Abstract
Background
To analyze the epidemiological characteristics and disease burden of digestive system cancer in Guangdong in 2019, and to provide evidence for prevention and treatment of digestive system cancer.
Methods
Both incidence and mortality data of the five digestive system cancers (esophageal cancer, stomach cancer, colorectal cancer, liver cancer and pancreatic cancer ) used in calculations originated from the cancer registration system of Guangdong Province. Crude incidence rate, mortality rate, age-standardized incidence and mortality rate, 35–64 year-old truncated incidence and mortality rate, 0–64 year-old cumulative incidence and mortality rate, disability adjusted life years (DALY), and cause-eliminated life expectancy were used to estimate the disease burden due to digestive system cancers in Guangdong province in this study. The life expectancy and the cause-eliminated life expectancy were calculated using an abridged life table method in this study. The standard population adopted in this study was the Segi’s world standard population.
Results
In 2019, the crude incidence rates and crude mortality rates of digestive system cancers were 82.30/100,000 and 56.53/100,000 respectively in Guangdong Province. The age-standardized incidence rates and age-standardized mortality rates were 59.61/100,000 and 37.27/100,000, respectively. The total DALY and DALY rate of digestive system cancers in Guangdong Province were 1,681,089 person-years and 1,459.42/100,000. After eliminating causes of death from digestive system cancers, the life expectancy increased by 0.83 years, from 84.10 years to 84.93 years in Guangdong Province. In the disease burden of digestive system cancer, the disease burden is higher in males than in females and higher in rural areas compared to urban areas. Among these, colorectal cancer has the highest incidence, liver cancer exhibited the highest mortality, disease burden, and the most significant impact on life expectancy.
Conclusions
Digestive system cancers exhibited a heavy disease burden in Guangdong Province. There were discernible gender and regional disparities in the incidence, mortality, and disease burden associated with five digestive system cancers. Liver cancer and colorectal cancer emerged as the predominant malignancies contributing to the disease burden in Guangdong Province. The vast majority of DALYs were due to YLL, indicating the need to focus resources on disease prevention and early detection. Guangdong Province should implement targeted interventions against modifiable risk factors for colorectal and liver cancers among high-risk populations and in high-incidence regions, thereby reducing the disease burden in the future.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-025-25783-6.
Keywords: Digestive system cancer, Liver cancer, Colorectal cancer, Stomach cancer, Epidemiology of chronic diseases, Disease burden, Cause-eliminated life expectancy
Introduction
Digestive system cancers, including esophageal, stomach, colorectal, pancreatic, and liver cancer, are leading causes of cancer deaths worldwide [1]. The incidence of colorectal cancer, stomach cancer, and liver cancer are among the top six most common types of cancer, accounting for 18.8% of the 20 million cancer cases in the world in 2022 [2]. In China, these cancers contribute to 26.4% of global cancer deaths and 24.2% of global cancer cases [2]. The seven most common cancers in China include lung, colorectal, thyroid, liver, stomach, breast, and esophageal cancers, which make up 69.46% of all new cases [3]. Except for lung, thyroid, and breast cancers, the remaining are digestive system cancers. Collectively, these figures underscore the substantial disease burden imposed by digestive system cancers in China.
In Guangdong Province, the incidence of digestive system cancers has been rising in recent years [4–6]. In 2018, colorectal and liver cancers were among the top five cancers, accounting for 12.32% and 9.55% of newly diagnosed cases, respectively [4]. Liver, colorectal, and stomach cancers were the top three causes of cancer-related deaths, responsible for 16.94%, 10.74%, and 5.74% of all cancer deaths [4]. Studies have demonstrated that the ASIR of both colorectal and liver cancers in Guangdong Province significantly exceed the corresponding national and global levels [2, 3]. Digestive system cancers pose a significant public health challenge in Guangdong. Most existing research focuses on individual digestive system cancers or specific parts of the digestive system, with limited attention to the overall disease burden of digestive system cancers [7–10]. Guangdong province is the most economically developed province in China due to its proximity to Hong Kong and Macau and its status as the first economic zones; meanwhile, Guangdong Province is one of the most economically developed regions in China, benefiting from its proximity to Hong Kong and Macau and its history as an early economic zone. Furthermore, it has the largest resident population in the country, accounting for approximately 9% of China’s total, its unique lifestyle and risk factor exposure patterns resulting in a cancer spectrum that differ from the country as a whole. Previous research has largely focused on single cancer types, lacking comprehensive comparisons of the health loss attributable to different digestive cancers. While incidence and mortality reflect disease frequency, they fail to account for losses from both premature death and disability. DALY integrates both aspects, offering a more complete burden profile. Cause-eliminated life expectancy further estimates the potential life years gained if a disease were eliminated, providing clear evidence for policy planning. This study systematically assesses the disease burden of digestive system cancers in Guangdong using DALY and cause-eliminated life expectancy as core indicators, to inform targeted prevention strategies and offer insights for similar areas.
Methods
Subjects and data sources
All analyses in this study were conducted using 2019 data from Guangdong cancer registration sites. Both incidence and mortality data used in calculations originated from the cancer registration system of Guangdong Province. The specific details of the population-based cancer registration system in Guangdong Province can be found in other published sources [4]. Demographic data are provided by the Public Security Bureau and the Bureau of Statistics. The data comprises the total population and population stratified by sex and age. The cancer registration data were double-coded using the ICD-10 and ICD-O-3. According to the international ICD-10 cancer classification, esophageal cancer (C15), stomach cancer (C16), colorectal cancer (C18-C21), liver cancer (C22) and pancreatic cancer (C25) were included in this study. The all-cause mortality data for this study were obtained from the cause-of-death registration system of the Guangdong Provincial Center for Disease Control and Prevention.
