Burden of esophageal cancer between 2010 and 2019 in Asian countries by geographical region and sociodemographic index: A comparison with global data

Abstract

Background

The aim of this study was to describe the trends in incidence, mortality, and burden of esophageal cancer (EC) in Asia from 2010 through 2019 and compare with other global continental data.

Methods

We collected EC data from the 2019 Global Burden of Disease study from 2010 to 2019 in 49 countries and territories in Asia based on the sociodemographic index (SDI). For all locations, annual case data and age‐standardized rates (ASRs) were extracted to investigate the EC incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs). The ASR relative difference (%) between years and the male/female (M/F) ratio were calculated. Data are reported in values and 95% uncertainty interval (UI).

Results

In 2019, more than 70% of EC new cases, deaths, prevalence, and DALYs occurred in Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALY number of EC increased over 1.10‐, 1.07‐, 1.14‐, and 1.03‐fold, in Asia. During this period, the age‐standardized incidence rate (ASIR), age‐standardized death rate (ASDR), age‐standardized prevalence rate (ASPR), and age‐standardized DALYs rate (DALYs ASR) of EC decreased by 18, 21, 14, and 22%, respectively. The rate of decline in Asia is higher than in the world and other continents. In 2019, age‐specific incidence, death, prevalence, and DALY cases of EC cancer peaked at 65–74, 70–74, 65–69, and 65–69 years, respectively. In 2019, the highest ASIR, ASDR, ASPR, and DALYs ASR of EC were observed in East Asian countries, while having the highest decreasing trend. In 2019, among high SDI Asian countries, Taiwan had the highest ASIR, ASPR, and DALYs ASR, and the United Arab Emirates had the highest ASDR. Among high‐middle SDIs, Kazakhstan had the highest ASIR, ASPR, ASDR, and DALYs ASR; among middle SDIs, China had the highest ASIR, ASDR, and ASPR, and Viet Nam had the highest DALYs ASR; among low‐middle SDIs, Mongolia had the highest ASIR, ASDR, ASPR, and DALY ASR of EC cancer. Among low SDI Asian countries, Pakistan had the highest ASIR and ASPR, and DALY ASR for EC cancer. For four indicators, in most countries, the ratio of men was higher than women, and in some countries, this ratio reached more than 10 times.

Conclusion

Although the rate of decline in incidence, death, prevalence and burden of EC in Asia was higher than in other areas in the last 10 years, more than 70% of these amounts occur in Asia. Therefore, it appears that adopting appropriate strategies in the field of identifying and controlling modifiable risk factors for EC, implementing screening programs, and timely diagnosis and treatment will help in reducing the burden of this disease in Asian countries.

In 2019, more than 70% of esophageal cancer (EC) new cases, deaths, prevalence, and DALYs occurred in Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALY number of EC increased over 1.10, 1.07, 1.14, and 1.03‐fold, in Asia. During this period, the age‐standardized incidence rate (ASIR), age‐standardized death rate (ASDR), age‐standardized prevalence rate (ASPR), and age‐standardized DALYs rate (DALYs ASR) of EC decreased by 18, 21, 14, and 22%, respectively. The rate of decline in Asia is higher than in the world and other continents.

INTRODUCTION

Esophageal cancer (EC) is the eighth most common cancer and the sixth deadliest cancer worldwide, ¹ and more than 500 000 deaths from EC occur worldwide each year, accounting for 5.3% of all global cancer deaths. ² Esophageal malignancies have a poor prognosis because they usually cause no symptoms and are therefore diagnosed very late. Distant metastases have developed in more than half of patients at the time of diagnosis. ³ For this reason, the survival rate of EC despite diagnostic and therapeutic advances is low and is at most 14%. ⁴ EC often occurs with chronic inflammation in the esophagus and disrupts normal cell growth. Alcohol consumption, smoking, low income, vitamin A and C deficiency, zinc deficiency, hot drinks, infections (such as human papillomavirus), and congenital diseases of the esophagus may increase the risk of developing EC. ³

EC has significant variations in incidence and mortality according to different geographical regions. ⁵ In the United States, the incidence and mortality of EC have shown a decreasing trend since 2010 after an increasing trend. ³ , ⁶ , ⁷ In China, the incidence and death of EC have been reported to be decreasing from 1990 to 2017, ⁸ and the average annual percentage decrease in death has been estimated as −4%. ⁹ Globally, the number of new cases of EC is predicted to increase rapidly in 2005–2030 due to increased exposure to risk factors and changing age composition of the population. ¹⁰ The incidence of EC in high‐incidence areas is 13‐fold higher than in low‐incidence areas, ¹¹ and its burden in some regions of the world is more than 35 times the disease burden in other regions. ¹² During the years 1980–2017, the incidence of EC has been increasing in males or females or both sexes in countries such as the Czech Republic, Spain, Japan, Norway, Thailand, the Netherlands, and Canada, while countries such as Bahrain, Colombia, Brazil, and India have seen a decreasing trend. ¹¹ The disability‐adjusted life years (DALYs) age‐standardized rate (ASR) of EC in China is about 1.3 times that of East Asia and the Pacific, twice that of the world, and more than twice that of Japan and South Korea. ¹³

Also, the highest prevalence of EC is observed in two geographical belts, one from north‐central China through the Central Asian republics to the north of Iran and the other from the east to the south of Africa. More than half of EC‐related deaths occur in the Republic of China; ¹⁴ the lowest rate was observed in Central and Western America. ¹¹

On the other hand, the share of death caused by EC among other cancers is higher than the share of its incidence. While EC accounts for 3.2% of all cancer diagnoses worldwide, it accounts for 5.3% of all cancer deaths. ³ The human development index is one of the other influencing factors on the distribution of cancer in Asia; ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ , ²⁰ so countries in Malawi, East Asia, and regions with high average socioeconomic indicators have the age‐standardized incidence rates (ASIR) and age‐standardized death rate (ASDR), and this trend shows an upward trend in western sub‐Saharan Africa. ¹²

Therefore, due to the high prevalence of EC in Asia and the existence of the Asian belt, and also since new and accurate information about the trend of incidence rate, mortality and burden of EC in Asia is not available, the current study was conducted to investigate the incidence, prevalence, mortality and burden of EC in Asia based on sociodemographic index (SDI) data from 2010 to 2019 and compare it with the global trend. It is hoped that the results of this study will help to understand the differences and ways to prevent and control the burden of EC.

METHODS

Data source

Esophageal cancer incidence, mortality, prevalence and burden data for 49 Asian countries, six global burden of disease (GBD) regions, worldwide and four continents were extracted from the GBD 2019 study. The GBD 2019 query tool was used to extract data from the Global Health Data Exchange (GHDx) (http://ghdx.healthdata.org/gbd-results-tool), based on the International Classification of Diseases 10 (ICD‐10 code C15.9 for EC). Also, to obtain the comparative assessment of health loss due to 364 diseases and injuries, in GBD, epidemiological indicators (incidence, death, prevalence, years of life lost [YLL], years lived with disability [YLD], and DALY) by time, location, gender, and age group for 204 countries and territories from 1990 to 2019 were estimated. ²¹ , ²² , ²³

In this study, data were extracted for various classifications of Asian countries based on a SDI, and six GBD regions of Asia from 2010 to 2019 and compared with worldwide and other continental data. Specifically, we use data for North Africa and the Middle East, given that 15 out of 21 GBD countries in North Africa and the Middle East belong to West Asia. Also in Southeast Asia countries, two countries were from Africa.

GBD has developed a standardized international form of quality‐adjusted life year (QALY), known as DALY. One DALY is defined as a wasted year of healthy living as a result of premature death and years with a disability of specific severity and duration. “Premature” death is a death at an age when one is not expected to die. The expected age at the death of a person is calculated according to the expected mortality for a certain age in a population standardized to the population of Japan, which has the longest lifetime at birth in the world. The total number of DALYs for a given condition within a population is equal to the sum of YLLs and YLDs of known severity and duration. ²⁴ , ²⁵

The geometric average of three indicators including lag‐distributed income per capita, average educational attainment of people aged 15 years and older, and the total fertility rate (in people aged <25 years) is known as the sociodemographic index (SDI). ²⁶ The SDI reflect the levels of social and economic conditions that can affect health outcomes in a given location. Based on SDI values, countries and territories were categorized into five groups: low SDI (<0.45), low‐middle SDI (≥0.45 and <0.61), middle SDI (≥0.61 and <0.69), high‐middle SDI (≥0.69 and <0.80), and high SDI (≥0.80). ²⁷ , ²⁸

The weighted average of the age‐specific rates per 100 000 persons within the corresponding age groups of the WHO standard population is known as the age‐standardized rate (ASR). The ASR has omitted the differences in the age distribution of the population by applying the rates for each population to a standardized population. ¹²

Ethical considerations

The study received approval from the Ethics Committee of the Birjand University of Medical Sciences in Iran (IR.BUMS.REC.1400.414). There was no need for informed consent because of the use of anonymous data online.

Statistical analysis

We eliminated the influence of the different components of the age groups within the populations by using age‐standardized rates (per 100 000 populations) of certain epidemiological indicators. The data are reported on a 95% uncertainty interval (UI) basis. Also, the selected epidemiological indicators for each classification system are presented separately. We used the relative changes (%) between years to show comparative changes in age‐standardized rates. The relative changes were calculated by dividing the value of the absolute difference by the value of the year of origin, which is multiplied by 100. ²⁹ The M/F ratio was computed by dividing the male ASRs by the female ASRs of each epidemiological index. The definition of what has been used is available at https://www.healthdata.org/terms-defined and https://www.healthdata.org/gbd/.

RESULTS

Morbidity of EC in Asia

Compared with global data and continents

In Asia, the number of EC incidences increased from 356 945 (95% UI: 271 888–389 070) in 2010 to 391 200 (95% UI: 332 573–449 273) in 2019, which is over a 1.1‐fold increase. In 2019 approximately 73.2% (391 200/534 563) of EC cases happened in Asia countries (Figure 1). During this period, the ASIR of EC with an 18% change, decreased from 10.09 (95% UI: 7.64–10.99) per 100 000 in 2010 to 8.24 (95% UI: 6.96–9.43) per 100 000 in 2019. At the same time, this rate globally decreased by 13%, in America and Europe by 4%, and in Africa by 7% (Figure 2).

FIGURE 1.

Distribution of incidence, death, prevalence, and disability‐adjusted life years (DALYs) cases of esophageal cancer (EC) among continents, in 2019.

FIGURE 2.

Temporal trend of incidence, prevalence, death and disability‐adjusted life years (DALYs) age standard rates (per 100 000 population) of esophageal cancer (EC) in ASIA comparison with global data and other continents from 1990 to 2019.

In Asian men, the number of EC incidences increased from 256 218 (95% UI: 199 447–284 021) in 2010 to 284 642 (95% UI: 233 255–339 631) in 2019, which is approximately a 1.11‐fold increase. In 2019 approximately 72.8% of Asia EC new cases occurred in Asian men which included 73.2% (284 642/388 827) of global male EC incidence cases. During this period, the ASIR of EC with a 16% change, decreased from 15.02 (95% UI: 11.54–16.59) per 100 000 in 2010 to 12.56 (95% UI: 10.28–14.89) per 100 000 in 2019; in the same time, this rate globally decreased by 12%, in America by 3% and in Europe and Africa by 5% (Table 1).

TABLE 1.

Comparison of the incidence, death, prevalence and burden rates of EC in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019 (males).

Location	Incidence					Death
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)
Global	344 564	11.53	388 827	10.13	−0.12	327 911	11.20	365 554	9.68	−0.14
	(284 566–373 669)	(9.47–12.47)	(335 510–444 000)	(8.73–11.56)	(−0.24 to 0.01)	(268 057–354 337)	(9.08–12.09)	(315 014–415 028)	(8.34–10.96)	(−0.25 to 0.01)
Continents
Africa	17 195	7.31	21 560	6.94	−0.05	17 567	7.72	21 945	7.32	−0.05
	(13 231–19 552)	(5.63–8.31)	(16 606–26 094)	(5.34–8.3)	(−0.14 to 0.06)	(13 532–19 992)	(5.95–8.76)	(16 762–26 550)	(5.62–8.74)	(−0.14 to 0.05)
America	30 371	6.68	37 837	6.47	−0.03	29 439	6.53	36 806	6.32	−0.03
	(29 418–30 993)	(6.45–6.82)	(33 771–42 519)	(5.78–7.27)	(−0.13 to 0.09)	(28 379–30 085)	(6.28–6.68)	(35 045–38 302)	(6–6.58)	(−0.06 to 0)
Asia	256 218	15.02	284 642	12.56	−0.16	243 909	14.73	266 188	12.03	−0.18
	(199 447–284 021)	(11.54–16.59)	(233 255–339 631)	(10.28–14.89)	(−0.3 to 0.01)	(187 259–269 671)	(11.22–16.24)	(218 454–315 018)	(9.93–14.17)	(−0.33 to 0)
Europe	40 551	7.17	44 522	6.79	−0.05	36 769	6.53	40 349	6.14	−0.06
	(39 415–41 404)	(6.96–7.32)	(39 733–49 673)	(6.06–7.57)	(−0.15 to 0.05)	(35 702–37 560)	(6.33–6.67)	(37 858–42 649)	(5.76–6.49)	(−0.11 to −0.01)
Asian GBD regions
Central Asia	2367	9.85	2929	9.51	−0.03	2424	10.47	2958	10.09	−0.04
	(2236–2767)	(9.28–11.54)	(2551–3627)	(8.37–11.53)	(−0.14 to 0.08)	(2287–2840)	(9.85–12.29)	(2582–3657)	(8.9–12.2)	(−0.14 to 0.08)
East Asia	198 125	26.79	213 576	21.70	−0.19	193 131	27.24	202 627	21.34	−0.22
	(140 587–226 088)	(18.73–30.44)	(161 490–263 961)	(16.37–26.61)	(−0.36 to 0.03)	(134 224–219 400)	(18.59–30.79)	(156 174–251 212)	(16.45–26.2)	(−0.39 to 0.01)
High‐income Asia Pacific	20 349	12.62	21 385	10.68	−0.15	12 769	7.90	13 641	6.66	−0.16
	(19 211–21 352)	(11.9–13.3)	(17 785–25 794)	(8.87–12.89)	(−0.3 to 0.03)	(11 969–13 380)	(7.4–8.32)	(12 441–14 825)	(6.11–7.25)	(−0.2 to −0.1)
North Africa and Middle East	4415	2.81	6259	2.90	0.03	4510	2.97	6310	3.04	0.02
	(3052–4954)	(1.98–3.14)	(4554–7272)	(2.17–3.33)	(−0.09 to 0.13)	(3136–5057)	(2.1–3.32)	(4603–7341)	(2.26–3.48)	(−0.1 to 0.12)
South Asia	23 864	4.55	31 250	4.46	−0.02	24 110	4.77	31 647	4.65	−0.02
	(21 243–33 044)	(4.05–6.34)	(25 409–44 454)	(3.65–6.39)	(−0.19 to 0.16)	(21 441–33 883)	(4.26–6.71)	(26 005–44 168)	(3.84–6.45)	(−0.18 to 0.15)
Southeast Asia	8214	3.83	10 990	3.84	0.00	8177	3.97	10 823	3.94	−0.01
	(7246–9341)	(3.44–4.39)	(9179–13 033)	(3.23–4.55)	(−0.13 to 0.16)	(7255–9307)	(3.55–4.61)	(9081–12 957)	(3.33–4.73)	(−0.14 to 0.13)

Location	Prevalence					DALY
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100.000
	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)	(95% UI)
Global	588 747	19.07	677 214	17.22	−0.10	8248 564	262.20	8 821 716	221.38	−0.16
	(491 528–635 737)	(15.95–20.55)	(585 587–774 916)	(14.87–19.67)	(−0.22 to 0.04)	(6 834 157–8 924 224)	(216.52–283.5)	(7 626 694–10 090 930)	(191.21–252.21)	(−0.27 to −0.01)
Continents
Africa	24 817	9.92	31 733	9.57	−0.04	501 482	195.35	624 213	183.35	−0.06
	(19 237–28 173)	(7.66–11.29)	(24 367–38 603)	(7.36–11.52)	(−0.13 to 0.08)	(386 919–571 253)	(150.58–222.4)	(473 688–763 542)	(139.98–222.51)	(−0.16 to 0.06)
America	49 757	10.76	61 313	10.42	−0.03	719 914	154.23	869 566	147.83	−0.04
	(48 522–50 695)	(10.48–10.97)	(54 416–69 340)	(9.26–11.76)	(−0.14 to 0.1)	(702 926–733 041)	(150.48–157.14)	(836 474–903 429)	(142.2–153.53)	(−0.07 to −0.01)
Asia	438 319	24.47	500 172	21.28	−0.13	6 125 226	333.10	6 378 988	265.89	−0.20
	(344 347–483 623)	(19.28–26.93)	(412 671–596 468)	(17.63–25.18)	(−0.28 to 0.05)	(4 800 405–6 776 342)	(258.73–368.22)	(5 255 579–7 615 340)	(219.88–314.77)	(−0.35 to −0.01)
Europe	75 494	13.31	83 574	12.90	−0.03	896 542	158.77	942 815	147.25	−0.07
	(73 498–77 303)	(12.96–13.63)	(73 592–94 379)	(11.36–14.56)	(−0.15 to 0.09)	(878 326–912 487)	(155.45–161.6)	(886 885–1 001 854)	(138.28–156.52)	(−0.13 to −0.01)
Asian GBD regions
Central Asia	3328	12.87	4271	12.59	−0.02	63 820	241.15	79 409	229.67	−0.05
	(3141–3882)	(12.13–15.08)	(3705–5305)	(11.01–15.46)	(−0.14 to 0.1)	(60 296–74 508)	(227.51–282.5)	(68 672–98 503)	(200.63–282.88)	(−0.16 to 0.08)
East Asia	316 900	39.94	357 712	34.48	−0.14	4 798 559	597.85	4 762 730	456.24	−0.24
	(224 400–362 097)	(28.1–45.55)	(270 061–444 418)	(26.02–42.64)	(−0.33 to 0.11)	(3 386 198–5 456 180)	(419.09–678.37)	(3 693 718–5 949 237)	(356.28–566.73)	(−0.41 to 0)
High‐income Asia Pacific	65 153	40.78	67 837	35.05	−0.14	271 081	171.27	263 572	139.04	−0.19
	(61 501–68 240)	(38.58–42.74)	(56 037–82 269)	(28.8–42.54)	(−0.29 to 0.05)	(258 496–284 904)	(163.51–180.82)	(243 999–288 037)	(129.26–153.24)	(−0.23 to −0.13)
North Africa and Middle East	6471	3.87	9506	4.10	0.06	116 901	67.85	164 791	69.00	0.02
	(4431–7274)	(2.69–4.33)	(6858–11 099)	(3.02–4.73)	(−0.07 to 0.17)	(78 471–132 238)	(46.43–76.36)	(116 101–195 254)	(49.77–80.63)	(−0.1 to 0.11)
South Asia	35 142	6.31	45 889	6.25	−0.01	684 214	120.20	869 512	116.47	−0.03
	(31 310–48 353)	(5.62–8.71)	(37 353–64 920)	(5.09–8.83)	(−0.18 to 0.17)	(609 980–952 000)	(107.05–168.16)	(709 751–1 206 889)	(95.56–161.69)	(−0.2 to 0.14)
Southeast Asia	12 691	5.50	17 349	5.66	0.03	228 238	96.91	295 010	94.94	−0.02
	(10 900–14 323)	(4.85–6.21)	(14 342–20 625)	(4.72–6.74)	(−0.12 to 0.19)	(197 297–259 496)	(85.74–109.71)	(245 807–348 668)	(79.03–113.21)	(−0.15 to 0.13)

Abbreviations: ASR, age‐standardized rate; EC, esophageal cancer; UI, uncertainty interval.

In Asian women, the number of EC incidences increased from 100 727 (95% UI: 69 127–112 364) in 2010 to 106 558 (95% UI: 83 567–125 405) in 2019, which is over a 1.06‐fold increase. In 2019 approximately 27.3% of Asia EC new cases occurred in Asian women which included 73.1% (106 558/145 736) of global female EC incidence cases. During this period, the ASIR of EC with a 22% change, increased from 5.58 (95% UI: 3.79–6.23) per 100 000 in 2010 to 4.33 (95% UI: 3.39–5.1) per 100 000 in 2019; in the same time, this rate globally decreased by 16%, in Africa and America by 8%, in Europe by 5% (Table 2).

TABLE 2.

Comparison of the incidence, death, prevalence and burden rates of EC in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019 (females).

