The global and regional burden of early-onset gastric cancer (15-49 years, 1990-2021): incidence and mortality with projections to 2030

Yujuan Jiang; Peng Wang; Haikuo Wang; Jinghua Chen; Dedi Jiang; Jianwei Liang; Yantao Tian

doi:10.1093/oncolo/oyaf244

. 2025 Aug 5;30(9):oyaf244. doi: 10.1093/oncolo/oyaf244

The global and regional burden of early-onset gastric cancer (15-49 years, 1990-2021): incidence and mortality with projections to 2030

Yujuan Jiang ^1,^‡, Peng Wang ^2,^‡, Haikuo Wang ³, Jinghua Chen ⁴, Dedi Jiang ⁵, Jianwei Liang ⁶, Yantao Tian ^7,^✉

¹ Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

² Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

³ Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

⁴ Department of Hepatobiliary surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

⁵ Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

⁶ Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

⁷ Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

^✉

Corresponding author: Yantao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China (tianyantao@cicams.ac.cn).

^‡

Yujuan Jiang and Peng Wang have contributed equally to this work.

Roles

Yujuan Jiang: Conceptualization, Data curation, Writing - original draft

Peng Wang: Software, Supervision, Validation

Haikuo Wang: Investigation, Methodology

Jinghua Chen: Formal analysis, Methodology

Dedi Jiang: Software, Supervision, Validation

Jianwei Liang: Writing - review & editing

Yantao Tian: Funding acquisition, Writing - review & editing

PMCID: PMC12448411 PMID: 40794596

Abstract

Background

While global gastric cancer incidence has declined, trends in early-onset gastric cancer (EOGC, age 15-49) remain unclear. This study evaluates EOGC’s global burden (1990-2021), projects trends to 2030, and identifies epidemiological drivers.

Methods

Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized incidence, mortality, disability-adjusted life years (DALYs), and estimated annual percentage change for EOGC globally and by sex, region, and income level. A Bayesian age-period-cohort model and decomposition analysis assessed temporal trends, epidemiological drivers (eg, aging, population growth), and projected burden through 2030.

Results

In 2021, EOGC caused 125 120 new cases and 78 871 deaths globally. From 1990 to 2021, age-standardized mortality, incidence, and DALYs declined worldwide. East Asia and high-middle-income regions bore the highest burden. Decomposition identified epidemiological changes as the primary driver of reduced EOGC burden. Males exhibited higher incidence, mortality, and DALYs than females. Projections suggest declining incidence and mortality rates by 2030 for both sexes, yet rising absolute case numbers due to population growth.

Conclusions

Early-onset gastric cancer burden shows complex patterns: while rates have decreased over 3 decades, absolute cases and deaths increased due to demographic expansion. Disparities persist across gender, geography, and development levels. These findings highlight the need for targeted interventions in high-risk populations and regions to address inequities. Policymakers should prioritize surveillance and prevention strategies tailored to evolving epidemiological trends.

Keywords: early-onset gastric cancer, epidemiology, incidence, mortality, risk factor, global burden trends

Implications for Practice.

The persistent disparities in early-onset gastric cancer (EOGC) burden underscore the urgency of tailored interventions. First, gender-specific prevention strategies are critical, given the significantly higher incidence, mortality, and disability-adjusted life years observed in males. Targeted screening programs (eg, Helicobacter pylori testing) and lifestyle modification campaigns (eg, smoking cessation) should prioritize young males in high-risk regions. Second, regionally adapted policies are needed: East Asia and high-middle-income areas require enhanced early detection systems (eg, endoscopy capacity building) to address their disproportionate burden. Third, policymakers must balance declining age-standardized rates with rising absolute cases driven by population growth. This necessitates integrating demographic projections into healthcare resource allocation, particularly in rapidly growing populations. Finally, global collaboration should address inequities by supporting low-income regions in adopting evidence-based interventions (eg, salt reduction policies, H. pylori eradication). Future research should explore EOGC’s molecular drivers to enable precision prevention strategies.

Introduction

Individuals aged 15 to 49 represent a diverse demographic, undergoing significant physical, emotional, and psychosocial changes as they transition into adulthood.¹ These developmental shifts are often influenced by factors such as career progression, higher education pursuit, relationship formation, and family planning.² This age group is susceptible to cancers typically observed in both pediatric and adult populations.¹ However, they face unique healthcare challenges, including limited time for medical check-ups, work-related stress, poor health habits, and various social and financial pressures.³ For cancer patients within the 15--49 age range, early detection, high-quality care, and tailored treatment approaches are critical.⁴^,⁵ Therefore, a comprehensive assessment of this population’s disease burden and epidemiological patterns of cancers is essential for improving health outcomes.

Early-onset gastric cancer (EOGC) lacks a standardized age definition. Current studies predominantly define EOGC as cases diagnosed between ages 15-49, a critical window for assessing its unique burden on younger populations.⁶^,⁷ Despite gastric cancer’s status as the fifth most common malignancy and fourth leading cause of cancer deaths globally,^8–10 EOGC epidemiology remains understudied. To date, only Li et al. (GBD 2019) have analyzed global EOGC trends in ages 15--50, yet their work neither projected future burden nor disentangled demographic drivers.¹¹ Our study extends this evidence by employing GBD 2021 data, Bayesian age-period-cohort modeling, and 2030 projections to address these gaps.