Statistical analysis
In this study, crude incidence rate, mortality rate, age-standardized (Segi’s world standard population was used) incidence and mortality rate (ASIR, ASMR), 35–64 year-old truncated incidence and mortality rate, 0-64-year old cumulative incidence and mortality rate, disability adjusted life years (DALY), and cause-eliminated life expectancy were used to estimate the disease burden due to digestive system cancer in Guangdong province. The standard population adopted in this study was the Segi’s world standard population’s, which served as the basis for calculating age-standardized rates. All individual rates are now calculated and presented by first retaining three decimal places for precision during summation, and then rounding the final total to two decimal places.
Disability adjusted life years (DALY), including years of life lost due to premature death (YLL) and years lived with disability (YLD) due to disease:
 |
Where 
is the DALY for a given cause c, age a, sex s, and year t. DALYs were calculated without age-weighting or a discount rate. In this study, the per-capita disease burden observed at the monitoring sites is assumed to be representative of Guangdong Province as a whole.
The basic formula for YLLs is the following for a given cause c, age a, sex s and year t:
 |
Where 
is the number of deaths due to the cause c for the given age a and sex s in year t; 
is years of life lost for a death at age a for sex s. The GBD 2019 standard life table was used in this study to calculate the YLL [11].
The basic formula for YLDs is the following for a given cause c, age a, sex s and year t:
 |
Where 
is the number of incident cases for cause c, age a and sex s; 
is the disability weight for cause c; 
is the average duration of the case until remission or death for cause c. The average duration for specific disease status used in this study were obtained from the study by Fernández de Larrea-Baz et al. [12]. The DW of each disease used was taken from the study by Lei et al. [13]. The cause-eliminated life expectancy was used to investigate the impact of certain cancers on the life expectancy of Guangdong residents. Life expectancy was derived using an abridged life table with 5-year age intervals (0–4, 5–9, …, 80–84, 85+). In this study, life expectancy (e₀) was calculated by the abridged life table method. Cause-eliminated life tables were constructed by subtracting age-specific mortality probabilities due to each digestive cancer from the all-cause mortality probabilities, then following standard life-table calculations to obtain e₁ [14]. The number of years lost (∆e) and the rate of life-year loss (∆e%) were also calculated to compare the health impact of specific cancers.
 |
 |
The YLL and YLD rates calculated from the 40 monitoring sites were applied to the provincial population to estimate the total provincial burden.
 |
 |
 |
Where 
and 
are the values of YLL and YLD of the province; 
and 
are the values of YLL and YLD for age a and sex s in the 40 monitoring sites; 
is the total population of the monitoring sites for age a and sex s; P is the total population of the province.
SAS 9.4, Office Excel 2016 and Origin2024 were used to conduct statistical analysis in this study.
Quality control
The data collection and quality control were carried out in accordance with the Guidelines for Cancer Registration in China [15] as well as the International Agency for Research on Cancer (IARC) and International Association of Cancer Registries (IACR) requirements for evaluating the completeness and validity of cancer registry data [16]. The main quality control indicators include an overall cancer crude incidence rate ≥ 180/100,000, crude mortality rate ≥ 100/100,000, 0.40 < mortality/incidence ratio(M/I) < 0.85, 50%< the proportion of morphological diagnosis (MV%) < 85%, the proportion of death certificates only (DCO%) < 10%. Based on these data quality evaluations, a total of 40 registered areas were included in this study, encompassing over 42.75 million people, which included 21.81 million males and 20.94 million females, accounting for 43.1% of the total population in Guangdong province in 2019.
Results
Incidence
In the study area, 35,190 new cases of digestive system cancer were registered in 2019, which represents 28.66% of all the registered cancer cases. Of those, 23,832 (67.72%) were male cases, 11,358 (32.28%) were female cases, 27,960 cases (79.55%) were in urban areas, and 7,230 cases (20.55%) were in rural areas. In the study area, the incidence rate of digestive system cancer in 2019 was 82.30/105 (ASIR was 59.61/105), which was 109.28/105 (ASIR was 83.04/105) for males and 54.22/105 (ASIR was 35.62/105) for females. The incidence rate was 82.53/105 in urban areas and 81.43/105 in rural areas.
Among the five cancers, colorectal cancer has the highest incidence rate (33.58/105), followed by liver cancer (27.47/105), stomach cancer (10.84/105), esophageal cancer (6.36/105) and pancreatic cancer (4.05/105). The incidence rate of digestive system cancer was higher in males than in females, with colorectal cancer ranking first in both genders (38.11/105 in males and 28.86/105 in females). The incidence rates of liver cancer and esophageal cancer in males were significantly higher than those in females, with male-to-female incidence rate ratios of 3.9 and 3.5, respectively. In urban areas, colorectal cancer exhibited the highest incidence rate (34.82/105), whereas in rural regions, liver cancer predominated with the highest incidence rate(29.01/105). The ASIR of esophageal cancer, stomach cancer, and liver cancer were higher in rural than those in urban areas. Detailed data are presented in Table 1.
Table 1.