Location	Incidence					Death
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
Global	134 720	3.97	145 736	3.33	−0.16	125 203	3.70	132 513	3.02	−0.18
	(99 564–146 772)	(2.93–4.32)	(119 952–165 068)	(2.74–3.77)	(−0.27 to −0.01)	(94 284–136 223)	(2.79–4.03)	(110 337–150 271)	(2.52–3.43)	(−0.28 to −0.04)
Continents
Africa	10 600	4.56	13 086	4.19	−0.08	11 074	4.95	13 640	4.56	−0.08
	(7721–12 523)	(3.32–5.37)	(9777–16 167)	(3.14–5.14)	(−0.16 to 0.01)	(8031–12 987)	(3.63–5.8)	(10 152–16 857)	(3.39–5.58)	(−0.16 to 0.01)
America	9621	1.74	11 303	1.61	−0.08	9175	1.64	10 744	1.51	−0.08
	(8980–9986)	(1.64–1.81)	(10 030–12 605)	(1.43–1.79)	(−0.16 to 0.02)	(8468–9562)	(1.53–1.7)	(9802–11 415)	(1.38–1.6)	(−0.12 to −0.04)
Asia	100 727	5.58	106 558	4.33	−0.22	92 634	5.25	94 936	3.91	−0.26
	(69 127–112 364)	(3.79–6.23)	(83 567–125 405)	(3.39–5.1)	(−0.35 to −0.03)	(64 439–102 599)	(3.61–5.81)	(76 397–111 530)	(3.13–4.59)	(−0.37 to −0.07)
Europe	13 698	1.72	14 707	1.64	−0.05	12 245	1.48	13 110	1.39	−0.07
	(12 681–14 295)	(1.62–1.79)	(12 944–16 563)	(1.45–1.85)	(−0.14 to 0.06)	(11 244–12 812)	(1.38–1.55)	(11 855–14 083)	(1.27–1.48)	(−0.11 to −0.01)
Asian GBD regions
Central Asia	1679	5.18	1904	4.70	−0.09	1762	5.54	1966	5.00	−0.10
	(1597–1792)	(4.92–5.51)	(1690–2158)	(4.19–5.29)	(−0.19 to 0.01)	(1673–1883)	(5.25–5.91)	(1748–2222)	(4.48–5.6)	(−0.19 to 0)
East Asia	73 577	9.58	71 332	6.67	−0.30	66 362	8.89	60 680	5.78	−0.35
	(40 841–85 227)	(5.32–11.07)	(47 153–89 703)	(4.39–8.38)	(−0.45 to −0.05)	(37 133–76 321)	(4.97–10.22)	(41 265–75 995)	(3.9–7.24)	(−0.49 to −0.12)
High‐income Asia Pacific	3349	1.60	3773	1.46	−0.09	2317	1.03	2697	0.93	−0.10
	(2817–3676)	(1.41–1.73)	(2925–4592)	(1.16–1.78)	(−0.24 to 0.08)	(1898–2552)	(0.88–1.11)	(2149–3061)	(0.79–1.03)	(−0.14 to −0.03)
North Africa and Middle East	2908	1.89	3765	1.81	−0.04	2904	1.96	3659	1.83	−0.07
	(2008–3352)	(1.34–2.17)	(2647–4391)	(1.32–2.09)	(−0.11 to 0.04)	(2017–3347)	(1.39–2.25)	(2593–4292)	(1.32–2.11)	(−0.13 to 0.01)
South Asia	16 232	3.13	22 238	3.11	−0.01	16 401	3.29	22 514	3.24	−0.02
	(14 136–21 692)	(2.72–4.23)	(18 422–28 843)	(2.58–4.07)	(−0.16 to 0.18)	(14 179–22 227)	(2.81–4.46)	(18 720–30 018)	(2.69–4.34)	(−0.17 to 0.16)
Southeast Asia	3800	1.58	4553	1.43	−0.09	3808	1.63	4508	1.46	−0.11
	(3256–4361)	(1.34–1.81)	(3747–5461)	(1.19–1.71)	(−0.22 to 0.06)	(3234–4410)	(1.39–1.89)	(3707–5483)	(1.2–1.77)	(−0.23 to 0.03)

Location	Prevalence					DALY
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100.000	Number	ASR per 100.000
Global	249 514	7.30	283 396	6.49	−0.11	2749 269	80.31	2844 300	65.29	−0.19
	(179 992–274 219)	(5.27–8.03)	(227 258–327 384)	(5.2–7.49)	(−0.24 to 0.06)	(2125 165–2973 920)	(61.83–86.92)	(2434 410–3195 247)	(55.83–73.33)	(−0.28 to −0.04)
Continents
Africa	14 978	6.03	18 923	5.62	−0.07	289 347	113.26	354 636	102.49	−0.10
	(10 917–17 728)	(4.39–7.11)	(14 205–23 517)	(4.22–6.95)	(−0.16 to 0.03)	(208 365–341 875)	(81.99–133.17)	(263 690–440 459)	(76.29–126.52)	(−0.18 to 0)
America	17 024	3.15	20 111	2.94	−0.07	188 940	35.13	217 826	32.13	−0.09
	(16 148–17 647)	(2.99–3.26)	(17 852–22 579)	(2.61–3.3)	(−0.16 to 0.05)	(180 731–194 545)	(33.71–36.13)	(204 835–229 712)	(30.3–33.89)	(−0.13 to −0.04)
Asia	189 304	10.11	213 651	8.53	−0.16	2 038 098	108.49	2 030 044	80.86	−0.25
	(124 737–213 526)	(6.63–11.4)	(162 933–256 456)	(6.47–10.25)	(−0.31 to 0.07)	(1 486 721–2 241 893)	(78.45–119.54)	(1 698 323–2 364 559)	(67.5–94.12)	(−0.37 to −0.06)
Europe	28 087	3.78	30 574	3.70	−0.02	231 402	31.56	240 189	29.44	−0.07
	(26 277–29 379)	(3.58–3.94)	(26 957–34 637)	(3.27–4.21)	(−0.13 to 0.11)	(219 357–239 268)	(30.23–32.48)	(223 255–256 126)	(27.59–31.39)	(−0.11 to −0.01)
Asian GBD regions
Central Asia	2325	6.92	2739	6.40	−0.08	43 774	127.95	50 410	116.04	−0.09
	(2210–2481)	(6.59–7.37)	(2412–3121)	(5.68–7.25)	(−0.18 to 0.03)	(41 707–46 595)	(121.82–135.86)	(44 435–57 482)	(102.83–131.58)	(−0.2 to 0.02)
East Asia	143 071	17.81	154 238	14.09	−0.21	1 352 732	170.57	1 160 135	106.42	−0.38
	(76 697–167 452)	(9.52–20.82)	(99 612–196 549)	(9.09–17.93)	(−0.38 to 0.1)	(774 931–1 553 605)	(97.23–195.94)	(828 882–1 451 416)	(75.55–133.05)	(−0.52 to −0.13)
High‐income Asia Pacific	10 147	5.28	11 117	4.91	−0.07	40 324	21.47	42 547	19.04	−0.11
	(8767–11 134)	(4.71–5.72)	(8737–13 570)	(3.94–6.03)	(−0.23 to 0.12)	(35 444–43 411)	(19.58–22.91)	(36 443–47 498)	(17.09–20.91)	(−0.16 to −0.05)
North Africa and Middle East	4522	2.76	6223	2.79	0.01	75 329	44.86	94 696	41.58	−0.07
	(3119–5226)	(1.95–3.15)	(4422–7269)	(2.04–3.24)	(−0.07 to 0.11)	(49 581–88 712)	(30.4–52.17)	(62 662–113 396)	(28.49–49.12)	(−0.15 to 0.01)
South Asia	24 223	4.38	33 259	4.46	0.02	458 053	81.34	607 078	80.40	−0.01
	(21 153–32 071)	(3.82–5.86)	(27 474–42 646)	(3.69–5.75)	(−0.15 to 0.21)	(399 022–607 357)	(70.59–108.77)	(508 286–792 963)	(67.34–105.74)	(−0.18 to 0.18)
Southeast Asia	5891	2.31	7290	2.19	−0.05	96 164	37.10	108 715	32.29	−0.13
	(5029–6625)	(1.98–2.61)	(5957–8675)	(1.79–2.6)	(−0.2 to 0.12)	(80 870–111 442)	(31.3–43.11)	(89 146–131 593)	(26.6–38.95)	(−0.26 to 0.02)

Abbreviations: ASR, age‐standardized rate; EC, esophageal cancer.

Age distribution

In 2010, the age‐specific incidence cases of EC were peaking at 60–64 years generally and in males, and 70–74 in females. In 2019, age‐specific incidence cases of EC were peaking at 65–74 years generally, 65–69 years in males, and 70–74 in females. In all age groups, the incidence cases of EC in males were higher (Figure 3).

FIGURE 3.

Age‐specific incidence cases of esophageal cancer (EC) among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest ASIR of EC was observed in East Asia countries (13.72 [95% UI: 10.64–16.25]); with a 23% decrease compared with 2010, while all Asian regions experienced a decreasing trend from 2% to 23%; the North African and Middle East countries experienced a stable trend from 2010 to 2019 (Figure 4).

FIGURE 4.

Temporal trend of incidence, prevalence, death and disability‐adjusted life years (DALYs) age standard rates (per 100 000 population) of esophageal cancer (EC) in Asian regions from 1990 to 2019.

In men, the highest ASIR of EC was observed in East Asia countries (21.7 [95% UI: 16.37–26.61]); with a 19% decrease compared with 2010, while all Asian regions experienced a decreasing trend from 2% to 19%. The North Africa and Middle East region experienced an increasing trend from 3% in 2010 to 2019.

In women, the highest ASIR of EC was observed in East Asia countries (6.67 (95% UI: 4.39–8.38)); with a 30% decrease compared with 2010. All Asian regions experienced a decreasing trend of 1%–30% from 2010 to 2019 (by 22%) (Table 1 and Figure 4).

Based on the sociodemographic index

Among high SDI Asian countries, Taiwan (Province of China) (9.99) and United Arab Emirates (8.08) had the highest ASIR of EC, and Cyprus (1.41) had the lowest rate. In this group from 1990 to 2019, Kuwait had an upward trend; Brunei Darussalam and Taiwan (Province of China) reported a stable trend; and eight countries recorded a downward trend. Among high‐middle SDI Asian countries, Kazakhstan (7.35) and Sri Lanka (4.61) had the highest ASIR of EC, and Jordan (1.14) had the lowest rate. In this group, five countries experienced a downward trend, three countries reported an upward trend from 6% (Lebanon) to 15% (Jordan), and one country had a stable trend from 1990 to 2019. Among middle SDI Asian countries, China (13.90) and Turkmenistan (9.58) had the highest ASIR of EC, and the Syrian Arab Republic (0.92) had the lowest rate. In this group, five countries experienced a downward trend of 2%–23%, five countries reported an upward trend of 1%–12%, and two countries had a stable trend from 1990 to 2019. Among low‐middle SDI Asian countries, Mongolia (21.93) had the highest ASIR of EC, and Palestine (1.10) had the lowest rate. In this group from 1990 to 2019, three countries had an upward trend, one country reported a stable trend and nine countries recorded a downward trend. Among low SDI Asian countries, Pakistan (7.86) had the highest ASIR of EC, and Yemen (6.31) had the lowest rate. In this group, two countries experienced a downward trend and two countries an upward trend from 1990 to 2019. More details are presented in Table 3 and Figure 5.

TABLE 3.

The incidence distribution of EC cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

Location	SDI 2019	Both					Male
		2010		2019		% change 1990–2010	2010		2019		% change 2010–2019
		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	0.823	6	3.25	9	3.25	0.00	4	4.95	6	5.20	0.05
		(5–7)	(2.86–3.99)	(7–11)	(2.76–3.99)	(−0.14 to 0.18)	(3–5)	(4.19–6.1)	(5–8)	(4.24–6.47)	(−0.14 to 0.29)
Cyprus	0.841	22	1.58	27	1.41	−0.10	16	2.51	20	2.17	−0.13
		(17–25)	(1.24–1.76)	(21–33)	(1.08–1.69)	(−0.23 to 0.05)	(12–18)	(1.91–2.89)	(14–25)	(1.58–2.68)	(−0.3 to 0.05)
Israel	0.803	149	1.67	189	1.62	−0.03	91	2.30	118	2.26	−0.02
		(137–160)	(1.53–1.79)	(145–240)	(1.24–2.08)	(−0.25 to 0.24)	(84–97)	(2.13–2.47)	(91–152)	(1.72–2.9)	(−0.25 to 0.25)
Japan	0.87	21 048	7.29	21 521	6.45	−0.12	17 972	13.74	18 119	11.87	−0.14
		(19 508–21 880)	(6.87–7.54)	(17 654–25 788)	(5.29–7.79)	(−0.27 to 0.08)	(16 926–18 582)	(13–14.18)	(14 518–22 269)	(9.46–14.71)	(−0.3 to 0.09)
Kuwait	0.851	20	1.48	35	1.50	0.01	14	1.67	26	1.90	0.14
		(18–22)	(1.32–1.64)	(28–43)	(1.19–1.87)	(−0.18 to 0.23)	(13–15)	(1.47–1.86)	(20–34)	(1.44–2.45)	(−0.12 to 0.45)
Qatar	0.83	14	4.67	24	4.47	−0.04	11	4.87	19	4.84	−0.01
		(11–18)	(3.57–5.66)	(16–35)	(3.16–6.14)	(−0.28 to 0.29)	(8–16)	(3.69–6.2)	(12–30)	(3.35–6.69)	(−0.27 to 0.36)
Republic of Korea	0.878	2496	3.97	3419	3.76	−0.05	2255	8.47	3090	7.63	−0.10
		(2286–3381)	(3.63–5.36)	(2691–4689)	(2.96–5.16)	(−0.24 to 0.15)	(2053–2976)	(7.69–11.09)	(2405–4271)	(5.98–10.48)	(−0.28 to 0.09)
Saudi Arabia	0.805	208	1.89	313	1.78	−0.06	126	1.95	204	1.90	−0.03
		(179–277)	(1.66–2.34)	(235–433)	(1.38–2.36)	(−0.23 to 0.12)	(108–177)	(1.68–2.55)	(151–292)	(1.45–2.7)	(−0.23 to 0.17)
Singapore	0.861	148	3.06	210	2.71	−0.11	118	5.23	171	4.60	−0.12
		(136–161)	(2.8–3.31)	(162–269)	(2.12–3.45)	(−0.3 to 0.13)	(109–127)	(4.82–5.68)	(131–221)	(3.55–5.91)	(−0.31 to 0.12)
Taiwan (Province of China)	0.868	3153	10.03	3864	9.99	0.00	2905	18.81	3552	19.18	0.02
		(2987–3333)	(9.5–10.58)	(2922–5131)	(7.58–13.27)	(−0.25 to 0.32)	(2744–3077)	(17.8–19.89)	(2683–4729)	(14.52–25.5)	(−0.23 to 0.35)
United Arab Emirates	0.88	145	9.03	383	8.08	−0.11	122	9.42	343	9.77	0.04
		(43–247)	(2.64–15.58)	(114–655)	(2.54–13.84)	(−0.33 to 0.12)	(34–214)	(2.57–17.02)	(92–599)	(2.68–16.93)	(−0.18 to 0.28)
High‐middle SDI
Bahrain	0.751	9	2.16	16	1.94	−0.10	7	3.04	13	2.76	−0.09
		(8–11)	(1.81–2.46)	(12–22)	(1.45–2.48)	(−0.3 to 0.12)	(5–8)	(2.4–3.58)	(9–18)	(2–3.58)	(−0.32 to 0.17)
Georgia	0.702	92	1.57	104	1.80	0.15	69	2.85	80	3.32	0.16
		(83–102)	(1.42–1.75)	(85–126)	(1.47–2.17)	(−0.07 to 0.4)	(61–77)	(2.54–3.21)	(65–98)	(2.67–4.04)	(−0.07 to 0.43)
Jordan	0.731	37	1.14	73	1.14	0.00	24	1.46	50	1.49	0.02
		(31–42)	(0.98–1.32)	(58–91)	(0.93–1.41)	(−0.18 to 0.23)	(19–28)	(1.21–1.72)	(37–66)	(1.11–1.93)	(−0.22 to 0.34)
Kazakhstan	0.723	1286	9.39	1238	7.35	−0.22	737	13.68	735	10.93	−0.20
		(1219–1348)	(8.89–9.86)	(1052–1447)	(6.27–8.51)	(−0.33 to −0.09)	(687–785)	(12.8–14.54)	(617–870)	(9.26–12.84)	(−0.33 to −0.05)
Lebanon	0.708	52	1.23	68	1.30	0.06	34	1.68	44	1.88	0.12
		(41–65)	(0.98–1.54)	(51–89)	(0.97–1.72)	(−0.12 to 0.24)	(26–43)	(1.3–2.11)	(32–57)	(1.38–2.42)	(−0.09 to 0.35)
Malaysia	0.737	434	2.40	690	2.66	0.11	271	2.93	451	3.45	0.18
		(392–494)	(2.13–2.68)	(531–871)	(2.06–3.34)	(−0.12 to 0.4)	(239–332)	(2.58–3.48)	(339–584)	(2.6–4.4)	(−0.08 to 0.53)
Oman	0.783	30	2.90	37	2.37	−0.18	20	3.33	25	2.81	−0.16
		(22–34)	(2.17–3.25)	(27–47)	(1.84–2.79)	(−0.32 to −0.01)	(14–23)	(2.51–3.83)	(17–33)	(2.08–3.42)	(−0.34 to 0.05)
Sri Lanka	0.69	1088	5.69	1170	4.61	−0.19	597	6.75	617	5.39	−0.20
		(837–1169)	(4.43–6.12)	(853–1570)	(3.4–6.19)	(−0.4 to 0.08)	(418–660)	(4.87–7.43)	(427–864)	(3.76–7.48)	(−0.43 to 0.09)
Turkey	0.748	1126	1.67	1380	1.56	−0.07	658	2.08	821	1.96	−0.06
		(976–1280)	(1.44–1.89)	(1071–1734)	(1.21–1.96)	(−0.28 to 0.21)	(540–761)	(1.74–2.43)	(613–1061)	(1.48–2.53)	(−0.28 to 0.25)
Middle SDI
Armenia	0.689	57	1.53	64	1.53	0.00	38	2.40	44	2.44	0.02
		(53–62)	(1.41–1.65)	(52–77)	(1.26–1.84)	(−0.17 to 0.2)	(35–41)	(2.2–2.62)	(35–54)	(1.98–2.97)	(−0.16 to 0.23)
Azerbaijan	0.683	591	8.54	781	8.67	0.01	384	12.37	534	13.09	0.06
		(468–933)	(6.68–13.69)	(595–1188)	(6.49–13.36)	(−0.14 to 0.2)	(305–646)	(9.74–21.38)	(380–882)	(9.24–21.94)	(−0.15 to 0.32)
China	0.686	265 921	18.08	278 121	13.90	−0.23	193 392	27.23	207 924	21.94	−0.19
		(178 685–298 081)	(11.95–20.22)	(213 512–331 600)	(10.7–16.52)	(−0.37 to −0.03)	(135 561–221 031)	(18.86–31.01)	(156 073–258 292)	(16.4–27.03)	(−0.37 to 0.03)
Indonesia	0.66	3952	2.40	4989	2.36	−0.02	2482	3.14	3318	3.25	0.04
		(3321–5463)	(2.04–3.35)	(3956–7218)	(1.89–3.41)	(−0.18 to 0.17)	(1957–3669)	(2.48–4.67)	(2434–5000)	(2.42–4.84)	(−0.19 to 0.3)
Iran (Islamic Republic of)	0.67	2298	4.49	3031	4.36	−0.03	1434	5.52	1859	5.33	−0.03
		(1681–2441)	(3.26–4.78)	(2417–3332)	(3.43–4.8)	(−0.11 to 0.09)	(933–1543)	(3.6–5.95)	(1384–2066)	(3.91–5.93)	(−0.14 to 0.14)
Iraq	0.671	193	1.22	291	1.26	0.03	118	1.57	179	1.64	0.05
		(150–244)	(0.96–1.52)	(221–368)	(0.97–1.55)	(−0.15 to 0.25)	(88–153)	(1.2–2.01)	(133–226)	(1.23–2.05)	(−0.18 to 0.34)
Philippines	0.623	776	1.32	1052	1.32	0.00	531	1.90	718	1.91	0.00
		(699–996)	(1.19–1.72)	(837–1402)	(1.06–1.75)	(−0.2 to 0.24)	(462–681)	(1.66–2.53)	(540–1000)	(1.45–2.68)	(−0.25 to 0.32)
Syrian Arab Republic	0.619	85	0.89	112	0.92	0.04	60	1.20	81	1.30	0.08
		(69–103)	(0.73–1.07)	(82–146)	(0.69–1.19)	(−0.22 to 0.37)	(47–76)	(0.94–1.48)	(58–108)	(0.94–1.69)	(−0.2 to 0.46)
Thailand	0.687	2410	3.19	3246	3.13	−0.02	1724	4.87	2373	4.92	0.01
		(1493–2820)	(2.01–3.73)	(2069–4396)	(2.01–4.22)	(−0.29 to 0.34)	(1094–2048)	(3.16–5.79)	(1554–3242)	(3.26–6.7)	(−0.28 to 0.42)
Turkmenistan	0.67	250	8.68	376	9.58	0.10	129	10.52	213	12.53	0.19
		(235–269)	(8.12–9.31)	(294–470)	(7.6–11.95)	(−0.13 to 0.4)	(121–139)	(9.82–11.36)	(165–272)	(9.77–15.89)	(−0.08 to 0.53)
Uzbekistan	0.631	934	6.32	1328	6.58	0.04	505	8.02	735	8.48	0.06
		(884–986)	(6.01–6.65)	(1088–1575)	(5.51–7.66)	(−0.13 to 0.23)	(470–541)	(7.5–8.59)	(597–881)	(7.03–9.95)	(−0.13 to 0.26)
Viet Nam	0.617	2068	2.92	2824	2.89	−0.01	1832	6.01	2530	5.95	−0.01
		(1450–2437)	(2.1–3.39)	(1926–3620)	(2.04–3.65)	(−0.2 to 0.2)	(1271–2174)	(4.41–7.01)	(1689–3291)	(4.3–7.47)	(−0.21 to 0.2)
Low‐middle SDI
Bangladesh	0.483	3681	4.22	4982	3.81	−0.10	2406	5.15	3167	4.68	−0.09
		(2973–5111)	(3.44–5.81)	(3522–7507)	(2.71–5.73)	(−0.29 to 0.14)	(1858–3447)	(3.99–7.28)	(2124–4852)	(3.16–7.11)	(−0.3 to 0.17)
Bhutan	0.455	20	4.57	26	4.69	0.02	13	5.53	17	5.83	0.07
		(15–28)	(3.43–6.15)	(18–36)	(3.3–6.46)	(−0.23 to 0.32)	(8–18)	(3.69–7.73)	(10–24)	(3.65–8.3)	(−0.3 to 0.55)
Cambodia	0.469	237	2.77	333	2.82	0.02	139	3.88	201	4.06	0.05
		(195–317)	(2.27–3.73)	(255–460)	(2.17–3.89)	(−0.15 to 0.2)	(108–191)	(3.05–5.41)	(146–290)	(2.99–5.9)	(−0.15 to 0.29)
Democratic People's Republic of Korea	0.558	2628	9.79	2923	8.96	−0.08	1828	16.75	2100	15.27	−0.09
		(1950–3372)	(7.36–12.39)	(2253–3771)	(6.96–11.6)	(−0.22 to 0.09)	(1330–2473)	(12.44–22.33)	(1590–2823)	(11.81–20.36)	(−0.24 to 0.1)
India	0.566	28 601	3.35	38 516	3.36	0.00	17 218	4.06	22 653	4.03	−0.01
		(25 610–40 554)	(2.99–4.77)	(31 813–55 988)	(2.78–4.89)	(−0.15 to 0.17)	(15 009–25 528)	(3.54–6.09)	(17 601–35 620)	(3.15–6.31)	(−0.21 to 0.22)
Kyrgyzstan	0.596	158	4.62	179	4.13	−0.10	101	7.01	121	6.52	−0.07
		(146–168)	(4.27–4.94)	(152–208)	(3.51–4.82)	(−0.24 to 0.04)	(94–108)	(6.5–7.52)	(101–142)	(5.51–7.62)	(−0.21 to 0.1)
Lao People's Democratic Republic	0.49	84	2.52	104	2.39	−0.05	52	3.25	66	3.13	−0.04
		(58–119)	(1.77–3.61)	(71–151)	(1.66–3.5)	(−0.22 to 0.16)	(35–75)	(2.23–4.75)	(44–104)	(2.12–4.96)	(−0.23 to 0.19)
Maldives	0.562	4	2.22	6	2.05	−0.08	2	1.83	3	1.76	−0.04
		(4–5)	(1.89–2.51)	(5–7)	(1.65–2.48)	(−0.25 to 0.12)	(2–2)	(1.53–2.13)	(2–3)	(1.39–2.16)	(−0.24 to 0.21)
Mongolia	0.606	316	24.29	426	21.93	−0.10	178	31.22	255	30.48	−0.02
		(249–378)	(16.1–29.23)	(327–550)	(14.53–27.95)	(−0.27 to 0.13)	(140–226)	(23.73–37.42)	(193–334)	(22.58–37.9)	(−0.23 to 0.22)
Myanmar	0.521	890	2.45	1039	2.25	−0.08	539	3.32	651	3.19	−0.04
		(687–1287)	(1.91–3.58)	(816–1577)	(1.79–3.39)	(−0.24 to 0.11)	(408–779)	(2.51–4.85)	(495–987)	(2.45–4.8)	(−0.22 to 0.19)
Palestine	0.588	18	1.11	25	1.10	−0.01	12	1.67	17	1.66	−0.01
		(16–22)	(0.98–1.41)	(20–33)	(0.9–1.49)	(−0.19 to 0.19)	(10–15)	(1.44–2.18)	(14–23)	(1.34–2.26)	(−0.21 to 0.21)
Tajikistan	0.539	363	10.38	338	7.16	−0.31	228	13.80	213	9.83	−0.29
		(306–510)	(8.65–15.08)	(244–709)	(5.26–15.41)	(−0.49 to 0.07)	(186–332)	(11.11–20.49)	(152–450)	(7.14–21.28)	(−0.49 to 0.13)
Timor‐Leste	0.514	13	2.05	19	2.32	0.13	7	2.31	11	2.74	0.19
		(9–19)	(1.48–2.97)	(13–27)	(1.69–3.4)	(−0.07 to 0.38)	(5–12)	(1.51–3.86)	(7–18)	(1.8–4.45)	(−0.05 to 0.52)
Low SDI
Afghanistan	0.343	658	6.92	827	6.55	−0.05	278	6.31	358	6.07	−0.04
		(216–979)	(2.25–10.11)	(266–1203)	(2.11–9.17)	(−0.22 to 0.15)	(90–416)	(2.05–9.41)	(121–528)	(2.04–8.7)	(−0.22 to 0.2)
Nepal	0.422	693	4.07	1053	4.78	0.18	402	4.77	646	6.14	0.29
		(548–933)	(3.27–5.51)	(772–1428)	(3.55–6.48)	(−0.05 to 0.42)	(305–541)	(3.66–6.38)	(449–865)	(4.29–8.15)	(−0.01 to 0.62)
Pakistan	0.449	7101	8.33	8911	7.86	−0.06	3826	8.50	4768	8.03	−0.05
		(5899–8423)	(6.94–9.83)	(7068–10 991)	(6.3–9.63)	(−0.24 to 0.2)	(2889–4877)	(6.48–10.72)	(3410–6450)	(5.81–10.75)	(−0.34 to 0.32)
Yemen	0.412	385	4.14	541	4.18	0.01	194	4.22	273	4.32	0.02
		(117–563)	(1.24–6.18)	(165–798)	(1.28–6.31)	(−0.15 to 0.22)	(60–296)	(1.33–6.45)	(87–419)	(1.37–6.52)	(−0.18 to 0.27)

