Age-Period-Cohort Analysis on the Burden of Gastrointestinal Cancers in China: Trends, Risk Factors, and Predictions

Background: Gastrointestinal cancer imposes a heavy public health burden worldwide. The six major subtypes of GI cancer cases accounted for over a quarter of the total cancer cases in China. We examined and predicted the amount and trend of the burden of gastrointestinal cancer in China. Methods: We collected the crude incidence rate (CIR), age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), crude DALY rate, age-standardized DALY rate, crude death rate (CDR), and age-standardized death rate (ASDR) by gender, age, and risk factors from the Global Burden of Disease 2021 database, covering the period from 1990 to 2021. We used an age–period–cohort (APC) model to calculate the age, period, and cohort effects separately and a Bayesian APC model to predict the epidemiological trends and the age-specific incidence. Results: In 2021, 1,957,948 incidence cases of gastrointestinal cancers were estimated in China, with an incidence rate of 137.62 per 100,000. The burden was notably higher for males, with tobacco use accounting for 26.48% of male GI cancer DALYs versus dietary risks (13.22%) being predominant in females. Metabolic risk factors showed concerning growth trends, with high fasting plasma glucose increasing by 166.06% in males and 275.72% in females. The age–period–cohort analysis revealed peak incidence at advanced ages (>80 years) for most GI cancers. By 2050, China’s gastrointestinal cancer burden is projected to increase substantially, with total cases reaching 2.92 (95% CI: 2.27, 3.77) million (49.06% increase) and crude incidence rate rising to 230.51 (95% CI: 178.98, 298.03) per 100,000 (a 67.49% increase), predominantly driven by colorectal cancer (41.74%) and stomach cancer (21.47%). While crude incidence rates show consistent increases across all GI cancers, particularly in males, age-standardized incidence rates are predicted to decrease for most cancer types except for male colorectal and biliary tract cancers. Conclusions: The burden of gastrointestinal cancer in China is growing rapidly and will continue to increase. The performance of ASIR indicated that population aging is a potential driver of the increasing burden. Cancer control policies should focus on older people. It is critical to distinguish prevention strategies by gender and age according to the major risk factors.