Global epidemiology of gastric cancer in 2022 and projections for 2050: A comprehensive analysis and forecasts based on GLOBOCAN data

BingyunLu1

DongjingZhang1

QizhenLiu1

XuanxuanZuo1

YeChen1,2,3✉Emailyechen@smu.edu.cn

1Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenGuangdongChina

2Integrative Microecology Clinical Center, Shenzhen Key Laboratory of Gastrointestinal Microbiota and DiseaseShenzhenGuangdongChina

3Shenzhen Hospital Southern Medical UniversityNo. 1333, Xinhu Road, Bao’an DistrictShenzhen CityGuangdong ProvinceChina

Bingyun Lu¹, Dongjing Zhang¹, Qizhen Liu¹, Xuanxuan Zuo¹, Ye Chen^1,2

Affiliation:

¹ Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China

² Integrative Microecology Clinical Center, Shenzhen Key Laboratory of Gastrointestinal Microbiota and Disease, Shenzhen, Guangdong, China

Corresponding author

Ye Chen, Shenzhen Hospital Southern Medical University

No. 1333, Xinhu Road, Bao'an District, Shenzhen City, Guangdong Province, China

Email: yechen@smu.edu.cn

Funding:

This study was supported by the Shenzhen Science and Technology

Program (KCXFZ20211020163558024), Research Foundation of Shenzhen Hospital of Southern Medical University (PY2022YM06).

Abstract

Background

Gastric cancer (GC) has greatly damaged the health of patients, and the burden exhibits substantial heterogeneity across diverse regions globally. This study aimed to analyze the burden of GC globally according to the latest estimates of GLOBOCAN 2022, with the hope of providing a reference for healthcare interventions.

Methods

This study utilized the data from GLOBOCAN 2022 to examine the incidence and mortality of GC globally, stratified by gender (males/females) and age (young group (15–39), middle-aged group (40–64), and elderly group (65–85+)). Finally, starting from the baseline year of 2022, the numbers of new cases and deaths globally by 2050 were predicted.

Results

In 2022, it was projected that 968,194 individuals were diagnosed with GC on a global scale, and 659,944 succumbed to the disease. Interestingly, in the young age group, the difference in disease burden between males and females was not very obvious, while in the middle-aged and elderly groups, the number of new cases and deaths among male patients was almost twice that among female patients. Moreover, the disease burden in the elderly group was more severe. Ultimately, in comparison to 2022, it is anticipated that by 2050, due to population growth and aging, the count of new GC cases will escalate by roughly 264% among elderly males, 268.3% among elderly females, and the count of deaths will surge by 275.3% among elderly males, 279.2% among elderly females.

Conclusion

The GC burden was more severe in elderly males and showed regional differences to some extent. This provided a new direction for subsequent research on GC and the formulation of cancer prevention and control strategies.

Keywords:

Gastric cancer

Incidence

Mortality

Human development index

Projection

1. Introduction

Gastric cancer (GC) is one of the most common malignant tumors worldwide and a leading cause of cancer-related deaths. According to the latest data from GLOBOCAN, GC ranks fifth in global incidence among malignancies, with over 960,000 new cases reported globally in 2022. The corresponding age-standardized incidence rates were 12.8 per 100,000 for men and 6.0 per 100,000 for women. An estimated 660,000 people died from GC in 2024, ranking it as the fourth leading cause of cancer-related mortality worldwide^[1]. The incidence of GC varies by sex, age, and region, with men being affected approximately twice as often as women. The risk of developing GC increases with age. Given global population growth, aging trends, and the persistence of related risk factors, the disease burden of GC is expected to gradually worsen. East Asia has the highest incidence rates, while Northern Europe, North America, and Africa have relatively lower rates^{[2, 3]} .

In recent years, advancements in endoscopic technology and the implementation of early cancer screening programs have led to an increasing detection rate of early GC. Countries like Japan and South Korea, which have long-established population-based endoscopic screening programs, have achieved early diagnosis rates exceeding 70%, significantly reducing the burden of gastric cancer. In China, the early detection rate is approximately 20%, and both the age-standardized incidence and mortality rates of GC have shown a declining trend^{[4, 5]}. Therefore, in the context of economic development and social transformation, it is necessary to conduct a comprehensive assessment, learn from the prevention and control experiences of countries with different Human Development Index (HDI) levels, and provide a scientific basis for formulating relevant prevention and management strategies.

Although studies based on the GLOBOCAN 2020 and 2022 databases have revealed the global burden of GC in the respective years^{[1, 6]}, there is still a lack of research systematically analyzing the characteristics of GC incidence and mortality stratified by young, middle-aged, and elderly age groups, combined with gender factors. Utilizing the detailed data provided by the latest 2022 GLOBOCAN database, this study aims to comprehensively assess the distribution of GC burden across different age groups and genders globally. Based on the most recent data from the GLOBOCAN database, this study analyzes the GC burden in various age groups worldwide, as well as its distribution by gender. Additionally, it predicts the development trends of the global GC burden in 2050, evaluates the latest epidemiological patterns and trends of the disease, and provides a theoretical foundation for better understanding the impact of GC on population health and for informing disease prevention, control, and strategy development.