Location	Female					M/F ratio
	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	2	1.86	3	1.82	−0.02	2.86
	(1–2)	(1.57–2.55)	(2–3)	(1.47–2.54)	(−0.19 to 0.17)
Cyprus	6	0.81	7	0.73	−0.10	2.98
	(5–7)	(0.62–0.94)	(6–9)	(0.56–0.92)	(−0.28 to 0.12)
Israel	59	1.14	70	1.07	−0.06	2.11
	(51–65)	(1–1.26)	(54–91)	(0.82–1.39)	(−0.28 to 0.22)
Japan	3076	1.85	3402	1.76	−0.05	6.76
	(2584–3378)	(1.64–1.98)	(2599–4196)	(1.37–2.17)	(−0.23 to 0.15)
Kuwait	6	1.18	9	0.90	−0.24	2.11
	(5–7)	(1.02–1.33)	(7–12)	(0.68–1.19)	(−0.4 to 0.01)
Qatar	3	4.07	4	3.22	−0.21	1.50
	(2–3)	(2.54–5.06)	(3–6)	(2.16–4.44)	(−0.4 to 0.12)
Republic of Korea	241	0.69	329	0.66	−0.05	11.63
	(202–385)	(0.58–1.1)	(250–530)	(0.5–1.05)	(−0.24 to 0.17)
Saudi Arabia	82	1.80	109	1.59	−0.12	1.19
	(70–103)	(1.53–2.19)	(79–153)	(1.16–2.15)	(−0.33 to 0.14)
Singapore	30	1.20	39	0.98	−0.18	4.69
	(27–34)	(1.05–1.36)	(30–51)	(0.75–1.27)	(−0.36 to 0.04)
Taiwan (Province of China)	248	1.61	312	1.48	−0.08	13.00
	(223–274)	(1.44–1.78)	(239–407)	(1.13–1.93)	(−0.29 to 0.2)
United Arab Emirates	22	7.90	40	3.82	−0.52	2.56
	(6–39)	(1.94–14.1)	(10–69)	(1.01–6.83)	(−0.62 to −0.26)
High‐middle SDI
Bahrain	2	1.22	3	0.98	−0.20	2.81
	(2–3)	(1.03–1.46)	(2–4)	(0.75–1.29)	(−0.37 to 0.02)
Georgia	23	0.64	24	0.70	0.10	4.77
	(20–26)	(0.56–0.72)	(20–29)	(0.57–0.84)	(−0.12 to 0.35)
Jordan	13	0.80	23	0.77	−0.04	1.94
	(10–15)	(0.64–0.99)	(17–32)	(0.57–1.05)	(−0.24 to 0.24)
Kazakhstan	549	6.62	504	5.07	−0.23	2.16
	(517–584)	(6.22–7.04)	(430–581)	(4.35–5.84)	(−0.35 to −0.12)
Lebanon	18	0.82	23	0.82	0.00	2.31
	(13–23)	(0.6–1.09)	(17–35)	(0.58–1.23)	(−0.21 to 0.24)
Malaysia	163	1.86	238	1.88	0.01	1.83
	(139–186)	(1.56–2.12)	(179–312)	(1.41–2.43)	(−0.21 to 0.33)
Oman	10	2.36	12	1.87	−0.21	1.50
	(7–12)	(1.64–2.79)	(9–15)	(1.36–2.34)	(−0.37 to 0.01)
Sri Lanka	491	4.78	553	3.96	−0.17	1.36
	(371–543)	(3.72–5.28)	(391–743)	(2.78–5.27)	(−0.41 to 0.11)
Turkey	468	1.30	560	1.20	−0.08	1.63
	(396–546)	(1.1–1.52)	(432–712)	(0.93–1.54)	(−0.3 to 0.2)
Middle SDI
Armenia	20	0.88	20	0.84	−0.04	2.89
	(18–22)	(0.8–0.96)	(17–24)	(0.7–1.01)	(−0.2 to 0.16)
Azerbaijan	207	5.49	246	5.21	−0.05	2.51
	(148–313)	(3.89–8.39)	(171–364)	(3.49–7.87)	(−0.24 to 0.18)
China	72 529	9.85	70 197	6.83	−0.31	3.21
	(40 096–84 117)	(5.42–11.39)	(46 044–88 566)	(4.45–8.61)	(−0.45 to −0.06)
Indonesia	1470	1.73	1671	1.56	−0.10	2.09
	(1076–2053)	(1.27–2.42)	(1205–2390)	(1.13–2.2)	(−0.29 to 0.14)
Iran (Islamic Republic of)	864	3.44	1172	3.39	−0.01	1.57
	(670–925)	(2.65–3.7)	(926–1319)	(2.67–3.83)	(−0.1 to 0.11)
Iraq	75	0.90	112	0.91	0.02	1.80
	(55–101)	(0.67–1.23)	(82–147)	(0.69–1.18)	(−0.22 to 0.34)
Philippines	245	0.81	334	0.81	0.00	2.36
	(216–324)	(0.71–1.09)	(254–447)	(0.62–1.11)	(−0.23 to 0.28)
Syrian Arab Republic	25	0.54	30	0.52	−0.03	2.49
	(20–31)	(0.43–0.69)	(22–41)	(0.39–0.71)	(−0.27 to 0.27)
Thailand	686	1.74	873	1.57	−0.10	3.13
	(360–824)	(0.92–2.09)	(440–1188)	(0.79–2.14)	(−0.33 to 0.25)
Turkmenistan	121	7.40	162	7.42	0.00	1.69
	(111–131)	(6.85–8.06)	(126–210)	(5.78–9.59)	(−0.21 to 0.28)
Uzbekistan	429	5.12	593	5.21	0.02	1.63
	(404–457)	(4.84–5.44)	(487–702)	(4.33–6.11)	(−0.15 to 0.19)
Viet Nam	236	0.60	294	0.57	−0.04	10.36
	(166–294)	(0.42–0.74)	(201–376)	(0.39–0.73)	(−0.25 to 0.18)
Low‐middle SDI
Bangladesh	1275	3.14	1816	2.88	−0.08	1.62
	(933–2031)	(2.3–5.01)	(1238–3117)	(1.98–4.92)	(−0.3 to 0.19)
Bhutan	7	3.54	9	3.49	−0.06	1.67
	(5–11)	(2.52–5.52)	(6–15)	(2.32–5.48)	(−0.34 to 0.32)
Cambodia	99	1.99	132	1.96	−0.02	2.08
	(78–134)	(1.58–2.72)	(101–181)	(1.51–2.69)	(−0.2 to 0.2)
Democratic People's Republic of Korea	800	4.99	823	4.30	−0.14	3.55
	(516–1137)	(3.23–7.05)	(548–1131)	(2.86–5.93)	(−0.31 to 0.1)
India	11 383	2.66	15 863	2.72	0.03	1.48
	(9728–16 344)	(2.26–3.84)	(12 265–22 073)	(2.11–3.82)	(−0.18 to 0.27)
Kyrgyzstan	57	2.85	58	2.40	−0.16	2.72
	(51–63)	(2.56–3.15)	(48–68)	(1.99–2.82)	(−0.3 to 0)
Lao People's Democratic Republic	32	1.85	38	1.70	−0.08	1.84
	(17–47)	(1.03–2.72)	(20–56)	(0.92–2.53)	(−0.26 to 0.12)
Maldives	2	2.71	3	2.39	−0.12	0.74
	(2–3)	(2.19–3.22)	(2–4)	(1.87–2.99)	(−0.31 to 0.1)
Mongolia	138	19.39	171	16.03	−0.17	1.90
	(76–173)	(8.94–24.38)	(94–230)	(7.5–21.37)	(−0.36 to 0.09)
Myanmar	351	1.76	388	1.53	−0.13	2.09
	(243–537)	(1.24–2.73)	(286–587)	(1.14–2.33)	(−0.3 to 0.06)
Palestine	6	0.68	8	0.65	−0.05	2.55
	(5–8)	(0.58–0.89)	(6–11)	(0.51–0.93)	(−0.25 to 0.19)
Tajikistan	135	7.32	125	4.89	−0.33	2.01
	(111–199)	(5.95–11.31)	(89–261)	(3.5–10.85)	(−0.52 to 0.03)
Timor‐Leste	5	1.80	8	1.91	0.06	1.44
	(4–8)	(1.31–2.53)	(5–10)	(1.38–2.68)	(−0.14 to 0.31)
Low SDI
Afghanistan	380	7.46	469	7.00	−0.06	0.87
	(107–606)	(2.15–11.46)	(134–747)	(2.01–10.77)	(−0.26 to 0.18)
Nepal	291	3.37	407	3.53	0.05	1.74
	(218–454)	(2.58–5.24)	(291–622)	(2.56–5.38)	(−0.18 to 0.3)
Pakistan	3276	8.11	4142	7.65	−0.06	1.05
	(2552–4032)	(6.33–10.03)	(3028–5479)	(5.66–9.89)	(−0.32 to 0.31)
Yemen	190	4.07	268	4.05	−0.01	1.07
	(51–303)	(1.09–6.72)	(72–460)	(1.07–7.04)	(−0.22 to 0.24)

Abbreviations: ASR, age‐standardized rate; EC, esophageal cancer; SDI, sociodemographic index.

FIGURE 5.

The relative change (%) in age‐standardized incidence rate (ASIR), the age‐standardized death rate (ASMR), the age‐standardized DALYs rate (DALYs ASR), and age‐standardized prevalence rate (ASPR) of esophageal cancer (EC) in Asian countries from 1990 to 2019.

National comparison

Among Asian countries, 30 countries experienced an increasing trend in the EC morbidity rate between 2010 and 2019; the greatest increase was detected in Nepal (increase in ASIR = 0.18 [95% UI: −0.05–0.42]) and the greatest decrease was detected in Tajikistan (decrease in ASIR = −0.31 [95% UI: −0.49–0.07]) (Figure 6).

FIGURE 6.

Age‐specific disability‐adjusted life years (DALYs) cases of EC among sexes in Asia, 2019.

In 2019, the highest ASIR (per 100 000) of EC was reported in Mongolia (21.93), China (13.9), Taiwan (Province of China) (9.99), Turkmenistan (9.58), and Democratic People's Republic of Korea (8.96). The lowest ASIR of EC was reported in the Syrian Arab Republic (0.92), Palestine (1.1), Jordan (1.14), Iraq (1.26), and Lebanon (1.3). In 2019, the highest ASIR (per 100 000) of EC in men was reported in Mongolia (30.48), China (21.94), Taiwan (Province of China) (19.18), Democratic People's Republic of Korea (15.27), and Azerbaijan (13.09). The lowest ASIR of EC was reported in the Syrian Arab Republic (1.3), Jordan (1.49), Iraq (1.64), Palestine (1.66), and Maldives (1.76).

In 2019, the highest ASIR (per 100 000) of EC in women was reported in Mongolia (16.03), Pakistan (7.65), Turkmenistan (7.42), Afghanistan, ⁷ and China (6.83). The lowest ASIR of EC was reported in the Syrian Arab Republic (0.52), Viet Nam (0.57), Palestine (0.65), the Republic of Korea (0.66), and Georgia (0.7). The results are presented in detail in Table 3.

Male/female ratio

In 2019, the ASIR of EC in Asian men was 2.9 times that in women. The ASIR of EC in Afghanistan and Maldives was reported to be higher in women than in men. In other countries, the incidence of EC in men was higher than in women. In the countries of Taiwan (Province of China), the Republic of Korea and Viet Nam, the incidence of EC in men was more than 10 times higher than in women (Figure 7).

FIGURE 7.

The male/female ratio of age‐standardized incidence rate (ASIR), the age‐standardized death rate (ASDR), the age‐standardized DALYs rate (DALYs ASR), and age‐standardized prevalence rate (ASPR) of esophageal cancer (EC) in Asian countries in 2019.

Mortality of EC in Asia

Compared with global data and continents

In Asia, the number of EC deaths increased from 336 543 (95% UI: 253 491–366 854) in 2010 to 361 124 (95% UI: 307 593–411 840) in 2019, which is over a 1.07‐fold increase. In 2019 approximately 72.5% (361 124/498 067) of EC deaths happened in Asia countries (Figure 1). During this period, the ASDR of EC with a 21% change, decreased from 9.74 (95% UI: 7.27–10.62) per 100 000 in 2010 to 7.73 (95% UI: 6.57–8.8) per 100 000 in 2019, while in the same period, this rate globally decreased by 15%, in America by 4%, in Europe by 5%, and in Africa by 7% (Figure 2).

In Asian men, the number of EC death increased from 243 909 (95% UI: 187 259–269 671) in 2010 to 266 188 (95% UI: 218 454–315 018) in 2019, which is over a 1.09‐fold increase. In 2019, 74% of Asia EC death, occurred in Asian men which included 73% (266 188/365 554) of global male EC death cases. During this period, the ASDR of EC with an 18% change, decreased from 14.73 (95% UI: 11.22–16.24) per 100 000 in 2010 to 12.03 (95% UI: 9.93–14.17) per 100 000 in 2019, while in the same period, this rate globally decreased by 14%, in Europe by 6%, in America by 3%, and in Africa by 5% (Table 1).

In Asian women, the number of EC death increased from 92 634 (95% UI: 64 439–102 599) in 2010 to 94 936 (95% UI: 76 397–111 530) in 2019, which is over a 1.03‐fold increase. In 2019 more than 26% of Asia EC deaths, occurred in Asian women which included 72% (94 936/132 513) of global female EC incidence cases. During this period, the ASDR of EC with 26% changes, decreased from 5.25 (95% UI: 3.61–5.81) per 100 000 in 2010 to 3.91 (95% UI: 3.13–4.59) per 100 000 in 2019, while in the same period, this rate globally decreased by 18%, in Europe by 7%, in American and Africans countries by 8% (Table 2).

Age distribution

In 2010, the age‐specific death cases of EC were peaking at 70–74 years generally, 60–64 in males, and 75–79 in females. In 2019, age‐specific death cases of EC were peaking at 70–74 years generally, 65–69 years in males, and 70–74 years in females. In all age groups, death cases of EC in males were higher than in females (Figure 8).

FIGURE 8.

Age‐specific death cases of esophageal cancer (EC) among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest ASDR of EC was observed in East Asia regions (12.96 [95% UI: 10.19–15.37]); with a 26% decrease compared with 2010. All Asian regions experienced a decreasing trend from 2% to 26% from 2010 to 2019 (Figure 4).

In men, the highest ASDR of EC was observed in East Asia countries (21.34 [95% UI: 16.45–26.2]); with a 22% decrease compared with 2010. While all Asian regions experienced a decreasing trend of 1%–10%, North Africa and the Middle East experienced an increasing trend of 2% from 2010 to 2019 (Table 1).

In women, the highest ASDR of EC was observed in East Asia (5.78 [95% UI: 3.9–7.24]) in 2019, with a 35% increase compared with 2010. All Asian regions experienced a decreasing trend from 2% to 35% from 2010 to 2019 (Table 2).

