Global, Regional, and National Epidemiology and Risk Factors of Geriatric Digestive System Cancers from 1990 to 2021

Congcong Xu¹Jing Chen¹Qingliang Wang²Chun Ju Fang³Hanyu Yu¹Qingna Liang⁴Xin Wang^5*

• ¹Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences（Qingdao Central Hospital）,Qingdao 266000,China., Qingdao, China
• ²Department of Hepatobiliary-Pancreatic-Splenic Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
• ³Department of Oncology, Guizhou Provincial People’s Hospital,, Guiyang, China
• ⁴Department of Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences（Qingdao Central Hospital), Qingdao, China
• ⁵Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Qingdao, China

Background: Using Global Burden of Disease (GBD) 2021 data, we analysed incidence, mortality, disability-adjusted life years (DALYs), and risk factors for six geriatric digestive system cancers (GDSC) in adults aged ≥60 years from 1990–2021; assessed Socio-demographic Index (SDI) impacts; and projected trends to 2050. Methods: The joinpoint regression model was used to analyse the age-standardized data for temporal trends; the decomposition method was used to assess the contributions of population growth, aging, and epidemiological changes; and frontier analysis was used to evaluate opportunities for burden reduction across countries. Results: Globally, the incidence of GDSC increased from 1,876,969 (age-standardized incidence rate [ASIR] 405.48/100,000) in 1990 to 3,854,209 (ASIR 360.89/100,000) in 2021, with a slight decrease in ASIR (−0.57% average annual percentage change [AAPC]). From 1990 to 2021, global GDSC deaths rose to 2,856,742, but age-standardized mortality rate (ASMR) declined to 270.14, with an AAPC of −1.72%. Gastric cancer showed the largest decline in incidence (−2.21% AAPC), whereas liver cancer increased (0.74% AAPC). Gender disparities were evident, with higher rates in males. High-income Asia-Pacific and East Asia had the highest ASIR and ASMR. Decomposition analysis showed that population growth was the major factor in GDSC burden changes, especially in high-SDI regions. By 2050, ASIR and ASMR are expected to continue declining, particularly for esophageal and gastric cancers. Major risk factors include smoking, alcohol, diet, and metabolic factors such as high body mass index (BMI) and elevated fasting glucose. Conclusions: Despite an overall decline in GDSC burden, health disparities persist, particularly between high-and low-SDI regions. The study provides valuable insights into risk factors and projections for disease burden and offers guidance for targeted prevention efforts.