Abstract / Summary
Asia carries most of the global esophageal cancer burden, but trends in rates may differ from changes in service demand. We assessed burden across 48 Asian locations during 2009–2023. We analyzed Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 estimates of incidence, prevalence, deaths, and disability-adjusted life years (DALYs). Primary analyses described 2023 burden and temporal trends. Secondary analyses examined age-sex patterns, Socio-demographic Index (SDI)-related inequality, and demographic decomposition. Pre-pandemic trend deviations, mortality-to-incidence indicators, and autoregressive integrated moving average (ARIMA) projections were exploratory. In 2023, the study region had 459,160 incident cases, 795,410 prevalent cases, 429,851 deaths, and 10,416,977 DALYs. From 2009 to 2023, incident cases and deaths increased by 29.7% and 28.8%, although age-standardized incidence and mortality rates were lower in 2023 than in 2009 in 31 and 33 locations, respectively. In the ages-20-or-older death decomposition, population growth (+78,696 deaths) and aging (+97,334) increased burden, whereas epidemiological change (−79,962) offset them; signed values are additive modeled contributions, not causal effects. The SDI-ranked slope index of inequality decreased for deaths (2009–2023 difference, −11.63; 95% confidence interval (CI), −22.39 to −0.86) and DALYs (−289.43; −548.41 to −30.45), but population-weighted fits were highly sensitive to China and India. All subregion-outcome series were cumulatively above direct count-model projections for 2020–2023. Projections used only 15 annual observations and were particularly sensitive to the GBD 2023 India trajectory. Declining age-standardized incidence and mortality rates should not be mistaken for diminishing esophageal cancer-care needs. Across the 48-location study region, absolute burden increased, with population growth and aging making positive contributions within the decomposition. These findings support locally tailored prevention, early detection, surveillance, and treatment-capacity planning.