Burden, patterns, and risk factors of esophageal cancer mortality in China, 2008-2021: a national mortality surveillance system data analysis

Background: Globally, China has the highest burden of esophageal cancer (EC). This study aims to analyze the trends and patterns of EC deaths in China. Methods: Data from the National Mortality Surveillance System were used to estimate national and provincial deaths, age-standardized mortality rate (ASMR), and years of life lost (YLL), which covered 605 disease surveillance points (DSPs) after 2013 and 161 DSPs before 2012 in mainland China. Joinpoint models were performed to calculate the average annual percent change (AAPC) by fitting the simplest joinpoint models (0 joinpoint). An age-period-cohort-based Nordpred model was used to predict trends until 2030. Multilevel Poisson and logistic regressions were used to assess factors influencing EC deaths, regional mortality and place of death. Findings: From 2008 to 2021, EC deaths and YLLs decreased from 227,677 to 167,529 (AAPC -2.19), and from 5.32 million to 3.50 million (AAPC -2.98). Meanwhile, ASMR and age-standardized YLL rate decreased from 24.34 to 11.01 per 100,000 (AAPC -5.49), and from 535.91 and 231.08 per 100,000 (AAPC -5.99). By 2030, EC deaths and ASMR are predicted to decline to 150,768 and 7.85 per 100,000. Nationwide, the average age at death increased from 68.46 to 72.45 years. Overall premature mortality was observed to decrease, except for increasing YLLs in urban populations aged ≥60 years. A substantial increase in the percentage of premature mortality burden occurred among older adults aged 65 years and older (63.62% in 2021; AAPC 2.40). Moreover, significant geographic variations were observed, ranging from ASMR of 2.84 (Xizang) to 21.62 (Jiangsu) per 100,000 in 2021. Higher burden was observed in rural than urban areas (2.01-fold), and among males than females (3.00-fold). Nationwide, individuals with agriculture-related occupations and low educational levels had significantly high risks of EC death. Regions with higher prevalences of smoking and harmful drinking, and low educational, economic, and medical levels were significantly associated with high mortality. Home was the leading place of EC deaths (80.02%). Interpretation: The EC mortality burden is decreasing in China but remains significant threats to public health. Promoting education, occupational prevention, healthy lifestyles, and medical treatment for targeted populations and regions is required. Funding: This research was supported by the Science and Technology Commission of Shanghai Municipality (21Y31900100).