Burden, Epidemiologic Patterns, and Risk Factors of Early-Onset GI Cancers in China, With Projections Till 2035: A National Ecologic Study.

Abstract

GI cancers contribute substantially to global cancer morbidity and mortality. China experiences a high burden of GI cancers, yet the burden, epidemiologic trends, and attributable risk factors of early-onset GI cancers in China have not been systematically investigated. We conducted a population-based ecologic study with data from the Global Burden of Disease 2023. Early-onset GI cancers were defined with the diagnosis during age 20-49 years. Temporal trends were evaluated using Joinpoint regression and age-period-cohort models. Risk-attributable mortality was assessed using the comparative risk assessment framework. Exponential smoothing models were applied to project incidence rates through 2035. In 2023, early-onset colorectal cancer had the highest incidence rate (7.31 [95% CI, 5.73 to 9.58] per 100,000), whereas stomach cancer had the highest mortality rate (3.30 [95% CI, 2.45 to 4.47] per 100,000). From 2000 to 2023, both incidence and mortality rates generally declined across early-onset GI cancers (average annual percent change range: -0.85 to -4.21 for incidence; -0.97 to -4.86 for mortality). However, all GI cancer sites showed increasing trends during 2020-2022. Risk-attributable patterns varied by sex, age group, and cancer type, with tobacco and alcohol contributing more prominently to mortality among males. Forecasts suggested largely stable trends for most sites through 2035, with persistent sex disparities. Early-onset GI cancers in China showed overall declines over the past two decades but a concerning rebound since 2020, alongside substantial heterogeneity in attributable risks by sex and age. These findings support longitudinal monitoring, alongside strengthened risk-stratified screening and targeted, integrated prevention strategies in alignment with the Healthy China 2030 agenda.