This study systematically evaluates trends in the global burden of EOGC using the updated GBD 2021 dataset, providing novel insights into the distribution and magnitude of this disease. Additionally, it offers refined predictions for the global EOGC burden over the next decade. The primary objective is to analyze trends in incidence, mortality, and case fatality, along with their long-term fluctuations. This analysis aims to guide the development of effective strategies for the primary prevention, screening, early detection, and treatment of EOGC.

Methods

We analyzed GBD 2021 data using standardized methodologies described previously.¹² Briefly, we extracted incidence, mortality, and disability-adjusted life years (DALYs) for gastric cancer in 15-49-year-olds across 204 countries. Age-standardized rates (ASRs) used the GBD world population. We employed Bayesian age-period-cohort modeling for trend analysis and projections through 2030. Decomposition analysis assessed contributions from population growth, aging, and epidemiological changes.

Data sources and study design

This population-based study utilized the Global Burden of Disease (GBD) 2021 database to analyze the epidemiological burden of gastric cancer (ICD-10 C16) in adolescents and young adults (15-49 years) across 204 countries. Data were extracted from the Global Health Data Exchange (http://ghdx.healthdata.org/gbd-results-tool), encompassing age-standardized incidence, mortality, prevalence, years lived with disability, years of life lost, and DALYs. Disability-adjusted life years quantify disease burden by combining years of life lost due to premature mortality and years lived with disability, providing a comprehensive measure of health gaps. All estimates were standardized using the GBD world population and stratified by age, sex, geographic region, and income-level quintiles (low to high).

Statistical methods

Age-standardized rates per 100 000 population were calculated using direct standardization.¹³ Temporal trends were evaluated through estimated annual percentage changes (EAPCs) derived from log-linear regression: ln(rate) = α + β×(year) + ε, where EAPC = 100 × (exp(β)−1). Bayesian age-period-cohort (BAPC) modeling was applied for trend decomposition and 2030 projections, incorporating probabilistic uncertainty estimates from 1000 GBD algorithm iterations.

Das Gupta’s decomposition method quantified contributions of 3 demographic drivers¹⁴: population growth, aging, and epidemiological risk. The analysis differentiated period effects (temporal risk variations) from cohort effects (generational risk differences) using longitudinal age-specific incidence curves.

To predict future trends in EOGC through 2030, this study employed the BAPC model.¹⁵^,¹⁶ This advanced methodology utilizes historical data in conjunction with probability distributions to estimate future patterns, accounting for the effects of age, period, and cohort factors.

Ethical considerations

As this study utilized fully anonymized, aggregate-level data from the GBD repository, neither institutional review board approval nor individual informed consent was required.

Sensitivity and validation

Methodological consistency was ensured through standardized GBD estimation frameworks. All statistical procedures were implemented in R 4.3.1 using validated packages (BAPC, decomposition). Model performance was verified through cross-validation against historical data trends (2015-2021). Uncertainty intervals (95% UI) represent the 25th-75th percentile range of 1000 posterior draws.

Results

Descriptive analysis of EOGC burden at global, regional, and national levels

According to the GBD 2021 estimates, a total of 125 120.5 new cases of EOGC were documented worldwide, with East Asia reporting the highest incidence. The global average ASR was 3 per 100 000 individuals, exhibiting regional variations from 7 per 100 000 in East Asia to 1.2 per 100 000 in Western Sub-Saharan Africa. Between 1990 and 2021, the ASR of incidence decreased by 47.6%. Regarding gender disparities, men (ASR: 3.9) exhibited approximately 1.86 times the global average incidence compared to women (ASR: 2.1), underscoring the gender-specific impact of EOGC.

Globally, EOGC accounted for 78 870.9 deaths, with East Asia recording the highest mortality rate (Table 1). The global average age-standardized mortality rate (ASMR) was 1.9 per 100 000 individuals, ranging from 0.6 in Australasia to 3.7 in Andean Latin America and East Asia, representing a 40.4% decrease from 1990 to 2021. Males (ASMR: 2.4) experienced approximately twice the mortality rate compared to females (ASMR: 1.4). When analyzed by income level, incidence and mortality ASRs were relatively higher in regions with high-middle and middle-income levels. A comprehensive summary of incidence and mortality data is provided in Table S1.

Table 1.

The case number and age-standardized rate (ASR, per 100 000) of incidence, mortality of EOGC in 1990 and 2021 for both sexes by income-level quintiles, with estimated annual percentage change (EAPC) from 1990 to 2021.