Incidence of digestive system cancers in Guangdong
| Cancer site | Register cases | Crude incidence rate (1/105) | ASIR (1/105) | Proportion(%) | 35–64 truncated incidence rate (1/105) | 0–64 cumulative incidence rate(%) | |
|---|---|---|---|---|---|---|---|
| Male | |||||||
| Esophageal | 2138 | 9.80 | 7.44 | 8.97 | 12.92 | 0.46 | |
| Stomach | 2980 | 13.66 | 10.20 | 12.50 | 15.86 | 0.56 | |
| Colorectal | 8311 | 38.11 | 28.48 | 34.87 | 44.34 | 1.57 | |
| Liver | 9433 | 43.25 | 33.65 | 39.58 | 69.29 | 2.36 | |
| Pancreatic | 970 | 4.45 | 3.28 | 4.07 | 5.10 | 0.18 | |
| Total | 23,832 | 109.28 | 83.04 | 100 | 147.51 | 5.13 | |
| Female | |||||||
| Esophageal | 582 | 2.78 | 1.63 | 5.12 | 1.89 | 0.07 | |
| Stomach | 1655 | 7.90 | 5.22 | 14.57 | 8.11 | 0.29 | |
| Colorectal | 6045 | 28.86 | 19.04 | 53.22 | 29.75 | 1.04 | |
| Liver | 2313 | 11.04 | 7.41 | 20.36 | 10.95 | 0.40 | |
| Pancreatic | 763 | 3.64 | 2.32 | 6.72 | 2.92 | 0.10 | |
| Total | 11,358 | 54.22 | 35.62 | 100 | 53.62 | 1.90 | |
| Urban | |||||||
| Esophageal | 2001 | 5.91 | 4.17 | 7.16 | 6.95 | 0.25 | |
| Stomach | 3605 | 10.64 | 7.48 | 12.89 | 11.78 | 0.42 | |
| Colorectal | 11,795 | 34.82 | 24.51 | 42.19 | 38.56 | 1.36 | |
| Liver | 9170 | 27.07 | 20.05 | 32.80 | 39.20 | 1.35 | |
| Pancreatic | 1389 | 4.10 | 2.82 | 4.97 | 4.00 | 0.14 | |
| Total | 27,960 | 82.53 | 59.03 | 100 | 100.49 | 3.51 | |
| Rural | |||||||
| Esophageal | 719 | 8.10 | 5.66 | 9.94 | 8.98 | 0.32 | |
| Stomach | 1030 | 11.60 | 8.22 | 14.25 | 12.67 | 0.46 | |
| Colorectal | 2561 | 28.84 | 20.26 | 35.42 | 31.14 | 1.10 | |
| Liver | 2576 | 29.01 | 21.43 | 35.63 | 42.83 | 1.47 | |
| Pancreatic | 344 | 3.87 | 2.70 | 4.76 | 4.03 | 0.15 | |
| Total | 7230 | 81.43 | 58.26 | 100 | 99.66 | 3.50 | |
| Total | |||||||
| Esophageal | 2720 | 6.36 | 4.48 | 7.73 | 7.38 | 0.27 | |
| Stomach | 4635 | 10.84 | 7.63 | 13.17 | 11.97 | 0.42 | |
| Colorectal | 14,356 | 33.58 | 23.63 | 40.80 | 37.00 | 1.30 | |
| Liver | 11,746 | 27.47 | 20.33 | 33.38 | 39.95 | 1.37 | |
| Pancreatic | 1733 | 4.05 | 2.79 | 4.92 | 4.01 | 0.14 | |
| Total | 35,190 | 82.30 | 59.61 | 100 | 100.31 | 3.51 | |
Figure S1 illustrated the age-specific incidence rates of five digestive system cancers in Guangdong Province. The incidence rates were very low among individuals under 30 years of age. They began to rise in the 35–39 age group and peaked in the 80–84 age group. Across all age groups, males exhibited higher incidence rates than females. The incidence of liver cancer increased rapidly starting in the 20–24 age group, peaking in males at the 65–69 and 80–84 age groups, and in females at the 80–84 age group. Other digestive cancers showed a steady increasea steady increase beginning in the 35–39 age group for both sexes, with a peak in the 80–84 age group. This pattern was consistent across both urban and rural areas. However, urban areas had higher colorectal cancer incidence rates than rural areas across all ages, while rural areas had higher esophageal cancer incidence rates than urban areas.
Mortality
A total of 21,527 deaths caused by digestive system cancer registered the study area in 2019, which accounted for 40.18% of all cancer deaths. Within the 21,527 deaths, 15,110 cases were male (70.19%), 6,417 cases were female (29.81%), 16,426 cases were registered in urban areas (76.30%), and 5,101 cases were registered in rural areas (23.70%). In the study area, the death rate caused by digestive system cancer was 56.53/105 (ASMR was 37.27/105). The death rate for males (78.18/105) was 2.28 times higher than that for females (34.22/105). In urban areas, the death rate was 56.25/105, whereas in rural regions, it was 57.45/105.
Within the five cancers, the mortality rate of liver cancer was the highest (25.08/105), which was followed by colorectal cancer (14.41/105), stomach cancer (7.74/105), esophageal cancer (5.58/105) and pancreatic cancer (3.72/105). By gender, the mortality rate of digestive system cancer in males was higher than that for females. The mortality rate of liver cancer (39.35 per 105) ranked first among males, while colorectal cancer ranked first among females (12.40 per 105). Liver cancer was the primary cause of death in both urban and rural regions, with mortality rates of 24.64/105 and 26.52/105, respectively. The mortality rates of liver and esophageal cancers exhibited the most pronounced gender disparities, being 3.79 and 3.87 times higher in males than in females, respectively. Mortality rates for esophageal, stomach, and liver cancers were higher in rural areas than in urban areas, whereas colorectal and pancreatic cancer mortality rates were higher in urban areas. Detailed mortality data are presented in Table 2.
Table 2.
