousefi, Telma Zahirian Moghadam, Leila Zaki, Mohammad Zamani, Maryam Zamanian, Hamed Zandian, Afshin Zarghi, Zhi-Jiang Zhang, Mohsen Naghavi, Reza Malekzadeh
Journal: The Lancet. Gastroenterology & hepatology (2019)

Stomach cancer is a major health problem in many countries. Understanding the current burden of stomach cancer and the differential trends across various locations is essential for formulating effective preventive strategies. We report on the incidence, mortality, and disability-adjusted life-years (DALYs) due to stomach cancer in 195 countries and territories from 21 regions between 1990 and 2017.Estimates from GBD 2017 were used to analyse the incidence, mortality, and DALYs due to stomach cancer at the global, regional, and national levels. The rates were standardised to the GBD world population and reported per 100 000 population as age-standardised incidence rates, age-standardised death rates, and age-standardised DALY rates. All estimates were generated with 95% uncertainty intervals (UIs).In 2017, more than 1·22 million (95% UI 1·19-1·25) incident cases of stomach cancer occurred worldwide, and nearly 865 000 people (848 000-885 000) died of stomach cancer, contributing to 19·1 million (18·7-19·6) DALYs. The highest age-standardised incidence rates in 2017 were seen in the high-income Asia Pacific (29·5, 28·2-31·0 per 100 000 population) and east Asia (28·6, 27·3-30·0 per 100 000 population) regions, with nearly half of the global incident cases occurring in China. Compared with 1990, in 2017 more than 356 000 more incident cases of stomach cancer were estimated, leading to nearly 96 000 more deaths. Despite the increase in absolute numbers, the worldwide age-standardised rates of stomach cancer (incidence, deaths, and DALYs) have declined since 1990. The drop in the disease burden was associated with improved Socio-demographic Index. Globally, 38·2% (21·1-57·8) of the age-standardised DALYs were attributable to high-sodium diet in both sexes combined, and 24·5% (20·0-28·9) of the age-standardised DALYs were attributable to smoking in males.Our findings provide insight into the changing burden of stomach cancer, which is useful in planning local strategies and monitoring their progress. To this end, specific local strategies should be tailored to each country's risk factor profile. Beyond the current decline in age-standardised incidence and death rates, a decrease in the absolute number of cases and deaths will be possible if the burden in east Asia, where currently almost half of the incident cases and deaths occur, is further reduced.Bill & Melinda Gates Foundation.