Based on SDI

In 2019, among high SDI Asian countries, the United Arab Emirates (8.42) and Taiwan (Province of China) (7.89) had the highest ASDR of EC, and Cyprus (1.27) had the lowest rate. In this classification, between 1990 and 2019, all countries recorded a decreasing trend of 1%–16% (Singapore). Among high‐middle SDI Asian countries, Kazakhstan (7.80) and Sri Lanka (4.49) had the highest ASDR of EC, and Jordan (1.16) had the lowest rate. In this group, six countries experienced a downward trend of 2%–23%, and three countries reported an upward trend from 1% to 15%, from 1990 to 2019. Among middle SDI Asian countries, China (13.15) and Turkmenistan (9.97) had the highest ASDR of EC, and the Syrian Arab Republic (0.96) had the lowest rate. In this group, five countries experienced a downward trend from 2% to 26%, five countries reported an upward trend from 2% to 10%, and two had a stable trend from 1990 to 2019. Among low‐middle SDI Asian countries, Mongolia (24.53) had the highest ASDR of EC, and Palestine (1.16) had the lowest rate. In this group, nine countries experienced a downward trend from 2% to 30%, three countries reported an upward trend from 1% to 12%, and one had a stable trend from 1990 to 2019. Among low SDI Asian countries, Pakistan (8.23) had the highest ASDR of EC, and Yemen (4.45) had the lowest rate. In this group, two countries experienced a downward trend, and two countries reported an upward trend from 1990 to 2019. More details are presented in Table 4 and Figure 5.

TABLE 4.

The death distribution of EC cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

Location	SDI 2019	Both					Male
		2010		2019		% change 1990–2010	2010		2019		% change 2010–2019
		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	0.823	5	3.12	8	3.03	−0.03	4	4.75	5	4.90	0.03
		(4–6)	(2.73–3.83)	(6–9)	(2.57–3.73)	(−0.17 to 0.14)	(3–4)	(4.05–5.84)	(4–7)	(4.05–6.06)	(−0.14 to 0.25)
Cyprus	0.841	20	1.45	24	1.27	−0.13	15	2.44	18	2.02	−0.17
		(15–22)	(1.14–1.63)	(18–29)	(0.97–1.5)	(−0.24 to 0.02)	(11–17)	(1.82–2.79)	(13–22)	(1.47–2.43)	(−0.3 to −0.02)
Israel	0.803	146	1.62	182	1.53	−0.05	91	2.30	117	2.21	−0.04
		(133–158)	(1.47–1.74)	(159–204)	(1.35–1.71)	(−0.14 to 0.05)	(83–97)	(2.12–2.46)	(103–131)	(1.97–2.48)	(−0.13 to 0.07)
Japan	0.87	13 294	4.43	14 000	3.91	−0.12	11 167	8.42	11 558	7.26	−0.14
		(12 168–13 862)	(4.13–4.58)	(12 469–15 103)	(3.59–4.19)	(−0.15 to −0.06)	(10 437–11 554)	(7.9–8.71)	(10 513–12 365)	(6.71–7.78)	(−0.18 to −0.08)
Kuwait	0.851	20	1.55	33	1.53	−0.01	14	1.79	26	1.98	0.11
		(18–22)	(1.38–1.71)	(27–41)	(1.22–1.9)	(−0.2 to 0.2)	(13–16)	(1.57–2)	(20–33)	(1.5–2.54)	(−0.13 to 0.41)
Qatar	0.83	12	4.96	21	4.84	−0.02	10	5.28	17	5.32	0.01
		(10–16)	(3.69–6.01)	(14–31)	(3.38–6.65)	(−0.26 to 0.31)	(8–14)	(3.98–6.62)	(11–27)	(3.67–7.37)	(−0.25 to 0.38)
Republic of Korea	0.878	1686	2.73	2193	2.43	−0.11	1519	5.92	1967	5.01	−0.15
		(1550–2261)	(2.5–3.66)	(1891–3173)	(2.09–3.52)	(−0.21 to 0.01)	(1391–1974)	(5.4–7.67)	(1678–2749)	(4.27–6.98)	(−0.26 to −0.03)
Saudi Arabia	0.805	201	1.97	287	1.78	−0.10	123	2.06	192	1.93	−0.06
		(175–270)	(1.75–2.43)	(215–394)	(1.4–2.36)	(−0.27 to 0.07)	(106–171)	(1.78–2.7)	(143–271)	(1.49–2.74)	(−0.25 to 0.13)
Singapore	0.861	101	2.14	137	1.81	−0.16	79	3.68	110	3.08	−0.16
		(93–108)	(1.95–2.31)	(120–160)	(1.57–2.1)	(−0.25 to −0.03)	(74–85)	(3.37–3.97)	(96–128)	(2.68–3.57)	(−0.27 to −0.04)
Taiwan (Province of China)	0.868	2482	7.97	3086	7.89	−0.01	2291	15.00	2845	15.29	0.02
		(2359–2614)	(7.58–8.39)	(2342–4087)	(6.02–10.38)	(−0.25 to 0.3)	(2184–2418)	(14.28–15.82)	(2139–3775)	(11.63–20.19)	(−0.23 to 0.34)
United Arab Emirates	0.88	135	9.61	355	8.42	−0.12	114	10.00	319	10.24	0.02
		(40–230)	(2.84–16.58)	(104–607)	(2.68–14.24)	(−0.34 to 0.09)	(31–199)	(2.71–17.97)	(86–556)	(2.84–17.7)	(−0.19 to 0.26)
High‐middle SDI
Bahrain	0.751	9	2.30	16	2.03	−0.12	7	3.32	13	2.98	−0.10
		(7–10)	(1.92–2.62)	(11–21)	(1.52–2.57)	(−0.31 to 0.1)	(5–8)	(2.61–3.9)	(9–17)	(2.16–3.87)	(−0.32 to 0.15)
Georgia	0.702	96	1.61	109	1.85	0.15	71	2.94	82	3.41	0.16
		(86–107)	(1.46–1.8)	(89–130)	(1.52–2.22)	(−0.07 to 0.4)	(63–80)	(2.63–3.31)	(66–100)	(2.76–4.16)	(−0.07 to 0.43)
Jordan	0.731	36	1.19	71	1.16	−0.02	24	1.55	49	1.54	0.00
		(30–41)	(1.03–1.39)	(56–87)	(0.95–1.43)	(−0.2 to 0.19)	(20–28)	(1.3–1.81)	(36–64)	(1.17–2.02)	(−0.23 to 0.3)
Kazakhstan	0.723	1347	10.07	1276	7.80	−0.23	755	14.58	743	11.59	−0.20
		(1275–1413)	(9.53–10.57)	(1088–1482)	(6.67–9.02)	(−0.34 to −0.1)	(704–804)	(13.61–15.51)	(626–878)	(9.83–13.69)	(−0.33 to −0.06)
Lebanon	0.708	52	1.24	65	1.25	0.01	35	1.73	44	1.87	0.08
		(41–65)	(0.99–1.57)	(49–86)	(0.94–1.66)	(−0.16 to 0.17)	(27–44)	(1.33–2.19)	(32–56)	(1.37–2.41)	(−0.11 to 0.3)
Malaysia	0.737	434	2.52	678	2.70	0.07	272	3.10	449	3.54	0.14
		(390–488)	(2.24–2.81)	(525–856)	(2.1–3.36)	(−0.14 to 0.34)	(240–331)	(2.7–3.62)	(337–577)	(2.67–4.47)	(−0.1 to 0.47)
Oman	0.783	29	2.91	34	2.38	−0.18	19	3.41	24	2.91	−0.15
		(21–33)	(2.22–3.26)	(25–43)	(1.87–2.78)	(−0.32 to −0.03)	(14–22)	(2.65–3.91)	(16–31)	(2.2–3.51)	(−0.33 to 0.04)
Sri Lanka	0.69	1064	5.75	1115	4.49	−0.22	588	6.90	596	5.36	−0.22
		(823–1143)	(4.56–6.19)	(823–1502)	(3.32–6.01)	(−0.42 to 0.04)	(416–649)	(5.06–7.6)	(414–834)	(3.74–7.39)	(−0.44 to 0.06)
Turkey	0.748	1117	1.68	1333	1.52	−0.09	659	2.13	809	1.97	−0.07
		(971–1266)	(1.46–1.92)	(1032–1682)	(1.18–1.93)	(−0.3 to 0.16)	(552–766)	(1.8–2.5)	(610–1039)	(1.48–2.57)	(−0.3 to 0.22)
Middle SDI
Armenia	0.689	61	1.63	67	1.62	0.00	39	2.52	45	2.55	0.01
		(56–65)	(1.5–1.76)	(55–81)	(1.34–1.94)	(−0.17 to 0.19)	(36–42)	(2.31–2.74)	(36–55)	(2.07–3.08)	(−0.17 to 0.22)
Azerbaijan	0.683	611	9.15	796	9.32	0.02	393	13.16	539	13.98	0.06
		(479–972)	(7.13–14.67)	(601–1220)	(6.87–14.35)	(−0.13 to 0.2)	(312–668)	(10.34–22.87)	(382–891)	(9.88–23.47)	(−0.13 to 0.33)
China	0.686	254 388	17.81	257 316	13.15	−0.26	189 034	27.83	197 716	21.69	−0.22
		(168 876–285 059)	(11.68–19.85)	(202 777–309 029)	(10.27–15.68)	(−0.39 to −0.05)	(130 187–215 329)	(18.82–31.54)	(151 479–246 007)	(16.61–26.66)	(−0.39 to 0.01)
Indonesia	0.66	4025	2.55	5069	2.51	−0.02	2528	3.35	3368	3.47	0.03
		(3414–5575)	(2.18–3.6)	(4062–7233)	(2.02–3.58)	(−0.17 to 0.14)	(1992–3615)	(2.65–4.89)	(2471–5119)	(2.59–5.34)	(−0.18 to 0.3)
Iran (Islamic Republic of)	0.67	2369	4.77	3069	4.54	−0.05	1497	5.90	1921	5.64	−0.04
		(1704–2525)	(3.44–5.09)	(2420–3361)	(3.54–4.99)	(−0.13 to 0.06)	(988–1617)	(3.88–6.38)	(1403–2130)	(4.07–6.26)	(−0.14 to 0.12)
Iraq	0.671	193	1.27	286	1.30	0.02	120	1.67	180	1.75	0.05
		(150–242)	(1–1.58)	(219–358)	(1.01–1.59)	(−0.15 to 0.24)	(90–154)	(1.29–2.13)	(134–227)	(1.32–2.15)	(−0.17 to 0.33)
Philippines	0.623	775	1.37	1046	1.36	0.00	527	1.97	711	1.97	0.00
		(698–1022)	(1.23–1.84)	(840–1418)	(1.1–1.88)	(−0.19 to 0.2)	(460–685)	(1.72–2.61)	(525–996)	(1.46–2.77)	(−0.25 to 0.3)
Syrian Arab Republic	0.619	84	0.93	110	0.96	0.03	61	1.26	82	1.35	0.07
		(68–102)	(0.77–1.12)	(81–144)	(0.73–1.23)	(−0.22 to 0.34)	(47–76)	(0.99–1.56)	(59–108)	(0.99–1.75)	(−0.2 to 0.44)
Thailand	0.687	2323	3.15	3096	3.00	−0.05	1663	4.83	2268	4.77	−0.01
		(1448–2711)	(2–3.67)	(2001–4168)	(1.95–4.03)	(−0.3 to 0.29)	(1068–1977)	(3.18–5.74)	(1498–3096)	(3.19–6.46)	(−0.3 to 0.38)
Turkmenistan	0.67	254	9.06	379	9.97	0.10	131	11.09	215	13.16	0.19
		(238–273)	(8.45–9.73)	(298–472)	(7.94–12.44)	(−0.12 to 0.39)	(122–141)	(10.32–11.98)	(167–273)	(10.26–16.66)	(−0.08 to 0.52)
Uzbekistan	0.631	942	6.73	1320	6.98	0.04	509	8.60	730	9.04	0.05
		(893–992)	(6.41–7.08)	(1084–1562)	(5.88–8.09)	(−0.13 to 0.22)	(474–543)	(8.03–9.17)	(596–873)	(7.52–10.57)	(−0.13 to 0.25)
Viet Nam	0.617	2050	2.95	2727	2.87	−0.03	1805	6.13	2434	5.97	−0.02
		(1464–2388)	(2.16–3.4)	(1899–3470)	(2.07–3.58)	(−0.21 to 0.17)	(1285–2131)	(4.57–7.1)	(1665–3129)	(4.41–7.42)	(−0.22 to 0.18)
Low‐middle SDI
Bangladesh	0.483	3746	4.47	5110	4.00	−0.11	2458	5.45	3265	4.91	−0.10
		(3028–5183)	(3.65–6.13)	(3629–7680)	(2.87–6)	(−0.29 to 0.12)	(1903–3513)	(4.24–7.65)	(2194–4974)	(3.33–7.43)	(−0.3 to 0.16)
Bhutan	0.455	21	4.88	27	5.00	0.03	13	5.93	17	6.25	0.07
		(16–28)	(3.69–6.54)	(19–37)	(3.56–6.86)	(−0.23 to 0.32)	(9–18)	(3.94–8.21)	(11–25)	(3.94–8.83)	(−0.27 to 0.53)
Cambodia	0.469	242	2.93	339	2.97	0.01	142	4.14	205	4.31	0.04
		(199–325)	(2.42–3.98)	(261–467)	(2.3–4.1)	(−0.15 to 0.19)	(111–196)	(3.26–5.84)	(149–296)	(3.2–6.28)	(−0.15 to 0.27)
Democratic People's Republic of Korea	0.558	2623	9.94	2906	9.01	−0.09	1805	17.22	2066	15.58	−0.09
		(1961–3354)	(7.52–12.51)	(2259–3752)	(7.06–11.56)	(−0.22 to 0.08)	(1310–2425)	(12.8–23.06)	(1576–2779)	(12.08–20.88)	(−0.23 to 0.09)
India	0.566	28 872	3.51	38 981	3.49	0.00	17 361	4.24	22 892	4.20	−0.01
		(25 608–41 893)	(3.1–5.07)	(32 203–56 283)	(2.9–5.05)	(−0.16 to 0.16)	(15 077–26 165)	(3.68–6.39)	(17 527–34 952)	(3.25–6.36)	(−0.21 to 0.22)
Kyrgyzstan	0.596	167	4.98	186	4.45	−0.11	105	7.49	124	6.96	−0.07
		(154–178)	(4.59–5.34)	(158–217)	(3.79–5.17)	(−0.24 to 0.04)	(97–112)	(6.93–8.04)	(104–145)	(5.9–8.13)	(−0.21 to 0.1)
Lao People's Democratic Republic	0.49	85	2.66	106	2.53	−0.05	53	3.44	67	3.32	−0.04
		(59–122)	(1.88–3.8)	(73–155)	(1.77–3.69)	(−0.21 to 0.15)	(36–76)	(2.36–5.05)	(44–107)	(2.27–5.25)	(−0.23 to 0.19)
Maldives	0.562	4	2.25	6	2.01	−0.11	2	1.90	3	1.78	−0.06
		(4–5)	(1.9–2.55)	(5–7)	(1.62–2.44)	(−0.27 to 0.09)	(2–2)	(1.57–2.22)	(2–3)	(1.41–2.18)	(−0.26 to 0.17)
Mongolia	0.606	332	27.07	448	24.53	−0.09	184	34.69	264	34.00	−0.02
		(253–397)	(16.72–32.63)	(333–577)	(15.33–31.27)	(−0.26 to 0.12)	(146–227)	(25.07–41.53)	(202–343)	(24.38–42.19)	(−0.23 to 0.22)
Myanmar	0.521	912	2.59	1060	2.37	−0.09	551	3.51	661	3.36	−0.04
		(709–1305)	(2.03–3.76)	(839–1604)	(1.9–3.58)	(−0.23 to 0.09)	(417–789)	(2.66–5.11)	(505–998)	(2.6–5.03)	(−0.22 to 0.17)
Palestine	0.588	18	1.18	25	1.16	−0.02	12	1.83	17	1.80	−0.01
		(16–23)	(1.04–1.52)	(20–33)	(0.94–1.58)	(−0.2 to 0.17)	(10–16)	(1.56–2.36)	(14–23)	(1.46–2.44)	(−0.2 to 0.2)
Tajikistan	0.539	376	11.07	342	7.72	−0.30	237	14.91	216	10.72	−0.28
		(316–534)	(9.21–16.24)	(249–722)	(5.69–16.63)	(−0.48 to 0.07)	(193–344)	(11.97–22.23)	(155–460)	(7.82–23.03)	(−0.48 to 0.13)
Timor‐Leste	0.514	13	2.21	19	2.48	0.12	8	2.49	11	2.93	0.18
		(9–19)	(1.62–3.2)	(14–28)	(1.82–3.6)	(−0.07 to 0.36)	(5–13)	(1.66–4.16)	(7–19)	(1.94–4.72)	(−0.06 to 0.49)
Low SDI
Afghanistan	0.343	672	7.32	832	6.96	−0.05	288	6.74	364	6.51	−0.03
		(220–985)	(2.41–10.61)	(268–1202)	(2.25–9.7)	(−0.21 to 0.15)	(94–431)	(2.19–9.97)	(123–531)	(2.19–9.26)	(−0.22 to 0.2)
Nepal	0.422	713	4.32	1091	5.10	0.18	416	5.10	674	6.60	0.29
		(565–962)	(3.5–5.82)	(804–1480)	(3.81–6.8)	(−0.04 to 0.42)	(318–561)	(3.93–6.84)	(471–903)	(4.6–8.78)	(0.01 to 0.61)
Pakistan	0.449	7159	8.73	8953	8.23	−0.06	3862	8.89	4798	8.40	−0.06
		(5889–8523)	(7.23–10.33)	(7184–11 011)	(6.62–9.96)	(−0.25 to 0.18)	(2884–4913)	(6.76–11.14)	(3352–6438)	(6.03–11.13)	(−0.33 to 0.34)
Yemen	0.412	393	4.42	551	4.45	0.01	200	4.54	280	4.64	0.02
		(119–579)	(1.32–6.68)	(168–815)	(1.36–6.78)	(−0.15 to 0.21)	(62–306)	(1.44–6.98)	(89–427)	(1.47–7.01)	(−0.18 to 0.26)

