Global Burden of Early-Onset Esophageal Cancer From 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021.

Objective: To estimate the global burden of early-onset esophageal cancer (EOEC) and its associated risk factors from 1990 to 2021.

Methods: We utilized data from the Global Burden of Disease study 2021 to assess EOEC incidence, mortality, and disability-adjusted life years (DALYs) across 204 countries. Statistical modeling techniques, including age-period-cohort analysis and joinpoint regression, were employed to assess trends.

Results: In 2021, the global age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) for EOEC were 1.24 (95% CI: 1.19-1.40), 0.95 (95% CI: 0.85-1.08), and 45.07 (95% CI: 40.03-50.89) per 100 000 population, respectively. The highest burden was observed in countries with high-middle SDI, while high-SDI countries had the lowest rates. Regionally, Southern Sub-Saharan Africa had the highest ASIR and ASMR, whereas Andean Latin America reported the lowest. Men consistently exhibited higher incidence and mortality rates than women, with rates approximately three times greater. Between 1990 and 2021, significant global reductions in ASIR, ASMR, and ASDR were observed, particularly between 2003 and 2007, driven primarily by improvements in high-SDI countries. Smoking and alcohol consumption emerged as predominant risk factors, contributing substantially to DALYs in high- and middle-SDI countries, while low vegetable intake was a key risk factor in low-SDI countries.

Conclusions: While EOEC incidence and mortality have declined globally, persistent disparities in low-SDI countries demand urgent attention. Prioritizing risk factor interventions will be essential in high-risk populations. Coordinated global efforts, aligned with international health goals, are crucial to closing the gap and addressing regional needs.