The global, regional, and national burden of oesophageal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

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Abstract

BACKGROUND: Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD). METHODS: We used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease). FINDINGS: There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5·9 (5·7-6·1) per 100 000 population and age-standardised mortality was 5·5 (5·3-5·6) per 100 000. Oesophageal cancer caused 9·78 million (9·53-10·03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22·0% (18·6-25·2), mortality decreased by 29·0% (25·8-32·0), and DALYs decreased by 33·4% (30·4-36·1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52·3% (45·9-58·9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40·0% (34·1-46·3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27·4% (22·1-33·1), from 7·68 million (7·42-7·97) to 9·78 million (9·53-10·03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4·46 million [4·25-4·69]) in 2017. The highest national-level age-standardised incidence rates in 2017 were observed in Malawi (23·0 [19·4-26·5] per 100 000 population) and Mongolia (18·5 [16·4-20·8] per 100 000). In 2017, age-standardised incidence was 2·7 times higher, mortality 2·9 times higher, and DALYs 3·0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39·0% [35·5-42·2]), alcohol consumption (33·8% [27·3-39·9]), high BMI (19·5% [6·3-36·0]), a diet low in fruits (19·1% [4·2-34·6]), and use of chewing tobacco (7·5% [5·2-9·6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution. INTERPRETATION: Despite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

˜The œLancet. Gastroenterology & hepatology

Topic

Esophageal Cancer Research and Treatment

Field

Medicine

Canadian institutions

—

Funders

National Cancer InstituteStudent Research Committee, Tabriz University of Medical SciencesGastrointestinal and Liver Diseases Research CenterDuke Global Health Institute, Duke UniversityUniversitair Ziekenhuis AntwerpenUniversitätsklinikum HeidelbergRede de Química e TecnologiaApplied Molecular Biosciences UnitImam Abdulrahman Bin Faisal UniversityKurdistan University Of Medical SciencesMekelle UniversityMansoura UniversityAddis Ababa UniversityUniversity of GondarUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversity of Cape TownUniversidade do PortoBahir Dar UniversityAmbo UniversityShahid Beheshti University of Medical SciencesShahrekord University of Medical SciencesGuilan University of Medical SciencesResearch Institute for Endocrine Sciences, Shahid Beheshti University of Medical SciencesDanmarks Tekniske UniversitetJimma UniversityLaboratório Associado para a Química VerdeUniversitetet i BergenShahrekord UniversityCleveland ClinicMazandaran University of Medical SciencesĐại học Quốc gia Hà NộiPublic Health Foundation of IndiaMashhad University of Medical SciencesJordan University of Science and TechnologyBirjand University of Medical SciencesLunds UniversitetGeorgetown UniversityUniversità di CataniaBundesministerium für GesundheitShahroud University of Medical SciencesMedical Research CouncilDebre Tabor UniversityUniversity of CalcuttaYonsei UniversityEdith Cowan UniversityUniversity of South AustraliaU.S. Food and Drug AdministrationPublic Health AgencyNewcastle UniversityUniversity of TorontoImperial College LondonHamad Bin Khalifa UniversityShenzhen UniversityUniversità degli Studi di PaviaBaki Dövlət UniversitetiMiddlesex UniversitySamara UniversityArak University of Medical SciencesSalahaddin University-ErbilUnited Nations Population FundMarch of Dimes FoundationBrigham and Women's HospitalTrường Đại học Nguyễn Tất ThànhWest Virginia UniversityA.T. Still UniversityMinistério da Ciência, Tecnologia e Ensino SuperiorTrường Đại học Duy TânFundação para a Ciência e a TecnologiaBill and Melinda Gates FoundationUniversità degli Studi di MilanoIran University of Medical SciencesHamadan University of Medical SciencesKhalifa University of Science, Technology and ResearchPublic Health Agency of CanadaNational Institutes of HealthGolestan University of Medical SciencesInstitute for Research in Fundamental SciencesAksum UniversityKaiser PermanenteSouth African Medical Research CouncilMoscow Institute of Physics and TechnologyKasturba Medical College, ManipalHarvard UniversityBanaras Hindu UniversityIstituto di Ricerche Farmacologiche Mario Negri - IRCCSJohns Hopkins UniversityU.S. Department of Veterans Affairs

Keywords

Burden of diseaseDisease burdenDiseaseMedicineEnvironmental healthCancerGeographyPathologyInternal medicine

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