Location	Female					M/F ratio
	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	1	1.81	2	1.71	−0.06	2.87
	(1–2)	(1.53–2.45)	(2–3)	(1.4–2.39)	(−0.21 to 0.12)
Cyprus	5	0.68	6	0.61	−0.10	3.31
	(4–6)	(0.52–0.78)	(5–8)	(0.48–0.74)	(−0.25 to 0.07)
Israel	56	1.05	66	0.95	−0.10	2.33
	(49–62)	(0.92–1.16)	(55–76)	(0.81–1.09)	(−0.2 to 0.02)
Japan	2127	1.16	2442	1.09	−0.06	6.66
	(1744–2342)	(1.01–1.25)	(1930–2783)	(0.93–1.22)	(−0.11 to 0.01)
Kuwait	6	1.16	7	0.84	−0.27	2.36
	(5–6)	(1.01–1.3)	(6–10)	(0.64–1.1)	(−0.43 to −0.05)
Qatar	2	4.11	4	3.16	−0.23	1.68
	(2–3)	(2.51–5.11)	(3–5)	(2.09–4.3)	(−0.42 to 0.08)
Republic of Korea	167	0.49	226	0.44	−0.10	11.35
	(137–272)	(0.4–0.8)	(180–363)	(0.35–0.7)	(−0.22 to 0.04)
Saudi Arabia	78	1.84	95	1.54	−0.17	1.26
	(66–96)	(1.57–2.19)	(69–130)	(1.13–2.09)	(−0.37 to 0.08)
Singapore	21	0.86	27	0.67	−0.22	4.57
	(19–24)	(0.75–0.98)	(22–32)	(0.54–0.8)	(−0.33 to −0.09)
Taiwan (Province of China)	190	1.25	240	1.11	−0.11	13.76
	(169–209)	(1.11–1.37)	(185–312)	(0.86–1.45)	(−0.31 to 0.14)
United Arab Emirates	21	8.53	35	3.89	−0.54	2.64
	(5–37)	(2.1–15.17)	(9–62)	(1.02–6.89)	(−0.64 to −0.3)
High‐middle SDI
Bahrain	2	1.25	3	0.96	−0.23	3.09
	(2–3)	(1.05–1.49)	(2–4)	(0.74–1.26)	(−0.38 to −0.02)
Georgia	25	0.67	27	0.74	0.09	4.63
	(22–29)	(0.59–0.77)	(22–32)	(0.61–0.89)	(−0.12 to 0.35)
Jordan	12	0.80	21	0.75	−0.06	2.05
	(9–15)	(0.64–0.99)	(16–29)	(0.57–1.01)	(−0.26 to 0.2)
Kazakhstan	591	7.24	533	5.46	−0.25	2.12
	(555–629)	(6.78–7.72)	(458–613)	(4.69–6.26)	(−0.35 to −0.13)
Lebanon	17	0.80	21	0.75	−0.07	2.49
	(12–23)	(0.58–1.06)	(15–32)	(0.53–1.12)	(−0.25 to 0.14)
Malaysia	162	1.95	229	1.88	−0.04	1.89
	(137–185)	(1.6–2.24)	(172–298)	(1.41–2.42)	(−0.24 to 0.24)
Oman	10	2.31	11	1.80	−0.22	1.62
	(7–11)	(1.62–2.72)	(8–14)	(1.31–2.22)	(−0.37 to −0.01)
Sri Lanka	476	4.77	519	3.77	−0.21	1.42
	(363–525)	(3.79–5.29)	(366–687)	(2.69–4.99)	(−0.43 to 0.05)
Turkey	457	1.29	524	1.13	−0.12	1.74
	(389–531)	(1.09–1.51)	(407–671)	(0.88–1.46)	(−0.33 to 0.13)
Middle SDI
Armenia	22	0.97	22	0.93	−0.04	2.74
	(20–24)	(0.88–1.06)	(19–27)	(0.78–1.11)	(−0.2 to 0.16)
Azerbaijan	218	6.00	257	5.73	−0.05	2.44
	(155–334)	(4.22–9.23)	(177–385)	(3.75–8.7)	(−0.23 to 0.19)
China	65 354	9.14	59 600	5.92	−0.35	3.67
	(36 160–75 242)	(5.04–10.53)	(40 464–74 974)	(3.98–7.45)	(−0.49 to −0.12)
Indonesia	1497	1.84	1701	1.66	−0.10	2.09
	(1091–2049)	(1.36–2.54)	(1213–2390)	(1.21–2.29)	(−0.28 to 0.12)
Iran (Islamic Republic of)	873	3.60	1148	3.43	−0.05	1.64
	(660–936)	(2.72–3.89)	(900–1294)	(2.68–3.88)	(−0.12 to 0.06)
Iraq	73	0.91	106	0.90	0.00	1.94
	(54–99)	(0.68–1.24)	(79–138)	(0.69–1.16)	(−0.23 to 0.29)
Philippines	247	0.86	335	0.85	−0.01	2.33
	(218–335)	(0.75–1.18)	(259–460)	(0.66–1.17)	(−0.23 to 0.27)
Syrian Arab Republic	23	0.55	29	0.53	−0.04	2.57
	(18–29)	(0.45–0.72)	(21–39)	(0.39–0.72)	(−0.27 to 0.24)
Thailand	660	1.71	828	1.49	−0.13	3.21
	(348–795)	(0.9–2.05)	(421–1121)	(0.76–2.01)	(−0.35 to 0.19)
Turkmenistan	123	7.70	165	7.70	0.00	1.71
	(114–134)	(7.13–8.39)	(128–213)	(6–9.93)	(−0.21 to 0.27)
Uzbekistan	433	5.44	590	5.52	0.01	1.64
	(408–460)	(5.14–5.78)	(486–698)	(4.6–6.44)	(−0.15 to 0.19)
Viet Nam	245	0.63	293	0.58	−0.08	10.29
	(175–301)	(0.45–0.77)	(201–372)	(0.4–0.74)	(−0.26 to 0.13)
Low‐middle SDI
Bangladesh	1288	3.32	1845	3.02	−0.09	1.63
	(940–2057)	(2.44–5.31)	(1256–3162)	(2.07–5.13)	(−0.3 to 0.17)
Bhutan	8	3.77	10	3.70	−0.05	1.69
	(5–12)	(2.69–5.94)	(6–15)	(2.47–5.84)	(−0.33 to 0.31)
Cambodia	100	2.10	134	2.05	−0.02	2.10
	(80–138)	(1.67–2.89)	(103–184)	(1.59–2.82)	(−0.2 to 0.19)
Democratic People's Republic of Korea	818	5.16	840	4.37	−0.15	3.57
	(531–1165)	(3.41–7.29)	(564–1156)	(2.94–5.96)	(−0.31 to 0.08)
India	11 511	2.79	16 089	2.83	0.01	1.48
	(9704–16 556)	(2.33–4.03)	(12 554–23 346)	(2.22–4.12)	(−0.19 to 0.26)
Kyrgyzstan	63	3.16	62	2.65	−0.16	2.63
	(56–69)	(2.84–3.5)	(52–73)	(2.21–3.12)	(−0.31 to −0.01)
Lao People's Democratic Republic	32	1.95	38	1.80	−0.08	1.85
	(18–48)	(1.1–2.91)	(21–57)	(0.98–2.68)	(−0.26 to 0.12)
Maldives	2	2.70	3	2.28	−0.16	0.78
	(2–3)	(2.21–3.21)	(2–4)	(1.78–2.82)	(−0.34 to 0.05)
Mongolia	148	21.90	184	18.22	−0.17	1.87
	(77–186)	(9.51–27.6)	(96–246)	(8.04–24.12)	(−0.36 to 0.08)
Myanmar	361	1.86	399	1.61	−0.13	2.08
	(251–547)	(1.31–2.88)	(297–608)	(1.22–2.48)	(−0.3 to 0.06)
Palestine	6	0.71	7	0.66	−0.07	2.71
	(5–8)	(0.6–0.94)	(6–10)	(0.53–0.97)	(−0.27 to 0.16)
Tajikistan	139	7.72	126	5.22	−0.32	2.05
	(113–210)	(6.25–12.22)	(90–265)	(3.73–11.78)	(−0.51 to 0.04)
Timor‐Leste	6	1.93	8	2.03	0.05	1.45
	(4–8)	(1.42–2.7)	(6–11)	(1.48–2.85)	(−0.14 to 0.3)
Low SDI
Afghanistan	384	7.85	468	7.39	−0.06	0.88
	(110–601)	(2.24–12.24)	(134–740)	(2.1–11.16)	(−0.26 to 0.18)
Nepal	296	3.56	416	3.73	0.05	1.77
	(224–457)	(2.72–5.48)	(298–635)	(2.72–5.64)	(−0.17 to 0.31)
Pakistan	3297	8.53	4155	8.02	−0.06	1.05
	(2598–4065)	(6.72–10.4)	(3123–5512)	(6.09–10.41)	(−0.29 to 0.25)
Yemen	193	4.30	271	4.27	−0.01	1.09
	(52–310)	(1.14–7.23)	(72–468)	(1.12–7.47)	(−0.22 to 0.23)

Abbreviations: ASR, age‐standardized rate; EC, esophageal cancer; SDI, sociodemographic index.

National comparison

Among Asian countries, 36 countries experienced a decreasing trend in the EC mortality rate between 2010 and 2019; the greatest increase was detected in Nepal (increase in ASDR = 0.18 [95% UI: −0.04–0.42]) and the greatest decrease was detected in Tajikistan (decrease in ASDR = −0.30 [95% UI: −0.48–0.07]) (Figure 5).

In 2019, the highest ASDR (per 100 000) of EC was reported in Mongolia (24.53), China (13.15), Turkmenistan (9.97), Azerbaijan (9.32), and Democratic People's Republic of Korea (9.01). The lowest ASDR of EC was reported in the Syrian Arab Republic (0.96), Palestine (1.16), Jordan (1.16), Lebanon (1.25), and Cyprus (1.27).

Among Asian men, the highest ASDR (per 100 000) of EC was reported in Mongolia, ³³ China (21.69), Democratic People's Republic of Korea (15.58), Taiwan (Province of China) (15.29), and Azerbaijan (13.98). The lowest ASDR of EC was reported in the Syrian Arab Republic (1.35), Jordan (1.54), Iraq (1.75), Maldives (1.78), and Palestine (1.8).

Among Asian women, the highest ASDR (per 100 000) of EC was reported in Mongolia (18.22), Pakistan (8.02), Turkmenistan (7.7), Afghanistan (7.39), and China (5.92). The lowest ASDR of EC was reported in the Republic of Korea (0.44), the Syrian Arab Republic (0.53), Viet Nam (0.58), Cyprus (0.61), and Palestine (0.66). The results are presented in detail in Table 4.

Male/female ratio

In 2019, the ASDR of EC in Asian men was 3.08 times that in women. The ASDR of EC in Afghanistan and Maldives is reported to be higher in women than in men. In other countries, the death of EC in men was higher than in women. In the countries of Taiwan (Province of China), the Republic of Korea and Viet Nam, death from EC in men is more than 10 times higher than in women. The highest ratio was reported in Taiwan (13.76‐fold) and the lowest ratio was recorded in the Maldives (0.78‐fold) (Figure 7).

Prevalence of EC in Asia

Compared with global data and continents

In Asia, the number of cases who lived with EC increased from 627 623 (95% UI: 480 802–682 919) in 2010 to 713 824 (95% UI: 604 880–818 494) in 2019, which is a 1.14‐fold increase. In 2019 more than 74% (713 824/960 610) of EC prevalence happened in Asian countries (Figure 1). During this period, the ASPR of EC with a 14% change, decreased from 17.06 (95% UI: 13.01–18.53) per 100 000 in 2010 to 14.65 (95% UI: 12.37–16.77) per 100 000 in 2019, while in the same period, this rate globally decreased by 10%, in America by 4%, in Africa by 5%, and in Europe by 2% (Figure 2).

In Asian men, the number of EC prevalence increased from 438 319 (95% UI: 344 347–483 623) in 2010 to 500 172 (95% UI: 412 671–596 468) in 2019, which is over a 1.14‐fold increase. In 2019 more than 70% of patients who lived with EC in Asia were men which included 74% (500 172/677 214) of global male EC prevalence cases. During this period, the ASPR of EC with a 13% change, decreased from 24.47 (95% UI: 19.28–26.93) per 100 000 in 2010 to 21.28 (95% UI: 17.63–25.18) per 100 000 in 2019; in the same period, this rate globally decreased by 10%, in America and Europe by 3%, and in Africa by 4% (Table 1).

In Asian women, the number of EC prevalence increased from 189 304 (95% UI: 124 737–213 526) in 2010 to 213 651 (95% UI: 162 933–256 456) in 2019, which is approximately a 1.13‐fold increase. In 2019 approximately 30% of patients who lived with EC in Asia were women, which included 75.4% (213 651/283 396) of global female EC prevalence cases. During this period, the ASPR of EC with a 16% change decreased from 10.11 (95% UI: 6.63–11.4) per 100 000 in 2010 to 8.53 (95% UI: 6.47–10.25) per 100 000 in 2019; in the same period, this rate globally decreased by 11%, in America and Africa by 7%, and in Europe by 2% (Table 2).

Age distribution

In 2010, the age‐specific prevalence cases of EC were peaking at 60–64 years generally and in males, and 65–69 in females. In 2019, age‐specific prevalence cases of EC were peaking at 65–69 years generally, in males, and females. In all age groups, the prevalence cases of EC in males were higher than in females (Figure 9).

FIGURE 9.

Age‐specific prevalence cases of esophageal cancer (EC) among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest ASPR of EC was observed in East Asia countries (23.89 [95% UI: 18.27–28.34]); with a 16% decrease compared with 2010. Three Asian regions experienced a decreasing trend, one increasing, and two stable trends (Figure 4).

In men, the highest ASPR of EC was observed in high‐income Asia Pacific countries (35.05 [95% UI: 28.8–42.54]); with a 14% decrease compared with 2010. While four regions experienced a decreasing trend of 1%–14%, two regions recorded an increasing trend of 3% and 6% (Table 1).

In women, the highest ASPR of EC was observed in high‐income Asia Pacific countries (14.09 [95% UI: 9.09–17.93]); with a 21% decrease compared with 2010. While four regions experienced a decreasing trend of 5%–21%, two regions recorded an increasing trend of 1% and 2% (Table 2).

Based on SDI

Among high SDI Asian countries, Taiwan (Province of China) (23.88) and Japan (22.00) had the highest ASPR of EC, and Kuwait (2.38) had the lowest rate. In this group, five countries experienced a downward trend from 4% to 11%, and six countries reported an upward trend from 1% to 7% from 1990 to 2019. Among high‐middle SDI Asian countries, Kazakhstan (9.85) and Sri Lanka (7.61) had the highest ASPR of EC, and Jordan (1.75) had the lowest rate. In this group, four countries experienced a downward trend of 7%–19%, four countries reported an upward trend of 5%–18%, and one had a stable trend from 1990 to 2019. Among middle SDI Asian countries, China (24.10) and Turkmenistan (13.30) had the highest ASPR of EC, and the Syrian Arab Republic (1.34) had the lowest rate. In this group, two countries experienced a downward trend of 1%–17%, and 10 countries reported an upward trend of 2%–11% from 1990 to 2019. Among low‐middle SDI Asian countries, Mongolia (26.62) and the Democratic People's Republic of Korea (13.45) had the highest ASPR of EC, and Palestine (1.57) had the lowest rate. In this group, eight countries experienced a downward trend of 1%–32%, and five countries reported an upward trend of 2%–15% from 1990 to 2019. Among low SDI Asian countries, Pakistan (11.00) had the highest ASPR of EC, and Yemen (5.68) had the lowest rate. In this group, two countries experienced a downward trend, and two countries reported an upward trend from 1990 to 2019. More details are presented in Table 5 and Figure 5.

TABLE 5.

The prevalence distribution of EC cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

Location	SDI 2019	Both					Male
		2010		2019		% Change 1990–2010	2010		2019		% Change 1990–2010
		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	0.823	11	5.37	17	5.68	0.06	8	7.98	12	8.71	0.09
		(9–13)	(4.69–6.58)	(14–21)	(4.77–6.99)	(−0.1 to 0.25)	(6–10)	(6.74–10.04)	(10–15)	(7.04–10.86)	(−0.11 to 0.35)
Cyprus	0.841	42	2.93	54	2.79	−0.05	28	4.18	36	3.90	−0.07
		(34–47)	(2.38–3.31)	(42–65)	(2.18–3.35)	(−0.2 to 0.12)	(22–32)	(3.28–4.84)	(26–45)	(2.89–4.88)	(−0.25 to 0.15)
Israel	0.803	253	2.90	331	2.95	0.02	145	3.70	195	3.77	0.02
		(231–273)	(2.66–3.13)	(253–427)	(2.25–3.82)	(−0.22 to 0.32)	(134–157)	(3.42–4)	(147–253)	(2.86–4.92)	(−0.23 to 0.33)
Japan	0.87	67 636	24.63	67 536	22.00	−0.11	58 292	45.67	57 532	39.87	−0.13
		(63 235–70 604)	(23.27–25.65)	(55 153–81 474)	(18.01–26.77)	(−0.26 to 0.1)	(55 011–60 701)	(43.2–47.56)	(45 680–71 225)	(31.52–49.56)	(−0.3 to 0.11)
Kuwait	0.851	33	2.23	63	2.38	0.07	22	2.39	44	2.84	0.19
		(30–36)	(2–2.46)	(51–79)	(1.9–2.94)	(−0.13 to 0.31)	(20–24)	(2.13–2.64)	(34–57)	(2.16–3.66)	(−0.09 to 0.52)
Qatar	0.83	25	6.37	45	6.13	−0.04	20	6.36	36	6.36	0.00
		(20–35)	(5.07–7.71)	(30–69)	(4.35–8.42)	(−0.27 to 0.3)	(15–30)	(4.94–8.09)	(23–58)	(4.42–8.84)	(−0.27 to 0.38)
Republic of Korea	0.878	7213	11.24	10 745	11.76	0.05	6503	23.25	9756	23.27	0.00
		(6460–9933)	(10.09–15.34)	(8346–14 944)	(9.14–16.44)	(−0.16 to 0.29)	(5771–8818)	(20.74–31.12)	(7532–13 834)	(17.99–32.54)	(−0.2 to 0.24)
Saudi Arabia	0.805	342	2.69	579	2.77	0.03	200	2.67	356	2.82	0.06
		(292–469)	(2.35–3.47)	(427–815)	(2.13–3.72)	(−0.17 to 0.25)	(169–289)	(2.3–3.59)	(260–521)	(2.12–4.03)	(−0.17 to 0.28)
Singapore	0.861	440	8.69	655	8.31	−0.04	351	14.56	537	13.90	−0.05
		(401–485)	(7.86–9.6)	(508–842)	(6.45–10.66)	(−0.25 to 0.22)	(319–387)	(13.16–16.13)	(409–700)	(10.7–18)	(−0.26 to 0.22)
Taiwan (Province of China)	0.868	7577	23.76	9071	23.88	0.01	6941	44.14	8274	45.14	0.02
		(7010–8122)	(22–25.49)	(6805–12 243)	(17.88–32.36)	(−0.24 to 0.35)	(6403–7460)	(40.82–47.35)	(6190–11 128)	(33.82–61.27)	(−0.23 to 0.38)
United Arab Emirates	0.88	255	12.12	678	11.33	−0.07	217	12.65	603	13.45	0.06
		(75–433)	(3.52–20.88)	(203–1166)	(3.48–19.29)	(−0.3 to 0.18)	(61–377)	(3.44–22.63)	(162–1052)	(3.69–23.28)	(−0.16 to 0.32)
High‐middle SDI
Bahrain	0.751	15	2.97	28	2.77	−0.07	11	3.98	22	3.71	−0.07
		(13–18)	(2.49–3.41)	(21–38)	(2.07–3.58)	(−0.27 to 0.18)	(9–14)	(3.15–4.69)	(15–31)	(2.68–4.84)	(−0.3 to 0.2)
Georgia	0.702	127	2.24	145	2.58	0.15	97	4.04	113	4.69	0.16
		(114–141)	(2.02–2.5)	(117–175)	(2.08–3.11)	(−0.08 to 0.41)	(86–109)	(3.6–4.59)	(91–139)	(3.75–5.73)	(−0.08 to 0.45)
Jordan	0.731	58	1.66	123	1.74	0.05	36	2.05	80	2.18	0.06
		(48–67)	(1.4–1.9)	(96–151)	(1.4–2.15)	(−0.13 to 0.3)	(29–43)	(1.67–2.42)	(58–105)	(1.62–2.85)	(−0.19 to 0.39)
Kazakhstan	0.723	1729	12.14	1744	9.85	−0.19	1016	17.56	1057	14.43	−0.18
		(1637–1814)	(11.53–12.71)	(1472–2056)	(8.37–11.52)	(−0.31 to −0.05)	(947–1083)	(16.38–18.67)	(883–1258)	(12.19–17.03)	(−0.32 to −0.02)
Lebanon	0.708	80	1.89	114	2.18	0.15	50	2.49	70	2.97	0.20
		(63–100)	(1.5–2.37)	(85–149)	(1.63–2.86)	(−0.06 to 0.37)	(38–63)	(1.91–3.12)	(50–90)	(2.16–3.81)	(−0.04 to 0.46)
Malaysia	0.737	669	3.39	1091	3.98	0.18	412	4.10	693	5.01	0.22
		(606–786)	(3.06–3.83)	(839–1391)	(3.06–5.03)	(−0.08 to 0.5)	(361–517)	(3.61–4.97)	(519–903)	(3.77–6.46)	(−0.06 to 0.6)
Oman	0.783	51	4.38	66	3.61	−0.18	32	4.81	43	4.01	−0.17
		(37–57)	(3.18–4.96)	(47–85)	(2.75–4.37)	(−0.33 to 0.02)	(22–38)	(3.51–5.59)	(29–59)	(2.9–5.02)	(−0.36 to 0.07)
Sri Lanka	0.69	1747	8.66	1988	7.61	−0.12	935	9.92	1005	8.41	−0.15
		(1304–1896)	(6.63–9.37)	(1430–2703)	(5.53–10.3)	(−0.35 to 0.18)	(639–1034)	(6.94–10.95)	(689–1414)	(5.8–11.78)	(−0.4 to 0.17)
Turkey	0.748	1783	2.56	2315	2.55	0.00	999	3.03	1298	2.98	−0.01
		(1468–2030)	(2.16–2.9)	(1754–2888)	(1.94–3.18)	(−0.23 to 0.29)	(795–1159)	(2.47–3.51)	(966–1676)	(2.24–3.88)	(−0.25 to 0.3)
Middle SDI
Armenia	0.689	77	2.06	88	2.10	0.02	53	3.29	63	3.40	0.04
		(71–83)	(1.9–2.22)	(72–107)	(1.72–2.54)	(−0.16 to 0.23)	(48–57)	(3.01–3.59)	(50–77)	(2.74–4.16)	(−0.16 to 0.27)
Azerbaijan	0.683	831	11.26	1134	11.44	0.02	544	16.29	785	17.23	0.06
		(670–1282)	(8.9–17.87)	(867–1709)	(8.7–17.47)	(−0.15 to 0.21)	(432–896)	(12.82–27.73)	(556–1285)	(12.16–28.41)	(−0.17 to 0.34)
China	0.686	448 436	28.96	498 410	24.10	−0.17	307 167	40.22	34 6178	34.55	−0.14
		(294 035–503 605)	(18.79–32.5)	(380 566–596 358)	(18.24–28.75)	(−0.33 to 0.06)	(214 848–35 1947)	(27.97–45.96)	(259 860–433 951)	(25.87–43)	(−0.34 to 0.11)
Indonesia	0.66	5852	3.29	7420	3.24	−0.01	3673	4.26	4928	4.42	0.04
		(4893–8044)	(2.77–4.55)	(5839–10 730)	(2.58–4.67)	(−0.19 to 0.2)	(2894–5350)	(3.35–6.36)	(3606–7432)	(3.26–6.66)	(−0.2 to 0.33)
Iran (Islamic Republic of)	0.67	3357	6.23	4660	6.36	0.02	2034	7.50	2733	7.46	−0.01
		(2507–3561)	(4.61–6.61)	(3820–5112)	(5.11–7)	(−0.06 to 0.15)	(1356–2188)	(4.93–8.08)	(2081–3034)	(5.6–8.3)	(−0.11 to 0.19)
Iraq	0.671	300	1.75	473	1.89	0.08	177	2.17	276	2.33	0.08
		(231–384)	(1.36–2.2)	(355–607)	(1.44–2.37)	(−0.13 to 0.33)	(131–232)	(1.63–2.81)	(204–355)	(1.74–2.94)	(−0.17 to 0.39)
Philippines	0.623	1176	1.86	1608	1.89	0.02	804	2.67	1096	2.70	0.01
		(1061–1487)	(1.67–2.39)	(1270–2111)	(1.51–2.51)	(−0.19 to 0.27)	(699–1024)	(2.32–3.46)	(822–1518)	(2.04–3.75)	(−0.25 to 0.34)
Syrian Arab Republic	0.619	134	1.27	175	1.34	0.06	90	1.66	122	1.83	0.10
		(107–163)	(1.03–1.53)	(128–232)	(0.99–1.75)	(−0.21 to 0.42)	(69–114)	(1.28–2.08)	(85–165)	(1.3–2.43)	(−0.2 to 0.51)
Thailand	0.687	4030	5.14	5587	5.34	0.04	2857	7.69	4030	8.17	0.06
		(2455–4734)	(3.18–6.03)	(3466–7699)	(3.33–7.33)	(−0.26 to 0.43)	(1789–3415)	(4.9–9.14)	(2585–5547)	(5.31–11.24)	(−0.25 to 0.5)
Turkmenistan	0.67	364	11.99	555	13.30	0.11	188	14.15	314	16.93	0.20
		(342–392)	(11.23–12.89)	(430–697)	(10.46–16.55)	(−0.13 to 0.4)	(175–203)	(13.26–15.27)	(241–405)	(13.23–21.58)	(−0.07 to 0.53)
Uzbekistan	0.631	1373	8.35	2012	8.82	0.06	731	10.26	1102	11.06	0.08
		(1297–1452)	(7.92–8.79)	(1647–2396)	(7.28–10.36)	(−0.13 to 0.25)	(680–784)	(9.58–10.98)	(892–1330)	(9.11–13.07)	(−0.12 to 0.3)
Viet Nam	0.617	3231	4.39	4618	4.51	0.03	2880	8.86	4147	9.01	0.02
		(2171–3864)	(3.04–5.18)	(3035–6051)	(3.09–5.81)	(−0.18 to 0.27)	(1911–3472)	(6.19–10.5)	(2672–5478)	(6.17–11.56)	(−0.2 to 0.26)
Low‐middle SDI
Bangladesh	0.483	5428	5.85	7306	5.41	−0.08	3501	7.10	4569	6.59	−0.07
		(4369–7574)	(4.74–8.09)	(5124–10 996)	(3.82–8.1)	(−0.28 to 0.18)	(2688–5047)	(5.49–10.14)	(3058–7054)	(4.43–10.12)	(−0.29 to 0.21)
Bhutan	0.455	29	6.26	37	6.48	0.03	18	7.49	24	7.95	0.06
		(21–40)	(4.65–8.67)	(26–53)	(4.49–9.06)	(−0.16 to 0.25)	(12–26)	(5–10.6)	(14–34)	(4.95–11.38)	(−0.17 to 0.31)
Cambodia	0.469	348	3.79	494	3.92	0.04	202	5.26	297	5.55	0.06
		(281–459)	(3.1–5.07)	(372–682)	(2.99–5.41)	(−0.15 to 0.25)	(156–272)	(4.1–7.22)	(213–424)	(4.03–8.03)	(−0.16 to 0.31)
Democratic People's Republic of Korea	0.558	3958	14.38	4469	13.45	−0.06	2792	23.92	3259	22.20	−0.07
		(2872–5116)	(10.51–18.57)	(3394–5854)	(10.28–17.45)	(−0.22 to 0.13)	(2006–3797)	(17.44–32.07)	(2414–4415)	(16.83–29.8)	(−0.23 to 0.14)
India	0.566	42 344	4.67	56 869	4.75	0.02	25 368	5.63	33 223	5.63	0.00
		(37 956–59 621)	(4.19–6.59)	(47 009–81 784)	(3.93–6.85)	(−0.14 to 0.19)	(22 121–37 208)	(4.91–8.34)	(25 756–51 724)	(4.37–8.78)	(−0.21 to 0.23)
Kyrgyzstan	0.596	214	6.02	252	5.47	−0.09	139	9.13	173	8.60	−0.06
		(200–227)	(5.62–6.4)	(212–295)	(4.64–6.4)	(−0.23 to 0.06)	(130–148)	(8.5–9.78)	(144–205)	(7.2–10.11)	(−0.21 to 0.12)
Lao People's Democratic Republic	0.49	123	3.44	154	3.28	−0.05	76	4.41	98	4.26	−0.03
		(84–174)	(2.39–4.91)	(104–223)	(2.25–4.8)	(−0.23 to 0.18)	(51–111)	(3.02–6.42)	(64–154)	(2.82–6.74)	(−0.24 to 0.22)
Maldives	0.562	7	3.45	11	3.40	−0.01	3	2.67	5	2.72	0.02
		(6–8)	(2.94–3.9)	(9–13)	(2.72–4.13)	(−0.21 to 0.21)	(2–3)	(2.22–3.12)	(4–6)	(2.14–3.35)	(−0.2 to 0.28)
Mongolia	0.606	421	29.22	578	26.62	−0.09	242	37.23	351	36.64	−0.02
		(339–506)	(21.51–34.92)	(443–753)	(19.51–34.22)	(−0.27 to 0.15)	(190–318)	(29.52–45.21)	(263–478)	(27.61–46.8)	(−0.23 to 0.25)
Myanmar	0.521	1290	3.37	1527	3.13	−0.07	779	4.52	957	4.39	−0.03
		(977–1865)	(2.59–4.9)	(1186–2301)	(2.46–4.74)	(−0.24 to 0.15)	(588–1125)	(3.41–6.52)	(722–1433)	(3.35–6.64)	(−0.22 to 0.22)
Palestine	0.588	27	1.53	39	1.57	0.03	17	2.21	26	2.24	0.01
		(23–32)	(1.35–1.9)	(31–50)	(1.27–2.08)	(−0.17 to 0.24)	(15–22)	(1.9–2.85)	(21–35)	(1.79–3.01)	(−0.2 to 0.25)
Tajikistan	0.539	517	13.87	502	9.44	−0.32	319	17.92	313	12.61	−0.30
		(437–711)	(11.63–19.7)	(361–1039)	(6.89–20.15)	(−0.5 to 0.07)	(263–459)	(14.56–26.3)	(222–666)	(9.11–26.84)	(−0.5 to 0.13)
Timor‐Leste	0.514	18	2.76	27	3.17	0.15	10	3.09	16	3.72	0.20
		(12–27)	(1.92–4.07)	(19–39)	(2.26–4.64)	(−0.07 to 0.44)	(6–17)	(1.92–5.18)	(10–26)	(2.36–6.08)	(−0.05 to 0.57)
Low SDI
Afghanistan	0.343	942	9.26	1233	8.78	−0.05	386	8.33	528	8.02	−0.04
		(308–1429)	(3.03–13.84)	(396–1839)	(2.82–12.5)	(−0.23 to 0.16)	(124–591)	(2.72–12.58)	(177–795)	(2.72–11.71)	(−0.23 to 0.21)
Nepal	0.422	1002	5.56	1507	6.52	0.17	571	6.42	905	8.24	0.28
		(780–1343)	(4.38–7.46)	(1104–2063)	(4.78–8.85)	(−0.06 to 0.44)	(428–765)	(4.89–8.68)	(622–1225)	(5.69–11.07)	(−0.02 to 0.65)
Pakistan	0.449	10 563	11.53	13 429	11.00	−0.05	5684	11.84	7168	11.29	−0.05
		(8694–12 669)	(9.59–13.69)	(10 651–16 740)	(8.76–13.52)	(−0.25 to 0.23)	(4292–7288)	(8.95–15.04)	(5104–9742)	(8.11–15.23)	(−0.35 to 0.35)
Yemen	0.412	560	5.59	795	5.68	0.02	277	5.57	392	5.73	0.03
		(170–824)	(1.69–8.25)	(239–1172)	(1.73–8.41)	(−0.16 to 0.24)	(86–425)	(1.74–8.5)	(125–604)	(1.81–8.79)	(−0.19 to 0.29)