Location	Sex	Cases	ASR	Cases	ASR	EAPC	Cases	ASR	Cases	ASR	EAPC
		1990		2021		(1990-2021)	1990		2021		(1990-2021)
		Incidence (95% UI)		Incidence (95% UI)			Mortality (95% UI)		Mortality (95% UI)
Global	Both	146368.5 (126373.2-160638.1)	6.3 (5.4-6.9)	125120.5 (107268.8-144714.5)	3 (2.6-3.5)	−1.81 (−1.87-1.75)	108838.1 (93403.9-120127.4)	4.7 (4-5.2)	78870.9 (68333.8-90531.8)	1.9 (1.7-2.2)	−2.26 (−2.34-2.18)
	Female	53702.9 (47823.3-60030.1)	4.6 (4.1-5.2)	43335.8 (38352.8-49002.3)	2.1 (1.9-2.4)	−2.24 (−2.31-2.18)	40407.1 (35649.6-45387.2)	3.5 (3.1-3.9)	29057 (25953.3-32384.5)	1.4 (1.3-1.6)	−2.56 (−2.65-2.48)
	Male	92665.5 (74043.9-105868)	7.9 (6.3-9)	81784.8 (65890.5-100337)	3.9 (3.2-4.8)	−1.61 (−1.68-1.53)	68430.9 (53749.5-78519)	5.9 (4.6-6.7)	49813.9 (40443.5-60336.2)	2.4 (1.9-2.9)	−2.11(−2.2-2.02)
High-income	Both	28028.4 (26297.4-29503.2)	5.9 (5.5-6.2)	13627 (12828.2-14805.1)	2.3 (2.1-2.5)	−2.4(-2.46-2.34)	14465.8 (13447.6-15216.1)	3 (2.8-3.2)	5996 (5663.7-6561.7)	1 (0.9-1.1)	−2.79 (−2.81-2.76)
	Female	11275.6 (10491-12013.9)	4.7 (4.4-5.1)	5543.7 (5091.7-6066.2)	1.9 (1.8-2.1)	−2.57(-2.6-2.54)	6024.4 (5619.6-6395.9)	2.5 (2.4-2.7)	2456.8 (2286.1-2646)	0.8 (0.8-0.9)	−2.96 (−3.01-2.92)
	Male	16752.8 (15385.2-17982.2)	6.9 (6.4-7.5)	8083.3 (7423.8-9149.7)	2.6 (2.4-3)	−2.42 (−2.5-2.35)	8441.4 (7667.7-9112.7)	3.5 (3.2-3.8)	3539.3 (3246.3-4021.8)	1.1 (1-1.3)	−2.82 (−2.85-2.79)
High-middle-income	Both	46039.2 (38980-51309)	9.1 (7.7-10.2)	35727.6 (28840.3-43457)	4.6 (3.7-5.6)	−1.75 (−1.84-1.65)	35392.4 (29871.5-39486.5)	7.1 (6-7.9)	19858.9 (16316.4-23772.4)	2.5 (2.1-3)	−2.47(-2.59-2.35)
	Female	15018.8 (13000.5-17306.1)	5.9 (5.1-6.8)	10183.4 (8405-12506.7)	2.7 (2.3-3.4)	−2.3(−2.4-2.19)	11540 (9970.9-13313)	4.6 (4-5.3)	5877.7 (4947.8-7010.5)	1.6 (1.3-1.9)	−2.86 (−2.99-2.73)
	Male	31020.4 (24024.4-35978.2)	12.3 (9.5-14.2)	25544.2 (19221.8-32502.8)	6.5 (4.9-8.2)	−1.56 (−1.66-1.46)	23852.5 (18325.1-27688.5)	9.5 (7.3-11)	13981.2 (10749.7-17519.1)	3.5 (2.7-4.4)	−2.33 (−2.46-2.21)
Low-income	Both	5234.2 (4033.4-6121.4)	3.1 (2.4-3.6)	8479.2 (6623.1-9947)	2 (1.6-2.3)	−1.11 (−1.16-1.06)	4661.2 (3591.8-5463.7)	2.7 (2.1-3.2)	7352.8 (5741.3-8618.5)	1.7 (1.4-2)	−1.1 (−1.15-1.04)
	Female	2767.2 (2081.6-3372.3)	3.2 (2.4-3.9)	4426.7 (3476.4-5285.1)	2 (1.6-2.4)	−1.07 (−1.12-1.02)	2474.6 (1861.1-3020.1)	2.8 (2.1-3.5)	3877.2 (3026.3-4643.4)	1.8 (1.4-2.1)	−1.04 (−1.1-0.99)
	Male	2467 (1688.6-3010.7)	3 (2-3.6)	4052.5 (2757.8-4983.6)	2 (1.3-2.4)	−1.09 (−1.15-1.04)	2186.6 (1505.1-2663.8)	2.6 (1.8-3.2)	3475.6 (2381.4-4306.4)	1.7 (1.2-2.1)	−1.09 (−1.14-1.03)
Low-middle-income	Both	12867.2 (10966-14905)	2.9 (2.5-3.3)	17978.2 (15719.9-20761.2)	1.9 (1.7-2.2)	−0.82 (−0.86-0.78)	11227.3 (9558.2-12992.8)	2.5 (2.1-2.9)	14852.7 (13007.4-17132.2)	1.6 (1.4-1.8)	−0.89 (−0.94-0.85)
	Female	5901.9 (4925.6-6830.7)	2.6 (2.2-3.1)	7990.2 (6902.5-9136.8)	1.7 (1.5-1.9)	−0.88 (−0.91-0.84)	5181.6 (4320.9-6003.7)	2.3 (1.9-2.7)	6691 (5775.3-7667.8)	1.4 (1.2-1.6)	−0.93 (−0.98 − 0.89)
	Male	6965.3 (5594.4-8953.9)	3.1 (2.5-4)	9988.1 (8248.9-12492)	2.2 (1.8-2.7)	−0.7 (−0.76-0.65)	6045.8 (4846.9-7769.6)	2.7 (2.2-3.5)	8161.7 (6768.5-10221.3)	1.8 (1.5-2.2)	−0.78 (−0.84-0.72)
Middle-income	Both	54117.5 (44939.2-62691)	7.4 (6.2-8.6)	49237.3 (41300.5-59569.8)	3.6 (3-4.3)	−1.79 (−1.88-1.7)	43023.2 (35865.1-49842.5)	5.9 (4.9-6.9)	30754.5 (26181.2-36806.3)	2.2 (1.9-2.7)	−2.42 (−2.54-2.3)
	Female	18707.4 (15427.2-22761.7)	5.2 (4.3-6.3)	15163.3 (12830.3-18224.4)	2.2 (1.9-2.7)	−2.46 (−2.57-2.34)	15159.7 (12570.3-18380.4)	4.2 (3.5-5.1)	10131.3 (8759-11851.4)	1.5 (1.3-1.7)	−2.94 (−3.07-2.81)
	Male	35410.1 (26786.8-42983.6)	9.5 (7.2-11.6)	34074 (26695.4-43841.8)	4.9 (3.9-6.3)	−1.42 (−1.53-1.31)	27863.5 (21064.1-33766.8)	7.6 (5.7-9.2)	20623.3 (16505.3-26305.8)	3 (2.4-3.8)	−2.09 (−2.23-1.96)

