A retrospective cross-sectional analysis of global esophageal cancer and gastroesophageal reflux disease burden: temporal trends, regional disparities, and epidemiologic associations

Esophageal cancer (EC) demonstrates poor prognosis and regional disparities. Gastroesophageal reflux disease (GERD) is an established risk factor for adenocarcinoma, though its link to squamous cell carcinoma remains debated. Materials and Methods We analyzed data from 204 countries and territories (1990–2021) using the Global Burden of Disease (GBD) 2021 study. Incidence and disability-adjusted life years (DALYs) for EC and GERD were assessed by age, sex, and region. Time-series modeling, hierarchical clustering, and time-lagged analysis were employed to explore epidemiological trends and potential associations. Results In 2021, EC caused 576,529 new cases and 12.99 million DALYs globally, with an age-standardized DALY rate of 148.6 per 100,000. GERD accounted for 324.1 million new cases and 6.34 million DALYs, corresponding to a rate of 75.6 per 100,000. East Asia had the highest EC burden, while GERD burden peaked in Tropical Latin America. From 1990 to 2021, EC burden declined, while GERD increased slightly. EC burden remained high in men and in high-middle socio-demographic index (SDI) regions. GERD showed less sex disparity and was highest in low-middle SDI regions. Major regional risk factors included smoking (East Asia), alcohol (Europe), and tobacco chewing (South Asia). Forecasts suggested rising GERD burden and fluctuating EC trends. No global causal link was found between GERD and EC, but region- and sex-specific associations were observed, notably in Central Sub-Saharan Africa and among Australasian females. Conclusion Despite declining trends of EC burden, geographical and demographic disparities persist. Rising GERD prevalence may affect future EC risk in some populations. Region-specific prevention strategies targeting GERD and known EC risk factors are warranted.