Mortality of digestive system cancers in Guangdong
| Cancer site | Register deaths | Crude mortality rate (1/105) | ASMR (1/105) | Proportion(%) | 35–64 truncated mortality rate (1/105) | 0–64 cumulative mortality rate(%) | |
|---|---|---|---|---|---|---|---|
| Male | |||||||
| Esophageal | 1699 | 8.79 | 6.16 | 4.93 | 10.19 | 0.37 | |
| Stomach | 1855 | 9.60 | 6.54 | 5.38 | 8.61 | 0.30 | |
| Colorectal | 3160 | 16.35 | 10.85 | 9.17 | 12.66 | 0.46 | |
| Liver cancer | 7605 | 39.35 | 28.67 | 22.08 | 56.91 | 1.92 | |
| Pancreatic | 791 | 4.09 | 2.85 | 2.30 | 4.38 | 0.15 | |
| Total | 15,110 | 78.18 | 55.08 | 100 | 92.74 | 3.21 | |
| Female | |||||||
| Esophageal | 426 | 2.27 | 1.14 | 2.23 | 0.88 | 0.03 | |
| Stomach | 1094 | 5.83 | 3.42 | 5.72 | 4.78 | 0.17 | |
| Colorectal | 2326 | 12.40 | 6.78 | 12.16 | 7.49 | 0.27 | |
| Liver | 1944 | 10.37 | 6.18 | 10.16 | 8.37 | 0.30 | |
| Pancreatic | 627 | 3.34 | 1.94 | 3.28 | 2.20 | 0.08 | |
| Total | 6417 | 34.22 | 19.67 | 100 | 23.72 | 0.84 | |
| Urban | |||||||
| Esophageal | 1537 | 5.26 | 3.32 | 3.71 | 5.10 | 0.18 | |
| Stomach | 2213 | 7.58 | 4.71 | 5.34 | 6.31 | 0.22 | |
| Colorectal | 4337 | 14.85 | 8.80 | 10.47 | 10.05 | 0.36 | |
| Liver | 7194 | 24.64 | 16.62 | 17.37 | 30.83 | 1.05 | |
| Pancreatic | 1145 | 3.92 | 2.46 | 2.76 | 3.38 | 0.12 | |
| Total | 16,426 | 56.25 | 35.91 | 100 | 55.66 | 1.94 | |
| Rural | |||||||
| Esophageal | 588 | 6.62 | 4.59 | 4.84 | 6.91 | 0.25 | |
| Stomach | 736 | 8.29 | 5.67 | 6.05 | 7.92 | 0.28 | |
| Colorectal | 1149 | 12.94 | 8.49 | 9.45 | 10.07 | 0.37 | |
| Liver | 2355 | 26.52 | 19.11 | 19.37 | 37.52 | 1.27 | |
| Pancreatic | 273 | 3.07 | 2.15 | 2.25 | 2.94 | 0.10 | |
| Total | 5101 | 57.45 | 40.00 | 100 | 65.36 | 2.27 | |
| Total | |||||||
| Esophageal | 2125 | 5.58 | 3.60 | 3.97 | 5.50 | 0.20 | |
| Stomach | 2949 | 7.74 | 4.92 | 5.50 | 6.68 | 0.24 | |
| Colorectal | 5486 | 14.41 | 8.74 | 10.24 | 10.06 | 0.36 | |
| Liver | 9549 | 25.08 | 17.20 | 17.82 | 32.38 | 1.10 | |
| Pancreatic | 1418 | 3.72 | 2.39 | 2.65 | 3.28 | 0.12 | |
| Total | 21,527 | 56.53 | 37.27 | 100 | 57.90 | 2.01 |
Figure S2 presented the age-specific mortality rates of five digestive system cancers in Guangdong Province in 2019. Mortality rates were low among individuals under 30 years of age, began to rise in the 35–39 age group, and peaked in the 80–84 age group. Across all age groups, males had higher mortality rates than females. Colorectal cancer mortality increased rapidly from the 45–49 age group, while liver cancer mortality rose quickly from the 25–29 age group. Other digestive cancers showed a steady increase from the 35–39 age group in both sexes. The mortality rates of all digestive system cancers reached their highest levels in the 80–84 age group. Mortality rates peaked at the 80–84 age group in both urban and rural areas. Rural esophageal cancer mortality exceeded urban rates across all ages.
Disability adjusted life years
In 2019, the estimated total DALYs due to the five digestive system cancers in Guangdong Province were 1,681,089 person-years (1,620,570person-years for males, 404,550for females). A total of 1,137,939 DALYs occurred in urban areas, while 490,131 DALYs occurred in rural areas. The YLLs due to early death accounted for 96.85% of total DALYs. Liver cancer was the most lethal cancer affecting public health, and it accounted for approximately 51.18% of the DALYs caused by the five digestive system cancers. In males, liver cancer caused 57.33% of the total DALYs (731,820 DALYs) among the five cancers, while in females, colorectal cancer caused 35.30% of the total DALYs (142,804 DALYs). In both urban and rural areas, liver cancer also caused the highest DALYs, which were 592,166 and 268,248, respectively. In 2019, the overall DALY rate for the five digestive system cancers in Guangdong was 1,459.42/105. The DALY rate for males was 2,126.52/105, and the rate for females was 733.42/105. Additionally, the DALY rate for urban areas was 1,429.92/105, and the rate for rural areas was 1,533.10/105. Males exhibited a higher disease burden for all five digestive cancers compared with females. Overall, urban areas had higher DALYs for these cancers. For rates, rural areas exceeded urban areas in esophageal, stomach, and liver cancers, whereas urban areas had higher DALY rates for colorectal and pancreatic cancers. Detailed DALY data are presented Table 3.
