Global burden of smoking-attributable digestive cancers From 1990 to 2021: insights from the global burden of disease study

Background: Smoking is causally linked to multiple cancers. We present global, regional, and national estimates of smoking-attributable digestive cancers (SADC) burden from 1990 to 2021 to inform smoking policy and cancer control. Methods: We analyzed data from the Global Burden of Disease (GBD) study, encompassing five subtypes of digestive cancers across 204 countries and territories. We estimated the mortality and disability-adjusted life years (DALYs) of SADC. Temporal trends were quantified by calculating the estimated annual percentage change (EAPC) of age-standardized rates. Results: Global SADC deaths increased from 347,533 in 1990 to 486,225 in 2021, while DALYs rose from 9.44 million to 11.81 million. The age-standardized mortality rate (ASMR) decreased from 8.8 to 5.6 per 100,000 [EAPC = —1.54], and the age-standardized DALY rate (ASDR) decreased from 228.5 to 134.7 per 100,000 [EAPC = —1.8]. In 2021, esophageal, stomach, and pancreatic cancers contributed the most deaths. The highest population-attributable fraction (PAF) for SADC deaths was observed in East Asia, High-Income North America, Central Europe, and Eastern Europe. China and Mongolia bear the greatest burden, with China having the highest number of deaths and DALYs globally, and Mongolia having the highest ASMR and ASDR, with increasing trends. Conclusion: Despite the downward trends in ASMR and ASDR, the global burden of SADC remains significant, with notable regional disparities. Effective anti-smoking policies and increased public awareness of smoking-related digestive cancer risks are essential to reduce smoking rates and mitigate the burden of SADC.