The global, regional, and national burden of stomach cancer in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease study 2017

Abstract

Stomach cancer is a major health problem in many countries. Understanding the current burden of stomach cancer and the differential trends across various locations is essential for formulating effective preventive strategies. We report on the incidence, mortality, and disability-adjusted life years (DALYs) due to stomach cancer in 195 countries and territories from 21 regions between 1990 and 2017.

Methods

Estimates from GBD 2017 were used to analyze the incidence, mortality, and DALYs due to stomach cancer at the global, regional, and national levels. The rates were standardized to the GBD world population and reported per 100,000 population as age-standardized incidence rates, age-standardized death rates, and age-standardized DALY rates. All estimates were generated with 95% uncertainty intervals (UIs).

Findings

In 2017, more than 1.22 million (95% UI 1.19–1.25) incident cases of stomach cancer occurred worldwide, and nearly 865,000 people (848,000–885,000) died of stomach cancer, contributing to 19.1 million (18.7–19.6) DALYs. The highest age-standardized incidence rates in 2017 were seen in the high-income Asia Pacific (29.5, 28.2–31.0 per 100,000 population) and east Asia (28.6, 27.3–30.0 per 100,000 population) regions, with nearly half of the global incident cases occurring in China. Compared with 1990, in 2017 more than 356,000 more incident cases of stomach cancer were estimated, leading to nearly 96,000 more deaths. Despite the increase in absolute numbers, the worldwide age-standardized rates of stomach cancer (incidence, deaths, and DALYs) have declined since 1990. The drop in the disease burden was associated with improved Socio-demographic Index. Globally, 38.2% (21.1–57.8) of the age-standardized DALYs were attributable to high-sodium diet in both sexes combined, and 24.5% (20.0–28.9) of the age-standardized DALYs were attributable to smoking in males.

Interpretation

Our findings provide insight into the changing burden of stomach cancer, which is useful in planning local strategies and monitoring their progress. To this end, specific local strategies should be tailored to each country's risk factor profile. Beyond the current decline in age-standardized incidence and death rates, a decrease in the absolute number of cases and deaths will be possible if the burden in east Asia, where currently almost half of the incident cases and deaths occur, is further reduced.