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Abbreviation: EOGC, early-onset gastric cancer; UI, uncertainty interval.

In terms of DALYs attributable to EOGC, an estimated 3 859 036.1 years were lost globally, with East Asia bearing the most significant burden. The worldwide average age-standardized DALYs rate was 94 per 100 000 individuals, exhibiting regional disparities ranging from 31.6 per 100 000 in Australasia to 188.2 per 100 000 in Oceania. From 1990 to 2021, the DALYs ASRs decreased by 59%. Males (ASR: 116.3) experienced approximately 1.6 times the DALYs compared to females (ASR: 71.5). Table S2 presents detailed data on DALYs.

Overall trends in EOGC burden using broad estimation methods

Globally, the age-standardized incidence, mortality, and DALYs for EOGC decreased from 1990 to 2021, with an EAPC of −1.81 (95% UI: −1.87 to −1.75) for incidence, −2.26 (95% UI: −2.34 to −2.18) for mortality, and −2.54 (95% UI: −2.62 to −2.46) for DALYs. Eastern Europe experienced the largest reduction in prevalence, with an EAPC of −2.81 (95% UI: −2.9 to −2.72), and the most significant decline in age-standardized mortality at −3.11 (95% UI: −3.21 to −3.02). Analysis of trends across income-level quintiles revealed that regions with high-income levels demonstrated the most substantial reductions in ASRs for incidence, mortality, and DALYs between 1990 and 2021. Notably, decreasing trends were observed across all income-level quintiles during this period.

Age, period, and cohort effects on incidence, mortality, and DALYs of EOGC

Incidence, mortality rates, and DALYs increased progressively with age, peaking in the 45-49 age group. Males exhibited significantly higher rates than females across all age groups (eg, incidence ratio: 1.86 at age 40-44, Figure 1A). A consistent decline in incidence (rate ratio: 0.8 by 2021) and mortality (rate ratio: 0.6 by 2021) was observed across all periods, with no significant sex-based disparities (Figure 1B). Successive birth cohorts (eg, 1970-1990) experienced reduced incidence and mortality risks, suggesting improved early-life exposures or preventive measures (Figure 1C).

Figure 1. — Age-period-cohort modeling: estimation of incidence, mortality, and disability-adjusted life years (DALYs) of EOGC globally, 1990 to 2021. (A) Longitudinal age curve; (B) period rate ratio; (C) cohort rate ratio. Shaded areas indicate the 95% CIs. EOGC, early-onset gastric cancer.

The APC model revealed consistent age-related patterns in EOGC incidence across all income-level quintiles, indicating an elevated risk for individuals aged 15 to 49 years (Figure S1). Similar trends were observed for mortality and DALYs (Figures S2 and S3). Nations in the high–middle-income category demonstrated a notably higher vulnerability to EOGC, while those in the low and low–middle-income groups exhibited the lowest morbidity rates. Period effects indicated that incidence risks remained relatively constant across income-level quintiles throughout the study period, with a global decrease from 1992 to 2021. Comparable declining trends were observed for mortality and DALYs, without significant sex-based disparities during this timeframe. The birth cohort effect exhibited a consistent global pattern, characterized by a progressive decrease in the incidence, mortality, and DALYs of EOGC across successive birth cohorts. Notably, countries in the high–middle-income group experienced a temporary increase in EOGC incidence between 1977 and 1991, followed by a sustained decline. The birth cohort effects remained consistent when analyzed by gender.

