The Burden of Esophageal Cancer and Its Correlation with Dietary, Metabolic, and Behavioral Risk Factors in 204 Countries and Territories: Results from the Global Burden of Disease Study 2021

<i>Background and Objectives</i>: Esophageal cancer (EC) remains a major global public health challenge due to its aggressiveness and poor survival rates. Therefore, this study aims to summarize the incidence, mortality, prevalence, and global burden of EC based on sex, age, and geographical divisions and to investigate the correlation of some risk factors including the Sociodemographic Index (SDI) and important health indicators to identify high-risk populations. <i>Materials and Methods</i>: We extracted the number and age-standardized rates (ASRs) of EC incidence, mortality, disability-adjusted life years (DALYs), and targeted risk factors for 204 countries and territories from the Global Burden of Disease 2021 study. Correlations between the ASRs of incidence, death, and DALYs and risk factors were investigated using SPSS 22 with Spearman's correlation coefficient at a 0.05 significance level. <i>Results</i>: In 2021, the global age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate for EC were 6.65 (95% UI: 5.88-7.45), 6.25 (95% UI: 5.53-7.00), and 148.56 (95% UI: 131.71-166.82) per 100,000, respectively. Middle-SDI and high-middle-SDI regions showed the highest and lowest ASIR, ASDR, and DALY ASRs of EC. SDI correlated negatively with ASIR (-0.363), ASDR (-0.414), and DALY ASRs (-0.422). Male-to-female ratios for ASIR, ASDR, and DALY ASRs were 3.32, 3.37, and 3.51, respectively. As age increased, the incidence, death, and DALYs of EC also increased. East Asia recorded the highest incidence, death, and DALY values and ASRs of EC. The ASIR, ASDR, and DALY ASRs also increased with dietary risks, including the low intake of calcium, fruits, omega-6 polyunsaturated fatty acids, seafood omega-3 fatty acids, and vegetables. <i>Conclusions</i>: Considering the incidence, mortality, and high burden of EC in some regions, alongside the presence of modifiable risk factors, major interventions are needed to reduce these risks. Therefore, identifying high-risk areas and factors of EC, promoting lifestyle changes, and lowering the screening age could enable earlier detection and reduce the mortality of EC.