Smoking-attributable gastrointestinal cancer burden in Brazil, Russia, India, China and South Africa (BRICS) and Associated Economies: A Global Burden of Disease study analysis 1990-2023.

Abstract

Introduction: BRICS and associated economies have a considerable share of the world's population and cancer burden; however, long-term trends, heterogeneity and inflection points of smoking-attributable gastrointestinal (GI) cancers are still unclear. This retrospective population-based secondary analysis utilized Global Burden of Disease (GBD) 2023 data to investigate the mortality, disability-adjusted life years (DALYs) and age-standardized rates (ASRs) of smoking-attributable GI cancers among 11 BRICS and associated economies in 1990-2023, and to provide data-driven evidence for epidemiological and clinical prevention research on smoking-related GI cancers.

Methods: This secondary analysis used 2023 GBD data, which included five main types of GI cancers caused by smoking: esophageal, stomach, colon and rectum, liver and pancreas cancers. Mortality, DALYs and ASRs were analyzed at the global, region and country levels. Joinpoint regression was used to compute annual percentage change (APC) and average annual percentage change (AAPC).

Results: The total number of smoking-attributable GI cancer deaths in the study regions rose from 236305.08 in 1990 to 328324.75 in 2023 and total DALYs increased from 6.53 million to 8.08 million; the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) decreased with an AAPC of -1.44% and -1.48%, respectively. Brazil and China experienced the greatest declines in ASMR. India, Egypt and Ethiopia showed an increasing trend. Esophageal cancer was still the main cause of death and pancreatic cancer had the highest increase in mortality rate. Age-stratified analysis showed that the 20-29 years age group had a growing disease burden and the 40-64 years group had the largest decrease in DALYs. For people aged >75 years, the decline of disease burden decelerated.

Conclusions: The burden of smoking-attributable GI cancers in BRICS and associated economies has increased with rising absolute mortality and DALYs and falling ASRs. Regional disparities, age trends and rising youth risks reveal marked epidemiological differences in GI cancer burden.