Assessment of the global burden of esophageal cancer from 1990 to 2021 and the forecasted global burden in 2050: Results from the Global Burden of Disease Study 2021

Background Esophageal cancer is a leading cause of cancer-related incidence and mortality globally. This study evaluates the global burden of esophageal cancer from 1990 to 2021 across various regions and populations, examines associated risk factors, and projects future trends through 2050. Methods We extracted esophageal cancer data from the Global Burden of Disease Study 2021, including incidence, deaths, Disability-Adjusted Life Years (DALYs), age-standardized rates (ASRs), and attributable risk factors from 1990 to 2021, stratified by gender and region. Regression analyses were employed to evaluate trends in esophageal cancer burden across regions and populations, while Bayesian age-period-cohort models were used to forecast future trends. Results Globally, the incidence of esophageal cancer rose from 354,731 cases (95% UI: 388,914.46–317,512.39) in 1990 to 576,529 cases (95% UI: 645,648.46–509,492.07) in 2021, while deaths increased from 356,263 to 538,602 during the same period. The age-standardized incidence rate decreased from 8.86 (95% UI: 9.69–7.96) to 6.65 (95% UI: 7.45–5.88) per 100,000, the age-standardized mortality rate decreased from 9.02 (95% UI: 9.87–8.11) to 6.25 (95% UI: 7.00–5.53) per 100,000. By 2021, incidence among the elderly population (> 80 years) had increased, particularly in high Social-Demographic Index (SDI) regions. Key risk factors contributing to death and DALYs from esophageal cancer include smoking, alcohol use, low vegetable intake, and chewing tobacco. The global burden of esophageal cancer is projected to continue increasing through 2050. Conclusions The burden of esophageal cancer varies significantly across regions, populations, and age groups. Although ASRs have decreased over recent decades, esophageal cancer remains a leading cause of incidence and death, particularly in high-middle SDI regions such as East Asia and sub-Saharan Africa. The identification of attributable risk factors underscores the need for targeted prevention strategies. Absolute incidence, death, and Disability-Adjusted Life Years are projected to rise due to population growth and aging. Future efforts should prioritize precision interventions and the reduction of known risk factors to mitigate the global burden.