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Population ageing and gastric cancer mortality burden in China, 2008-2021: a nationwide analysis with projections to
Haoyu Fang1, Yuezhou Zhang2, Yijiao Ning3
1Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Background:
Gastric cancer remains a major cause of mortality in China, yet updated nationwide evidence integrating mortality trends, premature mortality burden, and future projections is limited. Using data from China's Disease Surveillance Points (DSP) system, we evaluated long-term trends in gastric cancer mortality and demographic disparities.
Methods:
Gastric cancer deaths (ICD-10 code C16) from 2008 to 2021 were obtained from the national DSP system. Crude mortality rate (CMR), age-standardized mortality rate (ASMR), years of potential life lost (PYLL), and potential years of life lost rate (PYLLR) were estimated overall and by sex, residence (urban/rural), and region (eastern/central/western China). ASMRs were standardized to the 2010 Chinese standard population. Temporal trends were assessed using Joinpoint regression, age-period-cohort patterns using the National Cancer Institute age-period-cohort tool, and future ASMRs through 2036 using a Bayesian age-period-cohort model.
Results:
From 2008 to 2021, gastric cancer mortality declined substantially in China. CMR decreased from 20.64 to 18.39 per 100,000, while ASMR declined from 22.44 to 12.29 per 100,000. PYLLR also decreased from 1.38‰ to 0.83‰. Males and rural residents consistently had higher ASMRs and PYLLRs than females and urban residents. Regional disparities persisted, with ASMRs generally higher in eastern and central China than in western China, although the western region showed the steepest relative decline. Age-period-cohort analysis demonstrated a strong age effect, with mortality increasing sharply after age 60 and declining period and cohort effects over time. The burden of gastric cancer became increasingly concentrated among older adults. Model-based projections suggested continued declines in ASMR through 2036, although uncertainty widened over longer projection periods.
Conclusion:
Gastric cancer mortality and premature mortality burden declined substantially in China between 2008 and 2021, but important demographic and regional disparities remained. The larger decline in ASMR than in CMR, together with the increasing concentration of deaths among older adults, suggests that population ageing continues to reshape the future burden of gastric cancer.
