Esophageal cancer mortality in China, 2008-2021: trends, disparities, and projections

Using national mortality surveillance data, this study aimed to characterize temporal trends and population disparities in esophageal cancer mortality risk and premature mortality burden in China from 2008 to 2021, thereby informing stratified prevention and control strategies.

Esophageal cancer deaths were obtained from the Disease Surveillance Points (DSP) system of the Chinese Center for Disease Control and Prevention (2008-2021) and identified using ICD-10 code C15. We calculated the crude mortality rate (CMR), age-specific mortality rate, age-standardized mortality rate (ASMR), years of potential life lost (PYLL), and the PYLL rate (PYLLR), stratified by sex, age group, residence (urban/rural), and region (eastern/central/western China). ASMRs were estimated by direct standardization using the age structure of the 2010 Sixth National Population Census as the standard population. Joinpoint segmented regression was applied to estimate annual percent change (APC) and average annual percent change (AAPC). Group differences were assessed using chi-square tests in R. Age, period, and birth-cohort effects were examined with the US National Cancer Institute (NCI) online Age-Period-Cohort tool. An ARIMA model was fitted to the 2008-2021 ASMR time series to project ASMR trends for 2022-2036.

From 2008 to 2021, the ASMR of esophageal cancer in China declined from 14.39 to 7.62 per 100,000, indicating a sustained downward trend (AAPC = -4.82%). PYLLR also decreased from 0.77‰ to 0.41‰ (AAPC = -4.55%), suggesting concurrent reductions in mortality risk and premature mortality burden; however, their stratified and segmented patterns were not fully concordant. The burden was concentrated in older adults. Across the study period, ASMR and PYLLR were consistently higher in males than females and higher in rural than urban residents. Regional disparities across eastern, central, and western China narrowed over time, accompanied by shifts in relative ranking. ARIMA projections indicated that ASMR may continue to decline during 2022-2036, with increasing uncertainty over longer horizons.

Esophageal cancer mortality risk and premature mortality burden in China decreased substantially between 2008 and 2021, yet persistent-and dynamically evolving-inequalities by sex, residence, and region remain. Future control efforts should maintain the overall downward trajectory while prioritizing high-burden populations and key areas, strengthening early detection and early treatment, and optimizing stratified resource allocation to reduce ongoing health disparities.