An Ecological Analysis of Rising Gastrointestinal Cancer Burden in Low- and Middle-Income Countries From 1990 to 2023

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Abstract
Introduction: Gastrointestinal cancers (GICs) impose substantial health loss in low- and middle-income countries (LMICs). We examined long-term burden patterns and temporal changes from 1990 to 2023. Methods: This ecological secondary analysis used Global Burden of Disease 2023 estimates of disability-adjusted life years (DALYs) and age-standardised DALY rates (ASDRs) for six GIC types in 130 LMICs from 1990 to 2023. Joinpoint regression described temporal trends, and decomposition analysis separated population growth, population aging, and changes in age-specific DALY rates. Results: From 1990 to 2023, total GIC-related DALYs increased from 34.72 to 43.16 million in upper-middle-income countries (UMCs), from 7.20 to 19.76 million in lower-middle-income countries (LMCs), and from 1.88 to 4.69 million in low-income countries (LCs). In UMCs, ASDRs for all GICs except pancreatic cancer declined, especially for esophageal and stomach cancers. In LMCs and LCs, ASDRs for stomach and liver cancers declined, whereas the other four subtypes increased. The shares of global DALYs occurring in UMCs increased for colorectal and pancreatic cancers but decreased for stomach and liver cancers. In contrast, DALYs rose for all six subtypes in LMCs and LCs. Decomposition analysis indicated that population growth and aging were important demographic contributors to the increase in DALYs, whereas the epidemiological changes was negative in UMCs and counterbalanced part of the demographic contribution. Conclusion: The overall DALY burden of GICs increased across LMICs, whereas ASDR trends were heterogeneous across cancer subtypes. These findings support country- and cancer-specific prevention and care priorities.
Funding Information
  • Science and Technology Planning Project of Medicine and Health in Zhuji City (2023YW084)

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