Gastric Cancer in China, 1990 to 2023: Trends, Modifiable Risks, and Prevention Priorities.

[BACKGROUND] Gastric cancer (GC) remains a leading cause of cancer death in China. We quantified long-term trends in GC incidence, mortality, prevalence, and disability-adjusted life years (DALYs) from 1990 to 2023, by sex and age, and profiled the burden attributable to key behavioural risks.

[METHODS] We used Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates for China to obtain all-age numbers and age-standardized rates for incidence (ASIR), mortality (ASMR), prevalence (ASPR), and DALYs (ASDR) with 95% uncertainty intervals (UIs). Joinpoint log-linear regression was applied to derive the average annual percent change (AAPC) in age-standardized indicators overall and by sex and 3 age groups (15 to 49, 50 to 74, and ≥75 y).

[RESULTS] In 2023, China had 575,712 incident GC cases, 381,500 deaths, 1,363,127 prevalent cases, and 8,909,848 DALYs. Compared with 1990, incident and prevalent cases increased by 21.6% and 85.6%, whereas deaths and DALYs decreased by 10.9% and 26.6%. ASMR and ASDR declined from 50.93 to 16.62 and from 1,314.69 to 390.14 per 100,000 while the ASIR and ASPR also declined. Males and adults aged 75 years or older had the highest and most slowly declining burdens. Smoking, high sodium intake, and high alcohol use together accounted for a substantial but shrinking age-standardized share of GC deaths and DALYs.

[CONCLUSIONS] The GC burden in China has shifted toward lower ASMR and ASDR, but with higher case numbers, increasingly concentrated in older individuals and males, underscoring the need for intensified risk factor control and risk-adapted endoscopic screening.