Decomposition analysis of EOGC burden

This study employed decomposition analysis to evaluate the contributions of aging, population growth, and epidemiological changes to the global EOGC burden from 1990 to 2021 (Figure 2, Table S3). Globally, population growth, epidemiological changes, and aging contributed −255.52%, 485.22%, and −129.7%, respectively, to the overall increase in EOGC incidence. The impact of aging varied across income-level regions, with a substantial −349.59% effect in middle-income regions, followed by −133.13% in high–middle-income, and lesser impacts in low, low–middle, and high-income regions. Epidemiological shifts contributed to an increase in the disease burden, most notably in middle-income regions (811.44%). Regarding mortality, aging, population growth, and epidemiological changes had the most significant impacts in East Asia (−87.91%), middle-income quintile (−105.98%), and East Asia (187.81%), respectively. These factors contributed −58.12%, −122.62%, and 280.75% to the global increase in DALYs, respectively.

Figure 2. — Changes in EOGC burden according to aging, population growth, and epidemiological change from 1990 to 2021 at global level by income-level quintile and GBD regions. (A) Incidence; (B) mortality; (C) disability-adjusted life years (DALYs). GBD, Global Burden of Disease; EOGC, early-onset gastric cancer.

Predictions for incidence and mortality of EOGC from 2021 to 2030

Utilizing GBD data from 1990 to 2021, we projected future trends in EOGC incidence and mortality for the upcoming decade (Figure 3). While ASRs of incidence and mortality for both genders are expected to continue declining, the absolute number of new cases and deaths is anticipated to increase between 2021 and 2030, primarily due to population growth and aging. Projections indicate that by 2030, new EOGC cases will surpass 150 000, with deaths exceeding 90 000. For males, the number of new cases and deaths is expected to reach approximately 110 000 and 60 000, respectively. In females, these figures are projected to exceed 40 000 and 30 000, respectively. By 2030, the incidence and mortality rates among men are predicted to be more than twice those among women.

Discussion

Gastric cancer remains a significant global health burden,¹⁷ with EOGC exhibiting distinct epidemiological patterns.¹⁸ Our analysis of GBD 2021 data highlights 3 critical findings: (1) a persistent male predominance (incidence rate ratio [IRR] 1.86 vs females), (2) East Asia’s disproportionate burden (56% of global cases), and (3) sustained declines in age-standardized incidence (−1.8%/year) and mortality (−2.3%/year) since 1990. These trends reflect advancements in prevention, diagnostics, and treatment, yet underscore unmet needs in high-risk populations.

Following the release of GBD 2021, key methodological and data updates were identified compared to GBD 2019, necessitating trend reassessment. Specifically, GBD 2021 incorporated (1) expanded cancer registry coverage (expanded 12 countries, predominantly in sub-Saharan Africa),¹⁹ (2) refined cause-of-death redistribution algorithms for ill-defined gastric cancer codes (eg, ICD-10 C16.9),¹⁹ and (3) updated demographic inputs based on UN World Population Prospects 2022.¹⁹ These revisions resulted in a 6.7% upward adjustment of global EOGC incidence estimates (GBD 2019: 2.8 per 100 000 vs GBD 2021: 3.0 per 100 000) and a 4.1% reduction in mortality rates (GBD 2019: 2.0 vs GBD 2021: 1.9 per 100 000). Our analysis leverages these improvements to provide updated sex-, region-, and income level-stratified estimates of EOGC incidence (125 121 new cases), mortality (78 871 deaths), and DALYs (38 59 037 cases).

Our analysis demonstrates a sustained global decline in age-standardized incidence, mortality, and DALYs of EOGC from 1990 to 2021, with mortality rates decreasing at twice the pace of incidence (EAPC: −1.8% vs −0.9%). This progress reflects synergistic improvements across multiple domains. Dietary shifts, particularly reduced nitrate-preserved food intake (eg, East Asia’s 58% decline in salted fish consumption since 1990),²⁰ correlate with epidemiological evidence (RR = 1.4 per 10 g/day nitrate intake).²¹ Socioeconomic progress, measured by HDI (β = −0.62 per 0.1 increment, P < .01),²¹ paralleled infrastructure gains (33% rise in clean cooking access).²² Medical advances, including Japan’s H. pylori eradication program (50% to 25% prevalence reduction in under-50s),²³ and South Korea’s screening program (65% early-stage diagnoses, 21% mortality reduction),²⁴ further contributed.

Male predominance in EOGC (IRR 1.86; mortality ratio 1.71) contrasts with some studies defining EOGC as <40 years, excluding high-risk males aged 40--50.^25–27 This discrepancy likely reflects higher exposure to smoking, alcohol, and H. pylori in men,²⁸ compounded by hormonal influences. Experimental evidence suggests that low estrogen levels promote ERα36-mediated gastric cancer growth, while high estrogen inhibits it.²⁹ Future research should clarify hormonal mechanisms to guide sex-specific strategies.