Location	Female					M/F ratio
	2010		2019		% Change 1990–2010
	Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	3	3.14	5	3.26	0.04	2.67
	(3–4)	(2.62–4.3)	(4–7)	(2.59–4.49)	(−0.16 to 0.27)
Cyprus	14	1.85	18	1.76	−0.05	2.22
	(11–17)	(1.4–2.23)	(13–23)	(1.32–2.28)	(−0.27 to 0.21)
Israel	107	2.21	136	2.24	0.01	1.69
	(92–123)	(1.9–2.52)	(101–180)	(1.66–3)	(−0.25 to 0.37)
Japan	9344	6.23	10 005	6.04	−0.03	6.59
	(8017–10 275)	(5.56–6.73)	(7711–12 402)	(4.75–7.48)	(−0.22 to 0.19)
Kuwait	11	1.98	19	1.69	−0.15	1.68
	(10–13)	(1.73–2.25)	(14–26)	(1.27–2.27)	(−0.35 to 0.15)
Qatar	5	6.16	10	5.29	−0.14	1.20
	(4–7)	(3.92–7.69)	(7–14)	(3.58–7.41)	(−0.36 to 0.24)
Republic of Korea	710	2.00	989	2.03	0.02	11.44
	(586–1111)	(1.66–3.11)	(745–1573)	(1.55–3.19)	(−0.2 to 0.3)
Saudi Arabia	142	2.71	223	2.70	−0.01	1.05
	(119–185)	(2.31–3.34)	(158–323)	(1.94–3.69)	(−0.25 to 0.29)
Singapore	89	3.47	118	2.97	−0.14	4.68
	(76–104)	(2.95–4.04)	(90–155)	(2.27–3.91)	(−0.34 to 0.11)
Taiwan (Province of China)	635	4.06	797	3.90	−0.04	11.56
	(550–731)	(3.52–4.67)	(589–1092)	(2.86–5.39)	(−0.29 to 0.3)
United Arab Emirates	38	10.40	75	5.66	−0.46	2.38
	(10–65)	(2.55–18.52)	(19–131)	(1.5–10.03)	(−0.58 to −0.16)
High‐middle SDI
Bahrain	4	1.84	6	1.61	−0.13	2.31
	(3–5)	(1.52–2.22)	(5–8)	(1.21–2.09)	(−0.33 to 0.14)
Georgia	30	0.88	32	0.96	0.09	4.87
	(26–34)	(0.78–1)	(26–38)	(0.78–1.16)	(−0.13 to 0.36)
Jordan	22	1.23	43	1.27	0.03	1.71
	(17–27)	(0.97–1.52)	(31–59)	(0.94–1.73)	(−0.2 to 0.34)
Kazakhstan	713	8.44	687	6.72	−0.20	2.15
	(673–756)	(7.98–8.95)	(584–803)	(5.74–7.82)	(−0.32 to −0.07)
Lebanon	30	1.36	44	1.53	0.13	1.94
	(22–39)	(1.02–1.78)	(31–63)	(1.07–2.23)	(−0.13 to 0.44)
Malaysia	257	2.66	398	2.96	0.11	1.70
	(221–297)	(2.27–3.05)	(295–531)	(2.19–3.91)	(−0.15 to 0.47)
Oman	18	3.83	23	3.14	−0.18	1.28
	(13–21)	(2.7–4.54)	(17–30)	(2.25–4)	(−0.36 to 0.08)
Sri Lanka	813	7.55	983	6.90	−0.09	1.22
	(612–907)	(5.7–8.4)	(676–1342)	(4.79–9.36)	(−0.35 to 0.24)
Turkey	784	2.14	1017	2.16	0.01	1.38
	(643–917)	(1.77–2.5)	(766–1304)	(1.63–2.76)	(−0.24 to 0.32)
Middle SDI
Armenia	25	1.11	26	1.08	−0.02	3.14
	(22–27)	(1.02–1.2)	(21–31)	(0.9–1.3)	(−0.19 to 0.19)
Azerbaijan	287	7.14	348	6.74	−0.06	2.56
	(208–423)	(5.1–10.71)	(247–507)	(4.71–9.99)	(−0.25 to 0.19)
China	141 270	18.31	152 232	14.44	−0.21	2.39
	(75 277–165 471)	(9.72–21.44)	(97 826–194 585)	(9.25–18.42)	(−0.39 to 0.1)
Indonesia	2179	2.38	2492	2.15	−0.10	2.05
	(1575–3042)	(1.74–3.33)	(1756–3576)	(1.55–3.09)	(−0.3 to 0.18)
Iran (Islamic Republic of)	1323	4.94	1927	5.26	0.06	1.42
	(1041–1433)	(3.87–5.35)	(1579–2190)	(4.25–5.98)	(−0.04 to 0.2)
Iraq	123	1.37	197	1.49	0.09	1.57
	(91–167)	(1.01–1.84)	(141–266)	(1.09–1.96)	(−0.18 to 0.46)
Philippines	372	1.14	513	1.17	0.03	2.31
	(328–482)	(1–1.5)	(384–681)	(0.88–1.57)	(−0.22 to 0.33)
Syrian Arab Republic	43	0.82	53	0.82	0.00	2.23
	(33–55)	(0.65–1.02)	(38–72)	(0.6–1.11)	(−0.25 to 0.34)
Thailand	1173	2.88	1558	2.82	−0.02	2.89
	(612–1436)	(1.51–3.51)	(781–2153)	(1.42–3.91)	(−0.29 to 0.39)
Turkmenistan	177	10.42	241	10.54	0.01	1.61
	(163–193)	(9.64–11.35)	(185–314)	(8.16–13.68)	(−0.21 to 0.3)
Uzbekistan	641	6.94	910	7.16	0.03	1.54
	(603–685)	(6.52–7.36)	(743–1089)	(5.91–8.42)	(−0.15 to 0.22)
Viet Nam	351	0.87	471	0.89	0.02	10.13
	(242–443)	(0.61–1.11)	(314–613)	(0.6–1.15)	(−0.21 to 0.29)
Low‐middle SDI
Bangladesh	1927	4.40	2737	4.14	−0.06	1.59
	(1400–3066)	(3.22–7.04)	(1851–4663)	(2.81–7.09)	(−0.28 to 0.24)
Bhutan	11	4.92	14	4.93	0.00	1.61
	(8–17)	(3.47–7.55)	(9–22)	(3.23–7.83)	(−0.2 to 0.23)
Cambodia	146	2.75	197	2.76	0.00	2.01
	(115–197)	(2.18–3.74)	(150–269)	(2.11–3.79)	(−0.2 to 0.25)
Democratic People's Republic of Korea	1166	7.21	1210	6.44	−0.11	3.45
	(739–1681)	(4.63–10.35)	(783–1672)	(4.18–8.95)	(−0.28 to 0.15)
India	16 976	3.73	23 646	3.90	0.05	1.44
	(14 591–23 888)	(3.2–5.32)	(18 195–32 185)	(3.02–5.34)	(−0.17 to 0.3)
Kyrgyzstan	75	3.65	79	3.12	−0.15	2.76
	(68–81)	(3.31–3.99)	(66–94)	(2.6–3.68)	(−0.3 to 0.02)
Lao People's Democratic Republic	47	2.54	57	2.35	−0.08	1.82
	(25–69)	(1.38–3.75)	(30–84)	(1.25–3.49)	(−0.26 to 0.15)
Maldives	4	4.36	6	4.22	−0.03	0.64
	(3–5)	(3.53–5.19)	(5–8)	(3.27–5.34)	(−0.24 to 0.24)
Mongolia	179	23.19	227	19.31	−0.17	1.90
	(109–225)	(12.01–29.18)	(140–307)	(10.12–26.01)	(−0.37 to 0.11)
Myanmar	510	2.43	571	2.14	−0.12	2.06
	(346–776)	(1.67–3.7)	(415–856)	(1.57–3.22)	(−0.3 to 0.1)
Palestine	9	0.97	12	0.97	0.01	2.30
	(8–11)	(0.82–1.24)	(10–17)	(0.76–1.37)	(−0.22 to 0.25)
Tajikistan	198	10.11	189	6.64	−0.34	1.90
	(163–278)	(8.2–14.96)	(134–389)	(4.75–14.27)	(−0.53 to 0.03)
Timor‐Leste	8	2.42	11	2.62	0.08	1.42
	(5–11)	(1.71–3.43)	(8–15)	(1.85–3.63)	(−0.14 to 0.38)
Low SDI
Afghanistan	556	10.11	705	9.51	−0.06	0.84
	(154–911)	(2.87–15.95)	(200–1156)	(2.72–14.75)	(−0.26 to 0.2)
Nepal	431	4.70	602	4.93	0.05	1.67
	(319–672)	(3.53–7.34)	(428–920)	(3.53–7.5)	(−0.17 to 0.32)
Pakistan	4878	11.16	6261	10.66	−0.05	1.06
	(3816–6061)	(8.71–13.77)	(4520–8423)	(7.81–14.04)	(−0.31 to 0.35)
Yemen	282	5.61	404	5.63	0.00	1.02
	(76–451)	(1.52–8.97)	(108–694)	(1.5–9.8)	(−0.22 to 0.27)

Abbreviations: ASR, age‐standardized rate; EC, esophageal cancer; SDI, sociodemographic index.

National comparison

Among Asian countries, 27 countries experienced a decreasing trend in the EC prevalence rate between 2010 and 2019; the greatest increase was detected in Lebanon (increase in ASPR = 0.13 [95% UI: −0.13–0.44]) and the greatest decrease was detected in Oman (decrease in ASPR = −0.46 [95% UI: −0.58 to −0.16]) (Figure 5).

In 2019, the highest ASPR (per 100 000) of EC was reported in Mongolia (26.62), China (24.1), Taiwan (Province of China) (23.88), Japan, ²² and Democratic People's Republic of Korea (13.45). The lowest ASPR of EC was reported in the Syrian Arab Republic (1.34), Palestine (1.57), Jordan (1.74), Iraq (1.89), and the Philippines (1.89).

In Asian men, the highest ASPR (per 100 000) of EC was reported in Taiwan (Province of China) (45.14), Japan (39.87), Mongolia (36.64), China (34.55), and the Republic of Korea (23.27). The lowest ASPR (per 100 000) of EC was reported in the Syrian Arab Republic (1.83), Jordan (2.18), Palestine (2.24), Iraq (2.33), and the Philippines (2.7).

In women, the highest ASPR (per 100 000) of EC was reported in Mongolia (19.31), China (14.44), Pakistan (10.66), Turkmenistan (10.54), and Afghanistan (9.51). The lowest ASPR (per 100 000) of EC was reported in the Syrian Arab Republic (0.82), Viet Nam (0.89), Georgia (0.96), Palestine (0.97), and Armenia (1.08). Results are presented in detail in Table 5.

Male/female ratio

In 2019, the ASPR of EC in Asian men was 2.5 times that in women. The ASPR of EC in Afghanistan and the Maldives is reported to be higher in women than in men. In other countries, the prevalence of EC in men was higher than in women. In the countries of Taiwan (Province of China), the Republic of Korea and Viet Nam, the prevalence of EC in men is more than 10 times higher than in women. The highest ratio was reported in Taiwan (11.56‐fold) and the lowest ratio was recorded in the Maldives (0.64‐fold) (Figure 7).

Burden of EC in Asia

Comparison with global data and continents

In Asia, the number of EC DALYs increased from 8 163 324 (95% UI: 6 334 656–8 889 934) in 2010 to 8 409 032 (95% UI: 7 201 261–9 643 913) in 2019, which is a 1.03‐fold increase. In 2019, 73% (8 409 032/11 666 017) of EC DALYs happened in Asian countries (Figure 1). During this period, the DALYs ASR of EC with a 22% change, decreased from 218.18 (95% UI: 167.46–237.32) per 100 000 in 2010 to 170.51 (95% UI: 145.87–194.85) per 100 000 in 2019, in the same period, this rate globally decreased by 16%, in America by 5%, in Europe by 6%, and in Africa by 8% (Figure 2).

In Asian men, the number of EC DALYs increased from 6 125 226 (95% UI: 4 800 405–6 776 342) in 2010 to 6 378 988 (95% UI: 5 255 579–7 615 340) in 2019, which is over a 1.04‐fold increase. In 2019 approximately 76% of EC DALYs in Asia, occurred in men which included 54.7% (6 378 988/11 666 017) of global male EC DALYs cases. During this period, the DALYs ASR of EC with a 20% change, decreased from 333.1 (95% UI: 258.73–368.22) per 100 000 in 2010 to 265.89 (95% UI: 219.88–314.77) per 100 000 in 2019; in the same period, this rate globally decreased by 16%, in Europe by 7%; in America by 4%, and in Africa by 6% (Table 1).

In Asian women, the number of EC DALYs decreased from 2 038 098 (95% UI: 1 486 721–2 241 893) in 2010 to 2 030 044 (95% UI: 1 698 323–2 364 559) in 2019. In 2019 approximately 24% of DALYs related to EC in Asia were women, which included 71.4% (2 030 044/2 844 300) of global female EC DALYs cases. During this period, the DALYs ASR of EC with a 25% change, decreased from 108.49 (95% UI: 78.45–119.54) per 100 000 in 2010 to 80.86 (95% UI: 67.5–94.12) per 100 000 in 2019, while in the same period, this rate globally decreased by 19%, in American countries by 9%, in European countries by 7%, and in African countries by 10% (Table 2).