Table 3.
Disease burden due to the five digestive system cancers in Guangdong
| Cancer sties | YLL | YLL rate (1/105) | YLD (95%CI) |
YLD rate (1/105, 95% CI) |
DALY (95% CI) |
DALY rate (1/105, 95% CI) |
YLL/YLD (95%CI) |
|
|---|---|---|---|---|---|---|---|---|
| Male | ||||||||
| Esophageal | 125,443 | 208.97 |
2210 (2120,2292) |
3.68 (3.53,3.82) |
127,653 (127564,127735) |
212.65 (212.50,212.79) |
56.77 (54.73,59.17) |
|
| Stomach | 129,784 | 216.20 |
7166 (6944,7405) |
11.94 (11.57,12.34) |
136,950 (136728,137189) |
228.14 (227.77,228.54) |
18.11 (17.53,18.69) |
|
| Colorectal | 205,671 | 342.62 |
15,124 (14418,15831) |
25.19 (24.02,26.37) |
220,795 (220089,221502) |
367.81 (366.63,368.99) |
13.60 (12.99,14.27) |
|
| Liver | 720,818 | 1200.77 |
11,002 (10616,11360) |
18.33 (17.68,18.92) |
731,820 (731434,732179) |
1219.10 (1218.46,1219.70) |
65.52 (63.45,67.90) |
|
| Pancreatic | 58,818 | 97.98 |
502 (482,523) |
0.84 (0.8,0.87) |
59,320 (59300,59341) |
98.82 (98.78,98.85) |
117.09 (112.56,122) |
|
| Total | 1,240,536 | 2067.00 |
36,004 (34580,37410) |
59.98 (57.60,62.32) |
1,276,540 (1275116,1277946) |
2126.52 (2124.15,2128.86) |
34.46 (33.16,35.87) |
|
| Female | ||||||||
| Esophageal | 19,387 | 35.15 |
620 (595,644) |
1.12 (1.08,1.17) |
20,007 (19982,20031) |
36.27 (36.23,36.31) |
31.25 (30.13,32.57) |
|
| Stomach | 74,055 | 134.26 |
3334 (3230,3445) |
6.04 (5.86,6.25) |
77,389 (77285,77500) |
140.30 (140.11,140.50) |
22.21 (21.50,22.92) |
|
| Colorectal | 132,064 | 239.42 |
10,740 (10238,11242) |
19.47 (18.56,20.38) |
142,804 (142302,143306) |
258.89 (257.98,259.80) |
12.30 (11.75,12.90) |
|
| Liver | 126,640 | 229.59 |
1954 (1885,2017) |
3.54 (3.42,3.66) |
128,594 (128525,128657) |
233.13 (233.01,233.25) |
64.83 (62.78,67.18) |
|
| Pancreatic | 35,388 | 64.16 |
367 (353,382) |
0.67 (0.64,0.69) |
35,755 (35741,35770) |
64.82 (64.80,64.85) |
96.34 (92.62,100.39) |
|
| Total | 387,534 | 703.00 |
17,015 (16302,17730) |
30.85 (29.55,32.14) |
404,549 (403836,405264) |
733.42 (732.13,734.72) |
22.78 (21.86,23.77) |
|
| Urban | ||||||||
| Esophageal | 95,957 | 116.66 |
1826 (1752,1894) |
2.22 (2.13,2.3) |
97,783 (97709,97850) |
118.88 (118.79,118.96) |
52.56 (50.67,54.78) |
|
| Stomach | 140,248 | 170.51 |
7296 (7070,7540) |
8.87 (8.6,9.17) |
147,544 (147318,147787) |
179.38 (179.10,179.67) |
19.22 (18.60,19.84) |
|
| Colorectal | 247,323 | 300.68 |
19,425 (18517,20332) |
23.62 (22.51,24.72) |
266,748 (265841,267656) |
324.30 (323.19,325.40) |
12.73 (12.16,13.36) |
|
| Liver | 583,110 | 708.91 |
9056 (8738,9351) |
11.01 (10.62,11.37) |
592,166 (591849,592461) |
719.92 (719.54,720.28) |
64.39 (62.36,66.73) |
|
| Pancreatic | 71,300 | 86.68 |
631 (606,656) |
0.77 (0.74,0.8) |
71,931 (71906,71957) |
87.45 (87.42,87.48) |
113.01 (108.63,117.75) |
|
| Total | 1,137,938 | 1383.00 |
38,234 (36683,39773) |
46.48 (44.60,48.35) |
1,176,172 (1174621,1177711) |
1429.92 (1428.04,1431.79) |
29.76 (28.61,31.02) |
|
| Rural | ||||||||
| Esophageal | 48,874 | 148.40 |
1004 (964,1042) |
3.05 (2.93,3.16) |
49,878 (49837,49915) |
151.45 (151.32,151.56) |
48.66 (46.92,50.72) |
|
| Stomach | 63,592 | 193.09 |
3203 (3104,3310) |
9.73 (9.42,10.05) |
66,795 (66695,66901) |
202.81 (202.51,203.13) |
19.85 (19.21,20.49) |
|
| Colorectal | 90,411 | 274.52 |
6440 (6139,6741) |
19.55 (18.64,20.47) |
96,851 (96550,97152) |
294.07 (293.16,294.99) |
14.04 (13.41,14.73) |
|
| Liver | 264,349 | 802.65 |
3899 (3762,4026) |
11.84 (11.42,12.22) |
268,248 (268111,268375) |
814.49 (814.08,814.88) |
67.80 (65.66,70.26) |
|
| Pancreatic | 22,906 | 69.55 |
239 (229,248) |
0.72 (0.7,0.75) |
23,145 (23135,23154) |
70.28 (70.25,70.30) |
95.96 (92.24,99.98) |
|
| Total | 490,132 | 1488.00 |
14,785 (14198,15367) |
44.89 (43.11,46.66) |
504,917 (504330,505499) |
1533.10 (1531.32,1534.87) |
33.15 (31.90,34.52) |
|
| Total | ||||||||
| Esophageal | 144,831 | 125.73 |
2830 (2715,2935) |
2.46 (2.36,2.55) |
147,661 (147546,147766) |
128.19 (128.09,128.28) |
51.17 (49.34,53.33) |
|
| Stomach | 203,839 | 176.96 |
10,499 (10174,10849) |