Geographic disparities in EOGC burden primarily reflect population demographics and risk factor distribution. East Asia accounts for 56% of global cases, attributable to its large population, high H. pylori prevalence,²⁸ and historically elevated salt intake. This region has also demonstrated the most dramatic mortality reductions (−2.1%/year),³⁰ largely due to comprehensive screening programs^31–33 and therapeutic advances including D2 gastrectomy and FLOT chemotherapy.³⁴ Conversely, Southern Sub-Saharan Africa shows a rising incidence, highlighting persistent healthcare disparities. Notably, high-income nations exhibit both the highest incidence rates and most substantial declines, emphasizing the impact of healthcare infrastructure.²⁸

Recent studies have provided updated insights into the global burden of gastric cancer; however, they have not evaluated future trends, which are essential for informed policymaking.¹⁹^, ³⁵ This study projects incidence, mortality, and DALY trends for EOGC up to 2030, demonstrating a continued decline in both males and females. These findings suggest that current global policies on gastric cancer screening and treatment are proving effective. In East Asia, Japan’s nationwide H. pylori eradication program, based on 2009 guidelines,³⁶ has shown efficacy in reducing infection rates, though specific mortality reduction data from this program require further validation. South Korea’s National Cancer Screening Program demonstrated a 21% reduction in gastric cancer mortality (adjusted HR 0.79, 95% CI, 0.71-0.88) through biennial endoscopic screening.²⁴ Importantly, a recent cohort study confirmed H. pylori eradication reduces gastric cancer risk by 53% (95% CI, 34%-67%) in first-degree relatives of gastric cancer patients.³⁷ These preventive measures are complemented by therapeutic advances. The FLOT4 trial demonstrated that perioperative FLOT chemotherapy improved median overall survival to 50 months (HR 0.77, 95% CI, 0.63-0.94).³⁸ Non-clinical interventions like salt reduction remain important, with ecological studies showing 2.5-fold higher gastric cancer risk in populations consuming >10 g salt/day vs <5 g/day.²⁰ Despite progress, disparities persist, particularly in young male populations where incidence rates remain 1.86 times higher than females.²⁸ This underscores the need for tailored approaches in low-resource settings and gender-specific interventions, while maintaining global collaboration to scale cost-effective strategies like H. pylori testing. Decomposition analysis further revealed that changes in the EOGC burden are primarily driven by epidemiological factors and demographics rather than ASRs. In the coming decade, the continued implementation of effective screening programs and healthcare policies will be critical to further reducing the incidence and burden of EOGC.

Our findings underscore critical implications for clinical practice and trial design in managing EOGC. Three priorities emerge: First, sex-specific strategies are imperative to address the persistent male predominance (IRR: 1.86), necessitating targeted risk factor modification (eg, smoking cessation programs) and biomarker development focused on androgen signaling pathways. Second, despite progress in screening, East Asia—accounting for 56% of global EOGC cases—requires sustained expansion of early detection programs to mitigate its disproportionate burden. Third, proactive resource allocation is essential for transitioning middle-income regions facing a rising incidence due to demographic shifts. Projections of over 150 000 annual cases by 2030 highlight urgent needs to refine diagnostic and therapeutic frameworks, particularly for histology-specific challenges such as signet-ring cell carcinoma (SRCC), where diffuse growth patterns may render conventional response metrics inadequate. Future efforts must integrate scalable interventions (H. pylori eradication, salt reduction) with mechanistic research into EOGC pathogenesis, including hormonal influences and early-life exposures. Concurrently, clinical trials should adopt sex-stratified designs, prioritize enrollment from high-burden regions, and develop histology-specific response criteria to better capture treatment efficacy in SRCC. Age-optimized treatment protocols and dedicated supportive care pathways are equally vital, given the distinct toxicity profiles and quality-of-life concerns in younger patients. To address the paucity of prospective data, international registries should be established to longitudinally track outcomes and inform tailored management strategies for this vulnerable population.

Our analysis reveals 2 contrasting trends: while absolute EOGC cases increased 14.5% since 1990 (due to population growth), ASRs show consistent declines. This paradox reflects both demographic shifts and genuine progress in cancer control. However, significant disparities persist, particularly the 1.86-fold higher male incidence and East Asia’s disproportionate burden. Addressing these challenges requires integrated strategies combining demographic forecasting with precision prevention approaches. Study limitations include potential underdiagnosis in low-resource settings, lack of histopathological differentiation in GBD data, and inherent constraints of ecological analysis. The focus on demographic drivers may overlook other contributing factors, and population-level findings may not directly translate to individual risk.

In conclusion, while global EOGC burden shows encouraging declines, persistent sex and geographic disparities demand tailored interventions. Precision prevention strategies integrating population-level and individualized approaches will be essential to sustain progress against this biologically distinct malignancy.

Supplementary Material

oyaf244_Supplementary_Data

oyaf244_supplementary_data.zip^{(4.4MB, zip)}

Acknowledgments

We thank TopEdit (www.topeditsci.com) for its linguistic assistance during the preparation of this manuscript.

Contributor Information

Yujuan Jiang, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Peng Wang, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Haikuo Wang, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Jinghua Chen, Department of Hepatobiliary surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Dedi Jiang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Jianwei Liang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Yantao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Author contributions

Yujuan Jiang (Conceptualization, Data curation, Writing—original draft), Peng Wang (Software, Supervision, Validation), Haikuo Wang (Investigation, Methodology), Jinghua Chen (Formal analysis, Methodology), Dedi Jiang (Software, Supervision, Validation), Jianwei Liang (Writing—review & editing), and Yantao Tian (Funding acquisition, Writing—review & editing)

Supplementary material

Supplementary material is available at The Oncologist online.