Age distribution

In 2010, the age‐specific DALY cases of EC were peaking at 60–64 years generally, in males, and females. In 2019, DALY cases of EC were peaking at 65–69 years generally, in males, and females. In all age groups, DALY cases of EC in males were higher than in females (Figure 6).

Within Asian regions

In 2019, the highest DALYs ASR of EC was observed in East Asia countries (275.44 [95% UI: 221.92–331.75]); with a 27% decrease compared with 2010. Between 2010 and 2019, all regions recorded a decreasing trend of 2%–27% (Figure 4).

In men, the highest DALYs ASR of EC was observed in East Asia countries (456.24 [95% UI: 356.28–566.73]) with a 24% decrease compared with 2010. Only, North Africa and Middle East countries experienced an upward trend of 2%. Other Asian regions experienced a decreasing trend from 2010 to 2019 by 2% to 24% (Table 1).

In women, the highest DALYs ASR of EC was observed in Central Asia countries (116.04 [95% UI: 102.83–131.58]), with a 9% decrease compared with 2010. For all regions a decreasing trend of 1 (South Asia) to 38% (East Asia) was recorded (Table 2).

Based on SDI

In 2019, among high SDI Asian countries, Taiwan (Province of China) (230.22) and United Arab Emirates (195.31) had the highest DALYs ASR of EC, and Cyprus (26.58) had the lowest rate. In this group, all countries experienced a downward trend from 1% to 17% from 1990 to 2019. Among high‐middle SDI Asian countries, Kazakhstan (173.54) and Sri Lanka (102.04) had the highest DALYs ASR of EC, and Jordan (26.16) had the lowest rate. In this group, six countries experienced a downward trend from 1% to 26%, and three countries reported an upward trend from 2% to 13% from 1990 to 2019. In middle SDI Asian countries, Viet Nam (409.28) and the Philippines (370.31) had the highest DALYs ASR of EC, and the Syrian Arab Republic (140.02) had the lowest rate. In this group, seven countries experienced a downward trend from 1% to 28%, three countries reported an upward trend from 4% to 10%, and two recorded a stable trend from 1990 to 2019.

Among low‐middle SDI Asian countries, Mongolia (486.69) and the Democratic People's Republic of Korea (225.46) had the highest ASPR of EC, and Palestine (25.53) has the lowest rate. In this group, 11 countries experienced a downward trend from 1% to 32%, Timor‐Leste reported an upward trend (14%), and Cambodia recorded a stable trend from 1990 to 2019.

Among low SDI Asian countries, Pakistan (207.08) had the highest DALYs ASR of EC, and Yemen (103.13) had the lowest rate. In this group, two countries experienced a downward trend, and two countries reported an upward trend from 1990 to 2019. More details are presented in Table 6 and Figure 5.

TABLE 6.

The DALYs distribution of EC cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

Location	SDI 2019	Both					Male
		2010		2019		% change 1990–2010	2010		2019		% change 2010–2019
		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	0.823	131	63.18	196	62.31	−0.01	94	96.31	143	97.25	0.01
		(115–160)	(55.4–77.49)	(165–241)	(52.83–76.6)	(−0.16 to 0.17)	(80–117)	(82.5–118.74)	(114–179)	(80.33–119.91)	(−0.17 to –0.23)
Cyprus	0.841	427	30.02	509	26.58	−0.11	330	49.46	396	43.16	−0.13
		(346–484)	(24.5–33.84)	(389–608)	(20.53–31.78)	(−0.24 to 0.04)	(262–380)	(39.29–56.52)	(296–481)	(32.67–52.19)	(−0.27 to 0.04)
Israel	0.803	2784	32.16	3404	30.58	−0.05	1867	47.64	2350	45.76	−0.04
		(2578–2966)	(29.9–34.26)	(3031–3784)	(27.42–33.92)	(−0.14 to 0.04)	(1730–2000)	(44.13–50.94)	(2094–2625)	(41.01–51.04)	(−0.13 to 0.06)
Japan	0.87	270 348	100.41	255 594	85.81	−0.15	233 640	185.49	217 482	154.87	−0.17
		(255 367–278 911)	(95.88–103.11)	(235 520–274 033)	(80.47–91.96)	(−0.18 to −0.08)	(222 509–239 976)	(177.57–190.24)	(201 758–233 024)	(144.6–166.28)	(−0.21 to −0.1)
Kuwait	0.851	471	30.39	803	28.94	−0.05	339	34.82	619	37.51	0.08
		(432–513)	(27.48–33.19)	(641–1005)	(23.11–35.77)	(−0.23 to 0.18)	(308–373)	(31.25–38.34)	(474–800)	(28.67–48.07)	(−0.17 to 0.37)
Qatar	0.83	393	87.29	631	75.55	−0.13	328	91.82	529	82.38	−0.10
		(309–551)	(69.98–105.79)	(416–990)	(53.5–103.88)	(−0.35 to 0.17)	(245–494)	(71.05–117.83)	(340–865)	(57.16–116.09)	(−0.35 to 0.25)
Republic of Korea	0.878	38 625	60.08	47 390	51.74	−0.14	35 443	124.46	43 476	102.35	−0.18
		(35 638–53 551)	(55.46–83.18)	(40 428–70 394)	(44.19–76.96)	(−0.25 to −0.01)	(32 679–47 407)	(114.43–164.42)	(36 868–64 688)	(87.37–150.18)	(−0.29 to −0.04)
Saudi Arabia	0.805	5765	43.11	8787	39.79	−0.08	3589	45.26	5949	43.91	−0.03
		(4935–8030)	(37.77–57.19)	(6446–12 667)	(30.4–53.62)	(−0.26 to 0.11)	(3021–5164)	(38.96–61.59)	(4319–8710)	(33–62.74)	(−0.24 to 0.18)
Singapore	0.861	2300	44.31	2938	36.74	−0.17	1903	76.04	2471	62.46	−0.18
		(2133–2474)	(41.01–47.52)	(2574–3432)	(32.2–42.92)	(−0.27 to −0.05)	(1772–2045)	(70.68–81.59)	(2154–2890)	(54.7–72.83)	(−0.28 to −0.05)
Taiwan (Province of China)	0.868	74 369	233.50	87 728	230.22	−0.01	70 589	450.16	83 213	452.29	0.00
		(70 614–78 531)	(221.83–246.7)	(66 812–117 387)	(176.24–308.61)	(−0.25 to 0.31)	(66 959–74 649)	(427.38–476.35)	(62 995–111 968)	(345.39–607.33)	(−0.24 to 0.34)
United Arab Emirates	0.88	5076	210.28	13 029	195.31	−0.07	4420	225.26	11 780	235.11	0.04
		(1494–8583)	(61.07–362.6)	(3794–22 616)	(60.07–332.74)	(−0.3 to 0.18)	(1249–7651)	(60.7–402.13)	(3164–20 765)	(65.1–403.73)	(−0.18 to 0.3)
High‐middle SDI
Bahrain	0.751	245	45.33	428	39.70	−0.12	189	62.61	349	55.02	−0.12
		(202–292)	(37.74–52.23)	(307–577)	(29.24–51.88)	(−0.32 to 0.1)	(147–232)	(49.39–73.84)	(243–490)	(39.8–72.02)	(−0.34 to 0.14)
Georgia	0.702	2341	41.94	2633	47.57	0.13	1801	75.50	2075	86.43	0.14
		(2117–2597)	(37.93–46.71)	(2127–3176)	(38.48–57.38)	(−0.09 to 0.4)	(1601–2044)	(67.25–85.71)	(1660–2552)	(69.02–105.57)	(−0.09 to 0.43)
Jordan	0.731	958	26.54	1892	26.16	−0.01	630	34.20	1317	34.59	0.01
		(775–1104)	(22.23–30.43)	(1462–2355)	(20.79–32.39)	(−0.19 to 0.22)	(496–743)	(27.8–40.23)	(946–1738)	(25.41–45.53)	(−0.23 to 0.33)
Kazakhstan	0.723	32 140	223.15	31 017	173.54	−0.22	19 280	327.65	19 030	255.57	−0.22
		(30 443–33 790)	(211.84–234.21)	(26 091–36 787)	(146.82–203.35)	(−0.34 to −0.09)	(17 973–20 563)	(305.41–348.5)	(15 904–22 746)	(215.35–301.81)	(−0.36 to −0.07)
Lebanon	0.708	1140	27.16	1447	27.83	0.02	775	38.81	995	42.29	0.09
		(901–1416)	(21.56–33.71)	(1075–1899)	(20.63–36.68)	(−0.16 to 0.22)	(591–968)	(29.54–48.44)	(715–1277)	(30.4–54.48)	(−0.12 to 0.33)
Malaysia	0.737	10 764	53.58	16 320	59.09	0.10	6998	68.31	11 080	79.35	0.16
		(9769–12 735)	(48.39–61.31)	(12 560–20 857)	(45.73–75.08)	(−0.13 to 0.42)	(6132–8823)	(60.25–83.39)	(8267–14 423)	(59.54–102.64)	(−0.11 to 0.52)
Oman	0.783	798	66.90	958	49.78	−0.26	551	78.40	686	59.80	−0.24
		(575–902)	(48.35–75.76)	(684–1258)	(37.5–60.66)	(−0.4 to −0.06)	(381–636)	(56.78–91.08)	(462–946)	(43.21–75.54)	(−0.42 to −0.02)
Sri Lanka	0.69	26 777	131.30	26 741	102.04	−0.22	15 457	162.42	15 162	126.24	−0.22
		(19 831–28 892)	(99.86–141.32)	(19 249–36 195)	(73.71–138.42)	(−0.43 to 0.05)	(10 534–17 166)	(113.37–179.58)	(10 312–21 438)	(86.28–176.89)	(−0.45 to 0.08)
Turkey	0.748	28 298	40.20	33 554	36.71	−0.09	17 045	50.89	20 789	47.28	−0.07
		(23 233–32 003)	(33.61–45.46)	(25 496–42 068)	(28.11–46.04)	(−0.3 to 0.18)	(13 283–19 801)	(40.79–59.13)	(15 477–26 831)	(35.41–60.97)	(−0.29 to 0.24)
Middle SDI
Armenia	0.689	1380	36.73	1523	36.43	−0.01	951	58.98	1087	59.31	0.01
		(1279–1483)	(34.02–39.52)	(1242–1845)	(29.74–44)	(−0.18 to 0.2)	(873–1032)	(54.06–64.2)	(868–1342)	(47.82–72.73)	(−0.18 to 0.23)
Azerbaijan	0.683	15 923	210.45	21 021	208.98	−0.01	10 481	305.84	14 636	316.72	0.04
		(12 935–24 217)	(168.18–331.37)	(16 036–31 587)	(159.15–316.11)	(−0.17 to 0.19)	(8338–17 051)	(241.23–515.57)	(10 376–23 788)	(224.56–518.83)	(−0.18 to 0.31)
China	0.686	6 008 546	385.40	5 759 997	277.50	−0.28	4 677 604	604.84	4 622 298	458.55	−0.24
		(4 093 922–6 742 636)	(259.37–431.25)	(4 581 771–6 999 574)	(221.69–335.87)	(−0.42 to −0.06)	(3 266 314–5 334 393)	(420–688.2)	(3 552 362–5 810 370)	(354.39–572.18)	(−0.42 to 0)
Indonesia	0.66	109 285	60.01	133 605	57.40	−0.04	69 904	79.38	90 811	80.02	0.01
		(92 204–150 561)	(50.78–82.91)	(106 643–191 026)	(46.08–81.45)	(−0.21 to 0.15)	(54 605–98 190)	(62.39–113.12)	(65 931–136 590)	(58.77–121.68)	(−0.22 to 0.3)
Iran (Islamic Republic of)	0.67	55 624	101.04	70 307	94.25	−0.07	35 307	127.20	44 378	118.69	−0.07
		(40 630–59 031)	(73.12–107.42)	(57 445–77 012)	(75.29–103.27)	(−0.15 to 0.05)	(23 398–38 003)	(84.38–137.01)	(33 378–48 951)	(87.95–131.01)	(−0.17 to 0.11)
Iraq	0.671	5443	30.82	7966	30.97	0.00	3279	38.71	4852	39.53	0.02
		(4154–6954)	(23.83–38.86)	(5928–10 256)	(23.57–39.16)	(−0.19 to 0.23)	(2422–4325)	(28.96–50.14)	(3570–6224)	(29.36–49.94)	(−0.21 to 0.32)
Philippines	0.623	21 991	33.99	29 414	34.07	0.00	15 376	49.77	20 573	49.80	0.00
		(19 824–27 919)	(30.71–44.27)	(23 476–39 162)	(27.34–45.6)	(−0.19 to 0.23)	(13 409–19 411)	(43.55–64.34)	(15 157–28 782)	(36.8–69.41)	(−0.25 to 0.31)
Syrian Arab Republic	0.619	2266	20.86	2883	21.75	0.04	1588	28.41	2094	30.88	0.09
		(1809–2753)	(16.83–25.27)	(2098–3836)	(16.07–28.46)	(−0.22 to 0.39)	(1194–2005)	(21.77–35.56)	(1454–2820)	(21.91–41.1)	(−0.21 to 0.49)
Thailand	0.687	62 873	79.18	80 034	76.41	−0.03	46 998	124.64	61 426	124.35	0.00
		(38 723–74 158)	(49.36–93.02)	(49 925–110 058)	(48.12–104.93)	(−0.31 to 0.34)	(29 275–56 039)	(78.97–148.31)	(39 172–84 592)	(80.32–169.76)	(−0.3 to 0.41)
Turkmenistan	0.67	6989	223.65	10 410	245.69	0.10	3606	263.33	5919	312.51	0.19
		(6544–7512)	(209.54–240.58)	(8081–13 104)	(193.26–306.68)	(−0.14 to 0.39)	(3363–3895)	(246.43–283.98)	(4535–7637)	(243.66–397.57)	(−0.08 to 0.52)
Uzbekistan	0.631	26 674	156.80	38 097	162.45	0.04	14 143	192.54	20 780	203.29	0.06
		(25 243–28 213)	(148.99–164.8)	(31 208–45 398)	(134.23–191.13)	(−0.15 to 0.23)	(13 188–15 108)	(179.56–205.38)	(16 857–25 089)	(167.75–240.83)	(−0.14 to 0.26)
Viet Nam	0.617	56 860	76.06	75 348	72.98	−0.04	51 500	155.32	68 916	148.08	−0.05
		(37 926–68 275)	(52.02–90.16)	(49 100–98 541)	(49.39–93.95)	(−0.24 to 0.19)	(33 839–62 361)	(107.73–184.52)	(44 095–91 273)	(100.91–190.99)	(−0.24 to 0.18)
Low‐middle SDI
Bangladesh	0.483	102 880	108.44	132 618	97.07	−0.10	66 667	132.46	83 916	120.18	−0.09
		(82 735–143 771)	(87.95–150.82)	(92 755–200 855)	(68.5–145.98)	(−0.31 to 0.15)	(51 080–95 973)	(102.07–189.05)	(55 816–130 952)	(80.16–186.64)	(−0.31 to 0.18)
Bhutan	0.455	534	114.01	672	114.53	−0.01	337	138.05	432	143.32	0.04
		(394–752)	(84.37–159.62)	(456–949)	(78.75–161.67)	(−0.28 to 0.33)	(225–482)	(92.32–196.24)	(262–629)	(88.61–206.51)	(−0.32 to 0.55)
Cambodia	0.469	6619	70.77	8988	70.44	0.00	3929	100.27	5573	102.40	0.02
		(5346–8735)	(58.01–94.67)	(6717–12 384)	(53.61–97.28)	(−0.19 to 0.2)	(3045–5297)	(78.15–137.87)	(3983–7899)	(74.25–147.77)	(−0.19 to 0.27)
Democratic People's Republic of Korea	0.558	68 376	246.63	75 140	225.46	−0.09	50 365	425.12	57 219	385.92	−0.09
		(49 705–88 838)	(180.48–318.34)	(56 792–99 032)	(171.56–293.98)	(−0.24 to 0.11)	(36 033–67 685)	(309.11–566.44)	(42 231–76 763)	(291.49–517.88)	(−0.25 to 0.11)
India	0.566	811 258	87.87	1 055 009	86.99	−0.01	493 313	107.19	627 622	104.71	−0.02
		(721 907–1 167 780)	(77.99–127.03)	(869 421–1 514 411)	(71.98–124.54)	(−0.17 to 0.16)	(429 684–742 359)	(93.42–161)	(480 388–954 558)	(80.2–160.4)	(−0.23 to 0.21)
Kyrgyzstan	0.596	4040	111.57	4608	98.42	−0.12	2644	169.92	3170	154.79	−0.09
		(3796–4284)	(104.5–118.51)	(3881–5396)	(83.48–115.05)	(−0.25 to 0.03)	(2467–2824)	(158.23–181.83)	(2631–3743)	(129.69–182.48)	(−0.24 to 0.08)
Lao People's Democratic Republic	0.49	2404	65.59	2917	60.51	−0.08	1493	84.97	1871	79.96	−0.06
		(1644–3398)	(45.4–94.09)	(1956–4193)	(41.43–88.11)	(−0.25 to 0.15)	(1000–2177)	(57.98–123.43)	(1215–2960)	(52.92–126.27)	(−0.26 to 0.19)
Maldives	0.562	100	48.21	138	42.24	−0.12	45	41.28	71	38.42	−0.07
		(86–112)	(41.43–54.23)	(111–168)	(33.89–51.63)	(−0.29 to 0.07)	(38–53)	(34.29–48.2)	(56–88)	(30.17–47.36)	(−0.27 to 0.17)
Mongolia	0.606	8119	545.46	10 863	486.69	−0.11	4779	707.52	6741	680.59	−0.04
		(6634–9753)	(416.31–650.32)	(8385–14 155)	(364.21–628.73)	(−0.29 to 0.13)	(3738–6442)	(561.13–864.25)	(5011–9276)	(515.45–879.57)	(−0.25 to 0.23)
Myanmar	0.521	24 909	63.79	27 994	56.63	−0.11	15 319	87.06	17 981	81.44	−0.06
		(19 002–35 001)	(49.2–90.42)	(21 666–41 721)	(44.3–85.47)	(−0.27 to 0.1)	(11 595–21 788)	(65.71–124.06)	(13 525–26 668)	(62.08–122.76)	(−0.25 to 0.16)
Palestine	0.588	469	26.27	649	25.53	−0.03	315	38.55	459	37.62	−0.02
		(414–561)	(23.14–32.51)	(527–837)	(20.7–33.63)	(−0.21 to 0.18)	(268–388)	(33.04–49.34)	(366–609)	(30.08–50.59)	(−0.23 to 0.2)
Tajikistan	0.539	9988	258.33	9645	175.32	−0.32	6134	332.79	5970	233.13	−0.30
		(8401–13 569)	(216.43–362.73)	(6940–19 644)	(127.84–369.48)	(−0.51 to 0.06)	(5048–8752)	(271.71–490.14)	(4230–12 581)	(168.96–491.7)	(−0.51 to 0.13)
Timor‐Leste	0.514	335	50.31	486	57.30	0.14	194	57.52	293	68.74	0.20
		(223–499)	(34.34–74.63)	(337–711)	(40.51–84.21)	(−0.07 to 0.44)	(115–330)	(34.82–97.15)	(181–490)	(43.4–112.77)	(−0.05 to 0.58)
Low SDI
Afghanistan	0.343	19 309	182.19	24 997	169.51	−0.07	7867	162.42	10 701	154.09	−0.05
		(6323–29 551)	(59.59–272.53)	(8044–37 747)	(54.59–243.26)	(−0.24 to 0.14)	(2481–12 092)	(53.11–246.72)	(3581–16 230)	(52.25–225.6)	(−0.24 to 0.19)
Nepal	0.422	19 130	104.49	28 099	120.24	0.15	10 986	121.83	17 103	154.42	0.27
		(14 841–25 638)	(81.58–139.12)	(20 397–38 410)	(87.93–163.27)	(−0.08 to 0.43)	(8118–14 675)	(92.17–164.89)	(11 775–23 261)	(106.42–207.86)	(−0.03 to 0.63)
Pakistan	0.449	208 464	221.22	260 192	207.08	−0.06	112 911	229.03	140 438	215.43	−0.06
		(170 019–248 539)	(181.92–263.45)	(204 466–323 900)	(165.9–255.39)	(−0.26 to 0.21)	(83 778–145 832)	(170.96–291.84)	(97 543–191 188)	(150.27–290)	(−0.34 to 0.37)
Yemen	0.412	10 546	102.38	14 931	103.13	0.01	5312	103.80	7506	106.27	0.02
		(3189–15 519)	(31.01–150.27)	(4511–22 259)	(31.29–151.92)	(−0.16 to 0.23)	(1639–8144)	(32.24–158.48)	(2409–11 513)	(33.69–162.75)	(−0.19 to 0.28)