9.11 (8.83,9.42) |
214,338 (214013,214688) |
186.08 (185.79,186.38) |
19.41 (18.79,20.03) |
|
| Colorectal | 337,735 | 293.20 |
25,865 (24656,27073) |
22.45 (21.4,23.5) |
363,600 (362391,364808) |
315.66 (314.61,316.70) |
13.06 (12.47,13.70) |
|
| Liver | 847,459 | 735.71 |
12,955 (12501,13377) |
11.25 (10.85,11.61) |
860,414 (859959,860836) |
746.96 (746.57,747.33) |
65.41 (63.35,67.79) |
|
| Pancreatic | 94,206 | 81.78 |
870 (835,905) |
0.75 (0.72,0.79) |
95,076 (95041,95111) |
82.54 (82.51,82.57) |
108.33 (104.13,112.87) |
|
| Total | 1,628,070 | 1413.39 |
53,019 (50881,55140) |
46.03 (44.17,47.87) |
1,681,089 (1678951,1683210) |
1459.42 (1457.57,1461.26) |
30.71 (29.53,32.00) |
Cause-eliminated life expectancy
In 2019, the life expectancy in Guangdong Province was 84.10 years (81.79 years for males, 86.50 years for females), with 84.70 years for urban areas and 83.38 years for rural areas. Eliminating deaths from the five digestive cancers, life expectancy increased by 0.83 years, from 84.10 to 84.93 years. Specifically, it rose by 1.06 years for males (from 81.79 to 82.85 years) and by 0.53 years for females (from 86.50 to 87.03 years). In urban areas, the increase was 0.85 years (from 84.70 to 85.55 years), while in rural areas, it also increased by 0.85 years (from 83.38 to 84.23 years). Removing the death caused by esophageal, stomach, colorectal, liver and pancreatic cancers would add 0.08, 0.11, 0.21, 0.38 and 0.06 years, respectively, to life expectancy. Among these cancers, liver cancer had the most significant impact on life expectancy in Guangdong, followed by colorectal, stomach, esophageal and pancreatic cancers. Detailed results are presented in Table 4.
Table 4.
Cause-eliminated life expectancy of the five digestive system cancers in Guangdong
| Cancer sites | Life expectancy | Cause-eliminated life expectancy | Lost life years (∆e) | The rate of life years loss (∆e%) | |
|---|---|---|---|---|---|
| Male | |||||
| Esophageal | 81.79 | 81.91 | 0.12 | 0.15 | |
| Stomach | 81.92 | 0.13 | 0.16 | ||
| Colorectal | 82.00 | 0.21 | 0.26 | ||
| Liver | 82.33 | 0.54 | 0.66 | ||
| Pancreatic | 81.84 | 0.06 | 0.07 | ||
| Total | 82.85 | 1.06 | 1.28 | ||
| Female | |||||
| Esophageal | 86.50 | 86.53 | 0.03 | 0.04 | |
| Stomach | 86.59 | 0.09 | 0.10 | ||
| Colorectal | 86.68 | 0.19 | 0.22 | ||
| Liver | 86.66 | 0.16 | 0.19 | ||
| Pancreatic cancer | 86.55 | 0.05 | 0.06 | ||
| Total | 87.03 | 0.53 | 0.61 | ||
| Urban | |||||
| Esophageal | 84.70 | 84.78 | 0.08 | 0.09 | |
| Stomach | 84.81 | 0.11 | 0.13 | ||
| Colorectal | 84.92 | 0.22 | 0.26 | ||
| Liver | 85.08 | 0.38 | 0.45 | ||
| Pancreatic | 84.76 | 0.06 | 0.07 | ||
| Total | 85.55 | 0.85 | 0.99 | ||
| Rural | |||||
| Esophageal | 83.38 | 83.48 | 0.10 | 0.12 | |
| Stomach | 83.50 | 0.12 | 0.15 | ||
| Colorectal | 83.56 | 0.19 | 0.22 | ||
| Liver | 83.77 | 0.39 | 0.47 | ||
| Pancreatic | 83.42 | 0.05 | 0.06 | ||
| Total | 84.23 | 0.85 | 1.01 | ||
| Total | |||||
| Esophageal | 84.10 | 84.18 | 0.08 | 0.10 | |
| Stomach | 84.21 | 0.11 | 0.13 | ||
| Colorectal | 84.30 | 0.21 | 0.24 | ||
| Liver | 84.47 | 0.38 | 0.45 | ||
| Pancreatic | 84.15 | 0.06 | 0.07 | ||
| Total | 84.93 | 0.83 | 0.98 |
Figures 1 and 2 illustrate disparities in cause-eliminated life expectancy and life-year loss rates of the five digestive cancers between different genders and regions. Liver cancer had the most substantial impact on life expectancy in males and in both urban and rural areas, with life-year loss rates of 0.66% for males, 0.45% for urban areas, and 0.47% for rural areas. Colorectal cancer had the greatest impact on females’ life expectancy, resulting in a 0.22% loss rate. Esophageal, stomach, liver, and pancreatic cancers more significantly affected males’ life expectancy than females, while colorectal cancer had a more pronounced effect on females. Geographically, esophageal, stomach, and liver cancers had a more significant impact on rural residents, whereas colorectal and pancreatic cancers had a more pronounced effect on urban residents.
