Global burden of stomach cancer attributable to alcohol use (1990-2023): A comprehensive epidemiological analysis.

e16361 Background: Alcohol consumption is a Group 1 carcinogen by the International Agency for Research on Cancer, yet its attributable burden to stomach cancer (SC) remains understudied in global burden assessments. This systematic analysis leverages GBD 2023 data to quantify the evolving burden of alcohol-attributable SC from 1990-2023. Methods: Data were extracted from the GBD Study 2023 with comprehensive surveillance of incidence, mortality, disability-adjusted life years (DALYs), age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and age-standardized DALY rates (ASDR-DALY). Population-attributable fractions (PAF) for alcohol use were computed using comparative risk assessment frameworks, stratified by age, sex, sociodemographic index (SDI), and geographical regions. Results: In 2023, alcohol use was responsible for 178,000-195,000 incident SC cases globally (95% UI: 162,000-211,000), representing a PAF of 3.2-4.8%. Mortality attributable to alcohol-related SC reached 89,500-102,300 deaths annually (95% UI: 78,400-115,200), accounting for 3.4% of total SC mortality. DALYs attributable to alcohol consumption totaled 2.15-2.58 million (95% UI: 1.89-2.94 million), contributing 3.1% to global SC burden. ASIR revealed 2.45-2.89 per 100,000 person-years (95% UI), with males demonstrating 2.3-fold higher burden than females (male ASIR: 3.72-4.15 vs. female: 1.62-1.88 per 100,000). Conversely, ASDRs declined modestly by 8.3% (95% UI: -4.2 to -12.8%), reflecting improvements in diagnostic and treatment capacities. Regional stratification demonstrated that 67% of alcohol-attributable SC mortality occurred in East Asia, Central Asia, and South Asia, with Mongolia (ASDR: 3.24 per 100,000), Korea (2.15), and China (1.89) exhibiting highest burdens. Sociodemographic index analysis indicated inverse correlation between SDI and PAF, with low-SDI regions showing PAF of 5.2-6.1%, compared to high-SDI regions at 2.1-2.4%.Temporal analysis revealed two distinct epidemiological phases: Phase 1 (1990-2010) showed rising absolute cases (+32%) with declining age-standardized rates (-12.1%), reflecting competing forces of population growth and risk factor mitigation. Phase 2 (2010-2023) demonstrated accelerating absolute burden (+24.5%) with near-plateaued age-standardized improvements (-1.8% APC). Among alcohol-attributable cancers globally, SC represented 8.2% (95% UI: 6.8-9.6%) in 2023, ranking third after liver (27%) and esophageal cancers (24%). Conclusions: Alcohol use remains a significant but modifiable determinant of global SC burden, with 3.2-4.8% of all SC cases preventable through alcohol cessation. The 48.2% increase in absolute deaths from 1990-2023, coupled with persistent regional disparities, underscores urgent need for region-targeted alcohol reduction interventions in high-burden settings.