Funding

This research was funded by the Beijing Natural Science Foundation (7242113) and the National Natural Science Foundation of China (82473285).

Conflicts of interest

The authors have declared that no competing interests exist.

Data availability

The data originate from a publicly accessible database.

References

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23. Chiang T-H, Chang W-J, Chen SL-S, et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands. Gut. 2021;70:243-250. [DOI] [PMC free article] [PubMed] [Google Scholar]
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27. Yang Q, Xu D, Yang Y, Lu S, Wang D, Wang L. Global, regional, and national burden of gastric cancer in adolescents and young adults, 1990–2019: a systematic analysis for the global burden of disease study 2019. Am J Gastroenterol. 2024;119:454-467. [DOI] [PMC free article] [PubMed] [Google Scholar]
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29. Ur Rahman MS, Cao J. Estrogen receptors in gastric cancer: advances and perspectives. World J Gastroenterol. 2016;22:2475-2482. [DOI] [PMC free article] [PubMed] [Google Scholar]
30. Merchant SJ, Kim J, Choi AH, Sun V, Chao J, Nelson R. A rising trend in the incidence of advanced gastric cancer in young Hispanic men. Gastric Cancer. 2017;20:226-234. [DOI] [PMC free article] [PubMed] [Google Scholar]
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38. Al-Batran S-E, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet (London, England). 2019;393:1948-1957. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

oyaf244_Supplementary_Data

oyaf244_supplementary_data.zip^{(4.4MB, zip)}

Data Availability Statement

The data originate from a publicly accessible database.

[oyaf244-B1] 1. GBD 2019 Adolescent Young Adult Cancer Collaborators. The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Oncol. 2022;23:27-52. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B2] 2. Smith AW, Seibel NL, Lewis DR, et al. Next steps for adolescent and young adult oncology workshop: an update on progress and recommendations for the future. Cancer. 2016;122:988-999. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B3] 3. Ferrari A, Stark D, Peccatori FA, et al. Adolescents and young adults (AYA) with cancer: a position paper from the AYA working group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open. 2021;6:100096. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B4] 4. Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74:2913-2921. [DOI] [PubMed] [Google Scholar]

[oyaf244-B5] 5. Gupta S, Harper A, Ruan Y, et al. International trends in the incidence of cancer among adolescents and young adults. J Natl Cancer Inst. 2020;112:1105-1117. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B6] 6. Bleyer A, Barr R, Hayes-Lattin B, Thomas D, Ellis C, Anderson B. Biology and clinical trials subgroups of the US National Cancer Institute Progress Review Group in Adolescent and Young Adult Oncology. The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer. 2008;8:288-298. [DOI] [PubMed] [Google Scholar]

[oyaf244-B7] 7. Takatsu Y, Hiki N, Nunobe S, et al. Clinicopathological features of gastric cancer in young patients. Gastric Cancer. 2016;19:472-478. [DOI] [PubMed] [Google Scholar]

[oyaf244-B8] 8. Bleyer A, Choi M, Fuller CD, Thomas CR, Wang SJ. Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol. 2009;36:460-467. [DOI] [PubMed] [Google Scholar]

[oyaf244-B9] 9. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-249. [DOI] [PubMed] [Google Scholar]

[oyaf244-B10] 10. Zhong N, Yu Y, Chen J, Shao Y, Peng Z, Li J. Clinicopathological characteristics, survival outcome and prognostic factors of very young gastric cancer. Clin Exp Med. 2023;23:437-445. [DOI] [PubMed] [Google Scholar]

[oyaf244-B11] 11. Li Y, Hahn AI, Laszkowska M, Jiang F, Zauber AG, Leung WK. Global burden of young-onset gastric cancer: a systematic trend analysis of the global burden of disease study 2019. Gastric Cancer. 2024;27:684-700. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B12] 12. Bai Z, Wang H, Shen C, An J, Yang Z, Mo X. The global, regional, and national patterns of change in the burden of non-malignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade. Int J Surg. 2025;111:80-92. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B13] 13. Liu Z, Jiang Y, Yuan H, et al. The trends in incidence of primary liver cancer caused by specific etiologies: results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention. J Hepatol. 2019;70:674-683. [DOI] [PubMed] [Google Scholar]

[oyaf244-B14] 14. Das Gupta P. A general method of decomposing a difference between two rates into several components. Demography. 1978;15:99-112. [PubMed] [Google Scholar]

[oyaf244-B15] 15. Du Z, Chen W, Xia Q, Shi O, Chen Q. Trends and projections of kidney cancer incidence at the global and national levels, 1990-2030: a Bayesian age-period-cohort modeling study. Biomark Res. 2020;8:16. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B16] 16. Wang F, Ma B, Ma Q, Liu X. Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030. Int J Surg. 2024;110:1951-1967. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B17] 17. Venerito M, Vasapolli R, Rokkas T, Malfertheiner P. Gastric cancer: epidemiology, prevention, and therapy. Helicobacter. 2018;23Suppl 1:e12518. [DOI] [PubMed] [Google Scholar]

[oyaf244-B18] 18. Ap T, Tn W, Hb E-S. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol. 2023;20:[2024-10-14]. [DOI] [PubMed] [Google Scholar]

[oyaf244-B19] 19. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2100-2132. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B20] 20. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer. 2007;10:75-83. [DOI] [PubMed] [Google Scholar]

[oyaf244-B21] 21. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev. 2014;23:700-713. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B22] 22. WHO | Global Health Observatory (GHO) Data[EB/OL]. Accessed May 9, 2025. https://apps.who.int/gho/data/motd.html.