Fig. 1.
Cause-eliminated life expectancy from the five digestive system cancers in Guangdong
Fig. 2.
Potential life-year lost rate of the five digestive system cancers in Guangdong
Discussion
This research conducted a detailed analysis of the disease burden due to digestive system cancers among Guangdong Province residents in 2019. In Guangdong Province, newly reported cases and deaths of the five digestive system cancers in 2019 constituted 28.66% and 40.18% of all cancers, respectively. The crude incidence rate and ASIR were 82.30/105 and 59.61/105, respectively. The crude mortality rate and ASMR were 56.53/105 and 37.27/105, respectively. In 2019, the ASIR of the five digestive system cancers in Guangdong Province was higher than the average among medium SDI countries [17], while the ASMR was lower than the global level for other four digestive cancers except for liver cancer [1]. This may be attributable to a combination of more comprehensive cancer detection leading to higher recorded incidence, coupled with advancements in treatment availability within the province [18]. According to the study, the DALYs due to the five digestive system cancers were 1.16 million person-years, with the DALY rate at 1459.42/105, and YLL being the main component of DALY, accounting for 96.85% of DALYs. This indicates that the burden is driven almost entirely by premature mortality rather than disability from morbidity. This is in line with other studies [19, 20], showing that early death is the main cause of the disease burden of digestive system cancers. In 2019, life expectancy in Guangdong Province was 84.10 years, surpassing the national average [21] and aligning with Wuhan City [22] and Zhejiang Province [23]. After eliminating the deaths from the five digestive system cancers, life expectancy rose to 84.93 years, reflecting an average increase of 0.83 years and a life-year loss rate of 0.98%. The results showed that Guangdong Province suffered a serious disease burden caused by digestive system cancers. Furthermore, the vast majority of DALYs were due to YLL rather than YLD, indicating the need to focus resources on disease prevention and early detection. Our findings provide references for formulating digestive system cancer prevention and control policies.
In Guangdong Province, the characteristics of disease burden caused by different digestive cancers vary. Colorectal cancer has the highest incidence rate, whereas liver cancer is the leading cause of cancer-related death and DALYs and has the most substantial impact on life expectancy. The ASIR and ASMR of liver cancer in Guangdong are higher than national [24, 25] and global levels [26], whereas colorectal cancer’s ASIR and ASMR are lower than national levels [27, 28].Compared with other provinces, the ASIR of liver cancer among men in Guangdong was higher than that in both Zhejiang and Fujian [25], while the incidence rate of colorectal cancer in men exceeded that in Fujian [25]. The high incidence and mortality rates of colorectal cancer in Guangdong Province may be associated with risk factors such as unhealthy diets, smoking, and alcohol consumption, whereas liver cancer is primarily linked to the high prevalence of hepatitis B virus (HBV) infection and low HBV vaccination coverage in Guangdong Province [29–32]. Therefore, given the high incidence of liver and colorectal cancers in Guangdong Province, Guangdong must prioritize the prevention of these two cancers. For liver cancer, public health efforts should prioritize comprehensive HBV vaccination programs and antiviral therapy scale-up, alongside interventions to reduce aflatoxin exposure in food and harmful alcohol use. For colorectal cancer, priority should be given to expanding organized screening among high-risk populations and reinforcing interventions against modifiable risk factors such as smoking and excessive alcohol consumption.
Significant disparities in the disease burden of five digestive system cancers were observed between urban and rural areas in Guangdong Province. Urban areas exhibited higher ASIR and DALYs due to digestive system cancers, while rural areas had higher ASMR and DALY rates. These findings are consistent with those of previous studies [19, 33, 34]. Compared with the national levels in 2022, both urban and rural areas in Guangdong Province exhibited higher ASIR for liver and colorectal cancers, and higher ASMR for liver cancer in both areas and for colorectal cancer in rural areas [25]. However, the ASIR and ASMR for stomach, esophageal, and pancreatic cancers in both areas were lower than the national level [25]. The results indicated that colorectal and liver cancers exerted the most significant impact on both urban and rural residents in Guangdong Province. The higher colorectal-cancer burden in urban areas is attributable to a Western-style dietary pattern, characterized by high intakes of red and processed meat (212.02 g), and sedentary lifestyles, all recognized risk factors for colorectal carcinogenesis [35]. It has been documented that economically developed regions tend to exhibit higher incidence rates of colorectal cancer [36]. In contrast, the higher disease burden and mortality rates of liver cancer in rural areas may be ascribed to unfavorable lifestyle practices, lower socioeconomic status, and limited access to healthcare resources, particularly those required for liver cancer screening and treatment [37]. Moreover, the pronounced rural–urban differentials in HBV prevalence and in healthcare accessibility significantly account for the observed gradient in DALY rates between rural and urban areas for liver and colorectal cancers [38, 39]. The observed disparities in the disease burden of digestive system cancers between urban and rural areas in Guangdong Province highlight the need for targeted public health interventions. Evidence indicates that existing gastrointestinal-cancer screening programs can effectively reduce the disease burden [40]. In light of the higher incidence and associated DALYs of colorectal cancer in urban areas, it is recommended that urban areas strengthen opportunistic screening through primary-care networks and enhance early diagnosis and treatment to reduce the colorectal cancer burden among urban populations. Conversely, the higher mortality and DALY rates of liver cancer in rural areas indicate that rural areas should prioritize liver cancer prevention and control by extending screening through mobile units and home-based services delivered by community health workers; moreover, hepatitis B vaccination, antiviral therapy, and other hepatitis prevention and control measures should be incorporated into the assessment system, with their implementation status and effectiveness directly evaluated.