Location	Female					M/F ratio
	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000
High SDI
Brunei Darussalam	37	34.59	54	33.58	−0.03	2.90
	(32–48)	(29.43–46.27)	(43–73)	(27.26–46.65)	(−0.18 to 0.15)
Cyprus	97	12.88	113	11.28	−0.12	3.83
	(74–111)	(9.77–14.73)	(88–140)	(8.79–13.98)	(−0.27 to 0.06)
Israel	917	18.69	1054	17.03	−0.09	2.69
	(826–1002)	(16.84–20.36)	(911–1199)	(14.85–19.33)	(−0.19 to 0.03)
Japan	36 708	25.20	38 112	23.49	−0.07	6.59
	(32 300–39 198)	(23.14–26.46)	(32 441–42 640)	(21.13–25.97)	(−0.11 to 0.01)
Kuwait	132	23.08	184	16.25	−0.30	2.31
	(119–146)	(20.46–25.81)	(141–257)	(12.44–22.12)	(−0.45 to −0.06)
Qatar	65	73.50	102	53.66	−0.27	1.54
	(49–81)	(46.83–91.11)	(72–145)	(36.66–75.15)	(−0.45 to 0.03)
Republic of Korea	3182	9.11	3914	8.09	−0.11	12.65
	(2729–4987)	(7.8–14.18)	(3170–5922)	(6.59–12.09)	(−0.24 to 0.04)
Saudi Arabia	2176	40.02	2839	33.43	−0.16	1.31
	(1833–2891)	(34.25–49.71)	(2047–4111)	(24.44–45.6)	(−0.36 to 0.09)
Singapore	397	15.26	467	11.67	−0.24	5.35
	(355–442)	(13.61–17.03)	(393–552)	(9.8–13.78)	(−0.33 to −0.11)
Taiwan (Province of China)	3780	24.25	4515	21.81	−0.10	20.74
	(3446–4087)	(22.04–26.23)	(3425–5950)	(16.58–28.84)	(−0.31 to 0.18)
United Arab Emirates	655	166.49	1249	87.25	−0.48	2.69
	(169–1105)	(40.57–296.73)	(318–2138)	(22.99–154.17)	(−0.59 to −0.2)
High‐middle SDI
Bahrain	56	25.31	78	19.69	−0.22	2.79
	(46–68)	(21.08–30.29)	(58–104)	(15.06–25.8)	(−0.39 to 0)
Georgia	539	16.24	558	17.49	0.08	4.94
	(473–613)	(14.17–18.39)	(454–674)	(14.14–21.31)	(−0.14 to 0.34)
Jordan	328	18.32	574	16.84	−0.08	2.05
	(258–404)	(14.5–22.44)	(412–790)	(12.43–22.98)	(−0.28 to 0.21)
Kazakhstan	12 860	151.31	11 988	116.80	−0.23	2.19
	(12 146–13 646)	(143.1–160.62)	(10 147–14 047)	(99.17–136.38)	(−0.35 to −0.1)
Lebanon	365	16.68	451	15.86	−0.05	2.67
	(270–469)	(12.36–21.5)	(320–657)	(11.21–23.09)	(−0.25 to 0.18)
Malaysia	3765	38.65	5240	38.78	0.00	2.05
	(3282–4329)	(33.08–44.21)	(3872–6988)	(28.81–51.14)	(−0.23 to 0.31)
Oman	247	51.60	272	37.10	−0.28	1.61
	(177–286)	(35.72–60.33)	(203–352)	(27.25–46.75)	(−0.43 to −0.06)
Sri Lanka	11 320	104.43	11 579	81.23	−0.22	1.55
	(8336–12 462)	(78.35–114.88)	(8102–15 596)	(56.79–108.41)	(−0.45 to 0.05)
Turkey	11 253	30.53	12 765	27.02	−0.11	1.75
	(9106–13 010)	(25.08–35.2)	(9800–16 093)	(20.72–33.99)	(−0.33 to 0.16)
Middle SDI
Armenia	429	19.37	437	18.49	−0.05	3.21
	(392–469)	(17.81–21.03)	(359–523)	(15.25–22.26)	(−0.21 to 0.15)
Azerbaijan	5442	131.93	6385	121.34	−0.08	2.61
	(3997–7847)	(95.65–195.51)	(4547–9165)	(85.42–177.24)	(−0.27 to 0.16)
China	1 330 942	174.86	1 137 699	108.46	−0.38	4.23
	(757 914–1 532 223)	(99.08–201.36)	(809 672–1 428 715)	(76.74–135.97)	(−0.52 to −0.13)
Indonesia	39 380	41.97	42 794	36.32	−0.13	2.20
	(28 075–52 894)	(30.56–57.02)	(29 313–60 049)	(25.54–51.03)	(−0.33 to 0.11)
Iran (Islamic Republic of)	20 317	74.72	25 929	69.94	−0.06	1.70
	(15 725–21 716)	(57.14–80.13)	(20 597–29 163)	(55.29–78.6)	(−0.14 to 0.04)
Iraq	2164	23.34	3113	22.97	−0.02	1.72
	(1570–2927)	(17.13–31.5)	(2208–4181)	(16.72–30.19)	(−0.26 to 0.32)
Philippines	6615	19.77	8841	19.90	0.01	2.50
	(5816–8613)	(17.41–26.42)	(6695–11 830)	(15.17–26.8)	(−0.23 to 0.32)
Syrian Arab Republic	678	12.41	790	12.06	−0.03	2.56
	(519–856)	(9.92–15.43)	(575–1079)	(8.89–16.18)	(−0.29 to 0.31)
Thailand	15 875	38.70	18 608	33.67	−0.13	3.69
	(8412–19 188)	(20.55–46.62)	(9341–25 494)	(16.88–46.07)	(−0.37 to 0.21)
Turkmenistan	3383	194.50	4491	194.41	0.00	1.61
	(3120–3704)	(179.85–211.76)	(3437–5890)	(150.16–253.49)	(−0.22 to 0.29)
Uzbekistan	12 531	130.60	17 317	132.32	0.01	1.54
	(11 789–13 365)	(123.1–138.31)	(14 095–20 702)	(109.16–157.03)	(−0.17 to 0.2)
Viet Nam	5360	13.27	6432	12.06	−0.09	12.28
	(3700–6751)	(9.18–16.69)	(4274–8412)	(8.03–15.61)	(−0.29 to 0.15)
Low‐middle SDI
Bangladesh	36 213	80.50	48 702	72.53	−0.10	1.66
	(26 350–57 518)	(59.03–128.09)	(32 966–82 726)	(49.21–123.75)	(−0.32 to 0.19)
Bhutan	197	87.85	240	84.14	−0.10	1.70
	(138–304)	(62.05–135.61)	(155–384)	(55.35–132.55)	(−0.39 to 0.33)
Cambodia	2690	49.83	3415	47.38	−0.05	2.16
	(2126–3615)	(39.71–67.45)	(2591–4641)	(36.23–64.75)	(−0.24 to 0.18)
Democratic People's Republic of Korea	18 011	111.75	17 921	95.68	−0.14	4.03
	(11 432–25 978)	(71.61–160.86)	(11 633–24 777)	(62.41–132.69)	(−0.31 to 0.1)
India	317 946	68.73	427 387	69.85	0.02	1.50
	(271 406–447 326)	(58.46–97.44)	(331 056–603 257)	(54.36–99.11)	(−0.2 to 0.28)
Kyrgyzstan	1395	66.84	1438	55.75	−0.17	2.78
	(1271–1517)	(60.68–72.87)	(1201–1700)	(46.7–65.75)	(−0.31 to −0.01)
Lao People's Democratic Republic	912	47.50	1046	42.12	−0.11	1.90
	(484–1326)	(25.47–68.85)	(556–1536)	(22.57–61.88)	(−0.3 to 0.11)
Maldives	54	56.53	67	46.79	−0.17	0.82
	(45–64)	(46.4–66.47)	(53–84)	(36.88–57.95)	(−0.34 to 0.03)
Mongolia	3341	421.41	4122	343.15	−0.19	1.98
	(2160–4171)	(227.07–529.55)	(2692–5595)	(188.41–459.78)	(−0.38 to 0.09)
Myanmar	9590	44.71	10 013	37.03	−0.17	2.20
	(6408–13 988)	(30.4–66.48)	(7199–14 853)	(27.03–55.13)	(−0.35 to 0.03)
Palestine	154	15.99	191	14.67	−0.08	2.56
	(132–185)	(13.67–20.15)	(152–252)	(11.63–20.26)	(−0.28 to 0.15)
Tajikistan	3854	188.56	3674	123.94	−0.34	1.88
	(3168–5297)	(153.81–274.09)	(2615–7414)	(88.36–260.97)	(−0.52 to 0.03)
Timor‐Leste	141	43.08	193	45.92	0.07	1.50
	(96–202)	(30.01–61.28)	(132–268)	(32.12–64.02)	(−0.16 to 0.36)
Low SDI
Afghanistan	11 442	200.42	14 296	184.70	−0.08	0.83
	(3172–18 916)	(56.53–319.89)	(4062–23 594)	(52.9–287.99)	(−0.27 to 0.18)
Nepal	8144	87.19	10 995	88.91	0.02	1.74
	(6085–12 546)	(65.29–136.19)	(7771–17 000)	(63.9–136.01)	(−0.19 to 0.29)
Pakistan	95 553	212.11	119 754	197.64	−0.07	1.09
	(74 265–119 185)	(165.96–262.45)	(88 072–160 336)	(148.57–262.67)	(−0.31 to 0.27)
Yemen	5234	100.99	7426	100.17	−0.01	1.06
	(1408–8342)	(27.24–161.17)	(1966–12 780)	(26.92–173.51)	(−0.23 to 0.25)

Abbreviations: ASR, age‐standardized rate; DALYS, disability‐adjusted life years; EC, esophageal cancer.

National comparison

Among Asian countries, 38 countries experienced a decreasing trend in the EC DALYs ASR between 2010 and 2019; the greatest increase was detected in Nepal (increase in DALYs ASR = 0.15 [95% UI: −0.08–0.43]) and the greatest decrease was detected in Tajikistan (decrease in DALYs ASR = −0.32 [95% UI: −0.51–0.06]) (Figure 6).

In 2019, the highest DALYs ASR (per 100 000) of EC was reported in Mongolia (486.69), China (277.5), Turkmenistan (245.69), Taiwan (Province of China) (230.22), and Democratic People's Republic of Korea (225.46). The lowest DALYs ASR of EC was reported in the Syrian Arab Republic (21.75), Palestine (25.53), Jordan (26.16), Cyprus (26.58), and Lebanon (27.83).

In Asian men, the highest DALYs ASR (per 100 000) of EC was reported in Mongolia (680.59), China (458.55), Taiwan (Province of China) (452.29), Democratic People's Republic of Korea (385.92), and Azerbaijan (316.72). The lowest DALYs ASR (per 100 000) of EC was reported in the Syrian Arab Republic (30.88), Jordan (34.59), Kuwait (37.51), Palestine (37.62), and the Maldives (38.42).

In women, the highest DALYs ASR (per 100 000) of EC was reported in Mongolia (343.15), Pakistan (197.64), Turkmenistan (194.41), Afghanistan (184.7), and Uzbekistan (132.32). The lowest DALYs ASR (per 100 000) of EC was reported in the Republic of Korea (8.09), Cyprus (11.28), Singapore (11.67), Viet Nam (12.06), and Syrian Arab Republic (12.06). The results are presented in detail in Table 6.

Male/female ratio

In 2019, the DALYs ASR of EC in Asian men was 3.29 times that in women. The DALYs ASR of EC in Afghanistan and Maldives is reported to be higher in women than in men. In other countries, the DALYs of EC in men were higher than in women. In Taiwan (Province of China) the DALYs of EC in men were more than 20 times higher, and in the Republic of Korea and Viet Nam, the DALYs of EC in men were more than 10 times higher than in women (Figure 7).

DISCUSSION

EC is an important public health problem worldwide. The aim of this study was to investigate the temporal trend of EC, between 2010 and 2019, in Asian countries based on geographic region and SDI, and compare it with global data.

The results of the present study showed that: (1) The incidence cases of EC increased in both Asia and the world between 2010 and 2019 in both sexes. (2) The ASIR decreased during the mentioned years. (3) The highest incidence occurred in the 65–74 age group. (4) The highest ASIR was recorded in East Asia, but the ASIR trend has been decreasing between 2010 and 2019, while this rate has been stable in the countries of the Middle East and North Africa. (5) Among Asian countries, some countries have had an increasing trend of EC, and the highest increase has been seen in Nepal and the largest decrease in Tajikistan.

This finding has also been confirmed by other studies. ³⁰ , ³¹ The results of a study showed that the crude incidence of EC has increased in the world from 1990 to 2017, while the age‐standardized incidence of EC has decreased in these years, and the largest decrease has occurred in Central and Eastern Asia. ¹² A decreasing trend in the age‐standardized incidence of EC in the world, East Asia, Oceania, China, Japan, and South Korea from 1990 to 2017 has also been reported. ¹³ The reason for the decrease in the incidence of EC is not exactly clear. However, considering that a large part of the incidence of EC has been linked to smoking and alcohol consumption, it may be that the reduction in smoking and the increase in the general health of society can justify a part of this decreasing trend. ¹² Also, the results of several studies have shown that, in recent years, the socioeconomic level of societies has improved and the health literacy of the people has also increased, so it can be said that probably the change in these factors along with the reduction in the amount of smoking has been effective in reducing the incidence of EC. ³² , ³³ , ³⁴

It is stated that the growing population and ageing has led to an increase in the numbers of incidence, death, and DALYs in many locations. ³⁵ In China, the highest incidence of EC occurs in people aged 75–85, and most patients are 60 years old or more. ³⁶ The present study also showed that the highest incidence cases occurred in the age group of 65–74. In the world, the highest incidence cases have occurred in the over 70 years age group. ³⁰ In Canada, more than 90% of EC cases occurred in the age group above 60 years. ³⁷ In America, the average age of patients with EC at the time of diagnosis is 65 years. ³⁸ This finding is probably caused by the cumulative effects of people's exposure during their life, such as smoking, alcohol, not consuming fruit and fresh foods, etc., and also shows the importance of chronic diseases at the same time as the increase in life expectancy and the increase in the elderly population. ³⁹ On the other hand, early diagnosis and timely treatment are the major public health and clinical approaches to improve survival and reduction of cancer burden by preventing premature cancer deaths. ⁴⁰ Some studies consider old age to be an effective factor in reducing the survival rate of patients with EC after esophagectomy, ⁴¹ while other studies consider surgical esophagectomy to be as effective as performing this procedure in younger patients. These studies consider the experience of the elderly in postoperative care as a reason for the better results of esophagectomy in elderly patients. ⁴² , ⁴³

Based on the present study, the cases of death from EC in Asia have increased between 2010 and 2019 in both women and men. The ASDR has decreased during the mentioned years in both women and men in Asia and worldwide, and it has mostly occurred in the 65–74 age group, with most deaths occurring in men. Although in 2019, the highest ASDR was reported in East Asia, these countries also recorded the largest decline in ASDR from 2010 to 2019. Among Asian countries, some countries have an increasing trend of EC, and the largest increase has been seen in Nepal and the largest decrease in Tajikistan. The above findings are consistent with the results of other studies. In another study, the global trend of mortality from EC has been reported to be decreasing and the highest rate of decrease has been seen in Central Asian regions, especially Uzbekistan, Turkmenistan and Bahrain. ³⁰ This decreasing trend has been reported in the world, East Asia and the Pacific and the three countries of China, Japan and South Korea for both sexes between 1990 and 2017. Also, in previous studies, the rate of death due to EC in men is twice as high as in women. ¹³

All studies agree on the higher rates of incidence and mortality of EC in men compared to women. ⁴ , ¹² , ⁴⁴ The reason for gender inequality is not clear. The results of studies have shown that smoking and heavy alcohol consumption increase the risk of developing EC. ⁴⁵ , ⁴⁶ , ⁴⁷ Historically, these behaviors have been more common in men than in women. ⁴⁸ These reasons may partly explain the higher burden of EC in men than in women. Also, the effect of sex hormones is one of the other possible options to explain the gender difference in the incidence of EC. ⁴⁴

The findings of this study demonstrated that: (1) the number of patients with EC increased in 2019 compared to 2010, in both females and males, while the ASPR in the same period has decreased over time both in Asia and globally. (2) The highest prevalence was seen in the age group of 65–69, and in all age groups, the prevalence of the disease was higher in men than in women. (3) In 2019, the highest ASPR was seen in East Asian countries. (4) In both men and women, the highest prevalence of the disease has been observed in high‐income Asia‐Pacific countries. (5) Among Asian countries, 27 countries experienced a decrease in the prevalence of EC. The largest increase was observed in Lebanon and the largest decrease was observed in Oman. (6) In 2019, the ASPR of EC among Asian males is 2.5 times higher than that of women.

Not much information has been published regarding the prevalence of EC, and most statistics are related to the incidence and survival of EC. Nevertheless, considering that the prevalence is a function of the incidence of the disease and considering the decreasing trend in the incidence of EC during the years 2010–2019 based on the present study and similar studies, ¹² , ³⁰ , ³¹ a downward trend in disease prevalence also seems logical. On the other hand, the prevalence of a disease is also a function of the survival of patients, so with the increase in the survival rate, the prevalence also increases. However, with regard to EC, it appears that the decrease in the incidence has been more effective in the prevalence of the disease than the increase in the survival rate.

The results of studies have shown that the survival rate of EC has increased between 1973 and 2009 in the United States, which is mainly due to early diagnosis, starting treatment in the early stages of the disease and more use of effective treatment methods, especially surgery. ⁶ The results of the study conducted in Canada also showed that, despite the rarity of EC in Canada, the 5‐year survival rate of EC in this country increased between 2004 and 2006. ⁴⁹

The results of the present study also showed that the prevalence of the disease in both men and women was higher in countries with higher incomes. This finding is consistent with the results of other studies. According to the results of the study by Fan et al., the highest age‐standardized incidence in the world has been seen in East Asia and high‐income countries of the world. ¹² Of course, this finding is not consistent with the results of studies that have introduced socioeconomic level as a risk factor for the occurrence of EC. ³ Part of this difference in the prevalence of the disease in different communities may be related to the better survival of patients in communities with higher incomes. A study conducted in the USA shows an increase in the survival rate of patients with EC in this country. ⁴ Increased survival may also be due to better access to screening and treatment and care services.

The findings of the present study showed that: (1) the raw number of DALYs increased between 2010 and 2019. (2) In 2019, 73% of all cases of years of life lost due to EC occurred in Asia. (3) The trend of ASR DALYs between 2010 and 2019 has been decreasing in both Asia and the world. (4) In 2019, DALY cases due to EC generally peaked at 65–69 years, in both men and women. (5) Regionally, the highest number of DALYs to EC cancer occurred in East Asia. (6) In 2019, the highest DALY ASR was reported in Mongolia, China, Turkmenistan, Taiwan (province of China) and Korea. The lowest DALY ASR of EC was reported in the Syrian Arab Republic, Palestine, Jordan, Cyprus and Lebanon. (7) In 2019, DALYs ASR of EC in Asian men were 3.29 times that of women.

Regarding the burden of EC, the results of this study showed that the trend of DALYs between 2010 and 2019 has been decreasing in Asia and the world. This finding is consistent with the results of other studies. In China, South Korea and Japan, it also showed that the ASR DALY in all three countries from 1990 to 2017 is decreasing. ¹³ The result of a review study in Iran showed that the number of DALY crude rates due to EC has increased during the said years, but the age‐adjusted rate of this index was not reported. ⁵⁰ Possible reasons for the decreasing trend in DALYs ASR may be related to the decreasing trend in incidence as well as mortality. The results of various studies have shown that the trend of incidence and death of EC in the world is decreasing, considering that 96.8% of DALY cases in EC are affected by YLL. ⁵¹ Also, the decreasing trend of YLL can also lead to the decreasing trend of DALY.

In general, investigating the causes of geographical variation in the epidemiological rates of EC requires investigation of the impact of genetic variation, differences in lifestyles, differences in exposure to environmental risk factors, differences in gender characteristics, and injustices in access to screening, diagnostic, and treatment services in low and high prevalence areas.

In conclusion, although the rate of decline in incidence, death, prevalence and burden of EC in Asia is higher than in other regions in the last 10 years, more than 70% of these have occured in Asia. Considering the increasing rate of ageing in populations, it seems that EC will continue to be a health challenge. On the other hand, the geographical diversity in Asia also requires further study. Considering that in some countries the rates of EC in men are also more than 10 times higher than in women, the investigation of this gender inequality should be prioritized. Generally, it seems that adopting appropriate strategies in the field of identifying and controlling modifiable risk factors for EC, implementing screening programs, and timely diagnosis and treatment will help in reducing the burden of this disease in Asian countries.

One of the strengths of this study is the up‐to‐date and comprehensive presentation of incidence, mortality, and DALY patterns related to FBC in Asia. In addition, this study also has limitations. Among the challenges associated with quantifying all data sources, delays in data access, changes in coding practices, etc., is the possible impact of the lack or low quality of cancer reporting and registration systems in countries with low SDI on data interpretation. Therefore, the results should be interpreted with caution.

AUTHOR CONTRIBUTIONS

Conceptualization: HS, AM, and LA; Formal analysis: HS, SA, YK and AM; Data curation: HS, AM, YK and SA; Project administration: HS, AM, and LA; Writing‐original draft: all authors contributed to the writing‐original draft; Writing‐review and editing: all authors contributed in the editing the final proof.

CONFLICT OF INTEREST STATEMENT

The authors report no competing interest.

Mazidimoradi A, Amiri S, Khani Y, Allahqoli L, Salehiniya H. Burden of esophageal cancer between 2010 and 2019 in Asian countries by geographical region and sociodemographic index: A comparison with global data. Thorac Cancer. 2023;14(24):2361–2407. 10.1111/1759-7714.15026