Global trends and sociodemographic inequalities in smoking and high-salt diet attributable to gastric cancer: a secondary analysis based on the global burden of disease 2021 study.

[BACKGROUND] Gastric cancer is a common malignancy worldwide. Smoking and a high-salt diet are behavioural risk factors for gastric cancer that can be easily controlled; however, comprehensive and systematic studies are lacking. This study reports the variation trend in the attribution of the burden of gastric cancer in different regions from 1990 to 2021 and suggests personalised recommendations developed for regions with different sociodemographic indices (SDI).

[METHODS] In this project, the Global Burden of Disease (GBD) database was used to describe the variation trend of gastric cancer risk factors over time at the global, regional, and national levels. The trend was analysed based on a joinpoint regression analysis model, to determine whether there were significant differences in the risk factors in different regions. Finally, based on an autoregressive integrated moving average (ARIMA) model, we predicted the impact of the two risk factors on the burden of gastric cancer over the next 15 years.

[RESULTS] In 2021, smoking was the main contributor to global gastric cancer deaths and disability-adjusted life years (DALYs), and was the main factor contributing to the burden of gastric cancer in high SDI regions (10.84%), high-middle SDI regions (13.13%), and middle SDI regions (11.67%). A high-salt diet was the main factor contributing to the burden of gastric cancer in low-middle SDI regions (7.71%) and low SDI regions (7.06%). Males have the most severe gastric cancer burden, mainly owing to smoking. These two risk factors vary significantly across regions and countries. Similar trends were observed in China, Japan, and South Korea. Smoking will continue to be the main cause of gastric cancer burden over the next 15 years.

[CONCLUSIONS] Smoking is the major contributor to the burden of gastric cancer relative to a high-salt diet, and controlling smoking is the key to further reducing the burden of gastric cancer. Economic development constitutes a significant determinant of gastric cancer attribution, as evidenced by the correlation between SDI variations and the burden of gastric cancer.