Persistent Health Inequalities in the Burden of Gastrointestinal Cancers Among the Elderly From 1990 to 2021: A Population-Based Study

IntroductionGlobally, aging populations highlight gastrointestinal cancers as a major public health concern. Our study aimed to quantify the trends and inequalities in the burden of gastrointestinal cancers among the elderly from 1990 to 2021.MethodsUtilizing the 2021 Global Burden of Diseases (GBD) database, our secondary analysis targeted disability-adjusted life-years (DALYs) for gastrointestinal cancers among the elderly (60+). DALYs are a composite indicator of health loss, calculated as the sum of years of life lost due to premature mortality and years lived with disability. The age-standardized DALYs rate (ASDR) was calculated using the direct standardization method. Trends were quantified by estimated annual percentage change in ASDR. The Slope index of inequality (SII) and concentration index were employed to quantify absolute and relative health inequalities.ResultsIn 2021, colon and rectum cancer (CRC) had the highest global ASDR among the elderly, followed by stomach cancer (SC), esophageal cancer (EC), pancreatic cancer (PC), liver cancer (LC), and gallbladder and biliary tract cancer (GBTC). Between 1990 and 2021, ASDR for gastrointestinal cancers decreased globally, except for PC. Health inequalities exhibited varied patterns: EC showed a worsening inequality among lower SDI countries in SII, while SC experienced a shift to higher burden among lower SDI countries in SII. LC displayed an improving inequality among lower SDI countries in SII. The concentration index for EC, SC, and LC demonstrated a transition towards higher SDI countries. CRC, GBTC, and PC maintained a higher burden in higher SDI countries, while the SII and concentration index reflected improvements in inequality.ConclusionFrom 1990 to 2021, a substantial decline was observed in the burden of gastrointestinal cancers, except for PC. Persistent and evolving health inequalities highlight the need for comprehensive, multi-level interventions to reduce disparities and achieve equitable health outcomes for all.