Trends and Projections of Esophageal Cancer Incidence and Mortality in China, 1990 to 2050

Goals: The study aims to analyze and project esophageal cancer trends in China from 1990 to 2023 using GBD 2023 data. Background: Esophageal cancer (EC) remains a major public health challenge in China. Updated evidence on long-term trends and future burden is needed to inform prevention and control strategies. Methods: We extracted EC incidence and mortality data for China from 1990 to 2023 from the Global Burden of Disease (GBD) 2023 study. Joinpoint regression was used to characterize temporal changes and estimate annual percentage change (APC) and average annual percentage change (AAPC) in age-standardized incidence and mortality rates (ASIR/ASMR). Autoregressive integrated moving average (ARIMA) models were applied to project rates through 2050. Results: From 1990 to 2023, EC ASIR declined from 28.23 to 11.45 per 100,000, with an overall AAPC of −2.56% (95% CI: −3.00 to −2.13). ASMR decreased similarly, with an AAPC of −2.94% (95% CI: −5.36 to −0.47). Joinpoint analysis identified multiple trend segments, with the steepest decline in ASIR during 2007 to 2014 (APC: −7.00%). Notably, after a prolonged decrease, ASIR rebounded significantly during 2020 to 2023 (APC: 4.86%; 95% CI: 3.01-6.73). Conclusion: Although China has markedly reduced the esophageal cancer burden since 1990, the post-2020 rebound in incidence calls for intensified surveillance and rapid evaluation of potential drivers. Priority actions include risk-stratified prevention and strengthened targeted screening for high-risk populations.