[oyaf244-B23] 23. Chiang T-H, Chang W-J, Chen SL-S, et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands. Gut. 2021;70:243-250. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B24] 24. Jun JK, Choi KS, Lee H-Y, et al. Effectiveness of the Korean National Cancer Screening Program in Reducing Gastric Cancer Mortality. Gastroenterology. 2017;152:1319-1328.e7. [DOI] [PubMed] [Google Scholar]

[oyaf244-B25] 25. Ning F-L, Zhang N-N, Zhao Z-M, et al. Global, regional, and national burdens with temporal trends of early-, intermediate-, and later-onset gastric cancer from 1990 to 2019 and predictions up to 2035. Cancers (Basel). 2022;14:5417. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B26] 26. Li J, Kuang XH, Zhang Y, Hu DM, Liu K. Global burden of gastric cancer in adolescents and young adults: estimates from GLOBOCAN 2020. Public Health. 2022;210:58-64. [DOI] [PubMed] [Google Scholar]

[oyaf244-B27] 27. Yang Q, Xu D, Yang Y, Lu S, Wang D, Wang L. Global, regional, and national burden of gastric cancer in adolescents and young adults, 1990–2019: a systematic analysis for the global burden of disease study 2019. Am J Gastroenterol. 2024;119:454-467. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B28] 28. Li J. Gastric cancer in young adults: a different clinical entity from carcinogenesis to prognosis. Gastroenterol Res Pract. 2020;2020:9512707. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B29] 29. Ur Rahman MS, Cao J. Estrogen receptors in gastric cancer: advances and perspectives. World J Gastroenterol. 2016;22:2475-2482. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B30] 30. Merchant SJ, Kim J, Choi AH, Sun V, Chao J, Nelson R. A rising trend in the incidence of advanced gastric cancer in young Hispanic men. Gastric Cancer. 2017;20:226-234. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B31] 31. Zhang X, Li M, Chen S, et al. Endoscopic screening in Asian countries is associated with reduced gastric cancer mortality: a meta-analysis and systematic review. Gastroenterology. 2018;155:347-354.e9. [DOI] [PubMed] [Google Scholar]

[oyaf244-B32] 32. Fan X, Qin X, Zhang Y, et al. Screening for gastric cancer in China: advances, challenges and visions. Chin J Cancer Res. 2021;33:168-180. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B33] 33. Division U P. World Population Prospects 2022 : Data sources. 2022. UN, 2022. Accessed May 9, 2025. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd_2022_wpp-data_sources.pdf

[oyaf244-B34] 34. Joshi SS, Badgwell BD. Current treatment and recent progress in gastric cancer. CA Cancer J Clin. 2021;71:264-279. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B35] 35. Ito M, Haruma K, Kamada T, et al. Reduction in the incidence of Helicobacter pylori-associated carcinoma in Japanese young adults. Oncol Rep. 2001;8:633-636. [DOI] [PubMed] [Google Scholar]

[oyaf244-B36] 36. Asaka M, Kato M, Takahashi S, et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter. 2010;15:1-20. [DOI] [PubMed] [Google Scholar]

[oyaf244-B37] 37. Liu Z, Xu H, You W, Pan K, Li W. Helicobacter pylori eradication for primary prevention of gastric cancer: progresses and challenges. J Natl Cancer Cent. 2024;4:299-310. [DOI] [PMC free article] [PubMed] [Google Scholar]

[oyaf244-B38] 38. Al-Batran S-E, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet (London, England). 2019;393:1948-1957. [DOI] [PubMed] [Google Scholar]

PERMALINK

The global and regional burden of early-onset gastric cancer (15-49 years, 1990-2021): incidence and mortality with projections to 2030

Yujuan Jiang

Peng Wang

Haikuo Wang

Jinghua Chen

Dedi Jiang

Jianwei Liang

Yantao Tian

Roles

Abstract

Background

Methods

Results

Conclusions

Implications for Practice.

Introduction

Methods

Data sources and study design

Statistical methods

Ethical considerations

Sensitivity and validation

Results

Descriptive analysis of EOGC burden at global, regional, and national levels

Table 1.

Overall trends in EOGC burden using broad estimation methods

Age, period, and cohort effects on incidence, mortality, and DALYs of EOGC

Figure 1.

Decomposition analysis of EOGC burden

Figure 2.

Predictions for incidence and mortality of EOGC from 2021 to 2030

Figure 3.

Discussion

Supplementary Material

Acknowledgments

Contributor Information

Author contributions

Supplementary material

Funding

Conflicts of interest

Data availability

References

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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