In Guangdong Province, males suffered higher disease burden from digestive system cancers compared with females, whereas females had longer life expectancy and cause-eliminated life expectancy. These findings are consistent with those of previous studies [17, 34, 41, 42]. Colorectal cancer had the highest incidence rate in both sexes, while liver cancer had the highest fatality rate. The ASIR of liver cancer for both males and females and colorectal cancer for females exceeded global levels [43]. Similarly, the ASMR of liver cancer for both sexes and colorectal cancer for males were higher than global averages [43]. Moreover, the ASIR and ASMR for liver cancer and colorectal cancer in both sexes were higher than national levels [25]. The gender disparity in susceptibility to digestive system cancers may be attributed to the higher exposure of males to risk factors such as smoking, alcohol consumption, and unhealthy diets [44, 45]. Studies have shown that the adherence rates among women to non-smoking (99.4%) and either non-drinking or moderate drinking (99.8%) are significantly higher than those among men (57.5% and 97.1%, respectively) (all P < 0.05) [46]. The incidence and mortality rates of digestive system cancers were found to be lowest in the 0–30 age group and highest among those aged 80–84 years, findings that are consistent with prior studies [24, 47, 48]. These results suggest that older individuals are at a higher risk of developing digestive system cancers, likely attributable to age-related differences in cancer histology, mutations, and molecular changes [47–49]. Consequently, in view of the higher disease burden among men and the elderly, Guangdong should adopt comprehensive measures. These involve educating these high-risk groups on cancer prevention and control, strengthening behavioral interventions, and performing targeted cancer screenings.
Conclusions
In summary, digestive system cancers in Guangdong Province exhibited a significant disease burden, shortening the average life expectancy by 0.83 years. There were discernible gender and regional disparities in the incidence, mortality, and disease burden associated with five digestive system cancers. Liver cancer predominated among males and in both urban and rural areas, while colorectal cancer was more common among females. Consequently, Guangdong Province should implement targeted interventions against modifiable risk factors for colorectal and liver cancers among high-risk populations and in high-incidence regions, thereby reducing the disease burden, especially since the vast majority of DALYs were due to YLL, indicating the need to focus resources on disease prevention and early detection. This study has some potential limitations. First, the mean duration of disease and weight of disability parameters are derived from literature, which may lead to slight deviations from the actual situation. Second, due to the incomplete information regarding the stage of cancer diagnosis, this study failed to analyze the impact of the diagnosis stage on cancer mortality and disease burden. Third, although the 40 monitoring sites cover 43.1% of Guangdong’s population and their sex and age structures differ minimally from provincial parameters, their under-representation of rural areas means that extrapolation to the whole province should be undertaken with caution. This study has several strengths. First, the population-based surveillance data used in our study are representative of the province. Second, cancer site and region subgroup analyses were conducted to help identify disease required priority attention and population with high risk. Third, this study employed comprehensive indicators of disease burden, including cause-eliminated life expectancy and DALY, to examine the impact of different digestive cancers on the health of various population groups from multiple perspectives.
Supplementary Information
Acknowledgements
We appreciate the the cancer registry staff in various locations of Guangdong Province.
Authors' contributions
Yu Liao: Conceptualization; data collection; quality control; formal analysis; methodology; writing—original draft; writing—review and editing; funding acquisition. Ying Zhang: Formal analysis; methodology; visualization; and writing—original draft. Yixuan Chen: Methodology; visualization; writing—review and editing. Yue Gao: Data collection; quality control; formal analysis; writing—review and editing. Rongshou Zheng: Conceptualization; quality control; writing—review and editing. Ye Wang: Conceptualization; data collection; supervision. Xueyan Zheng: Data collection; quality control. Ruilin Meng: Data collection; quality control; supervision, Jiansen Li: Conceptualization; supervision; writing—review and editing. Zhuanping Zeng: Conceptualization; supervision. Kexin Sun: Quality control; writing—review and editing. Bingfeng Han: Quality control; writing—review and editing. Dejian Zhao: Data collection; quality control; formal analysis. Yutong Han: Data collection; quality control; formal analysis. Ning Liang: Conceptualization; supervision; writing—review and editing. Wenqiang Wei: Conceptualization; methodology; supervision; writing–review and editing; and funding acquisition.
Funding
Yu Liao is supported by the Guangdong Provincial Medical Science and Technology Research Fund (B2024104). Wenqiang Wei is supported by the Guangdong Provincial Center for Disease Control and Prevention Talent Support Program (2023D010).
Data availability
The datasets used or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
We confirm that this study utilized routine surveillance data from the China Cancer Registry, specifically aggregated statistical data that contain no personal identifiers. The research protocol was reviewed and approved by the Ethics Committee of the Guangdong Provincial Center for Disease Control and Prevention, which determined that individual informed consent was not required. The study was conducted in full accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yu Liao and Ying Zhang should be considered joint first author.
Contributor Information
Yu Liao, Email: liaoyu1207@126.com.
Wenqiang Wei, Email: weiwq@cicams.ac.cn.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used or analysed during the current study are available from the corresponding author on reasonable request.