Global, regional, and national burden of colorectal and stomach cancers attributable to smoking and alcohol use, 1990-2023, and projections to 2050.

OBJECTIVE

To quantify temporal and geographic trends in mortality and morbidity attributable to these risk factors from 1990 to 2023 and to project disease burden through 2050.

METHODS

Annual estimates of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were extracted by age, sex, and geographic region. Temporal trends in age-standardized rates were assessed using estimated annual percentage change (EAPC) derived from log-linear regression and joinpoint regression to identify inflection points. For projections through 2050, we applied an ensemble approach incorporating autoregressive integrated moving average (ARIMA) models, exponential smoothing state-space models, and Bayesian age-period-cohort (BAPC) analysis.

RESULTS

Between 1990 and 2023, age-standardized mortality from smoking-attributable gastric cancer declined substantially (EAPC -4.37, 95% CI -4.62 to -4.12), while declines for smoking-attributable colorectal cancer were more modest (EAPC -1.96, 95% CI -2.10 to -1.82). Alcohol-attributable colorectal cancer presented a complex pattern: although age-standardized rates decreased globally, absolute DALYs increased by 16.5%, with rising incidence in transitioning economies such as Vietnam. Males accounted for the majority of burden across all metrics.

CONCLUSIONS

While age-standardized rates for both malignancies have declined over three decades, absolute disease burden - particularly for colorectal cancer among men - persists.