2. Material and methods

2.1 Data collection

The study used the code C16 of the 10th Revision of the International Classification of Diseases (ICD-10)to define individuals with GC in clinical visits^[7]. The original disease burden data of GC were downloaded from the GLOBOCAN 2022 database (https://gco.iarc.who.int/en), encompassing data from 185 countries or territories, segmented by gender and age. Among them, the age was divided into young group (15–39), middle-aged group (40–64), and elderly group (65–85+). It included the incidence rates, mortality rates, and age-standardized estimates in various regions around the world in 2022. In addition, the 20 world regions could be divided into four levels according to the Human Development Index (HDI): very high (HDI ≥ 0.8), high (0.7 ≤ HDI < 0.8), medium (0.55 ≤ HDI < 0.7), and low (HDI < 0.55), in order to better evaluate the progress of human society^[8] .

2.2 Statistical analysis

Incidence and mortality together with age-standardized rates (ASR) (age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR)) were used to represent the burden of GC. The rates were reported per 100,000 population. Using the Segi-Doll world standard population as a reference, direct age standardization was used to calculate the ASIR and ASMR per 100,000 person-years^[9]. Furthermore, the count of incident cases and deaths attributable to global GC in 2050 was projected via the CANCER TOMORROW tool^[10] .

3.Results

3.1 GC incidence and mortality in different countries and regions in 2022

Globally, there were 11,629 new cases of GC in young males and 13,240 in young females in 2022. The number of GC deaths in young males was 7,551, and that in young females was 8,260. The ASIR of males and females were 0.7 and 0.82 per 100,000 population, respectively. The ASMR of males and females were 0.46 and 0.52 per 100,000 population, respectively. In short, whether in terms of the number of new cases or the number of deaths, the number of females was slightly higher than that of males (Table 1). In the middle-aged group, the number of new cases of GC in males was 220,035, and that in females was 111,954. The number of GC deaths in males was 135,950, and that in females was 67,218. The ASIR of males and females were 20.27 and 10.13 per 100,000 people, respectively. The ASMR of males and females were 12.53 and 6.09 per 100,000 people, respectively. In short, whether in terms of the number of new cases or the number of deaths, the number of males was nearly twice that of females (Table 2). In the elderly group, the number of new cases of GC in males was 395,410, and that in females was 215,926. The number of GC deaths in males was 283,894, and that in females was 157,071. The ASIR of males and females were 106.49 and 45.12 per 100,000 people, respectively. The ASMR of males and females were 75.25 and 31.65 per 100,000 people, respectively. Similarly, both the number of new cases and deaths among male patients were almost twice that among female patients (Table 3). The above results indicated that both the number of new cases and deaths from global GC in 2022 increased with age.

Table 1
Age-standardized morbidity and mortality rates by age group (15–39), sex, world region and human development index
	Incidence						Mortality
	male		female		both		male		female		both
World region	Number	ASR	Number	ASR	Number	ASR	Number	ASR	Number	ASR	Number	ASR
Africa
Eastern Africa	540	0.6	461	0.51	1001	0.55	458	0.51	407	0.45	865	0.48
Middle Africa	153	0.46	169	0.51	322	0.48	140	0.42	142	0.42	282	0.42
Northern Africa	335	0.62	436	0.82	771	0.72	251	0.47	335	0.63	586	0.55
Southern Africa	82	0.48	59	0.36	141	0.42	39	0.23	40	0.24	79	0.24
Western Africa	357	0.46	312	0.42	669	0.44	319	0.41	256	0.34	575	0.37
America
Caribbeaen	67	0.78	99	1.12	166	0.95	23	0.25	84	0.92	107	0.59
Central America	355	0.92	401	1	756	0.96	305	0.79	327	0.81	632	0.8
South America	707	0.79	952	0.99	1659	0.89	685	0.71	0.74	714	1399	0.72
Northern America	448	0.61	501	0.69	949	0.65	179	0.24	180	0.25	359	0.25
Asia
Eastern Asia	3445	1.05	3951	1.26	7396	1.15	1769	0.51	1850	0.58	3619	0.54
South-Eastern Asia	723	0.51	903	0.62	1626	0.56	423	0.3	550	0.38	973	0.34
South Central Asia	3113	0.65	3397	0.76	6510	0.7	2134	0.45	2407	0.54	4541	0.49
Western Asia	526	0.76	538	0.88	1064	0.81	348	0.52	351	0.58	699	0.54
Europe
Eastern Europe	288	0.5	613	1.02	901	0.76	250	0.38	381	0.62	631	0.5
Northern Europe	80	0.38	92	0.46	172	0.42	35	0.16	53	0.26	88	0.21
Southern Europe	114	0.44	129	0.51	243	0.48	66	0.23	66	0.24	132	0.24
Western Europe	220	0.61	194	0.56	414	0.59	98	0.26	101	0.28	199	0.27
Oceania
Australia-New Zealand	42	0.69	33	0.54	75	0.61	18	0.29	16	0.26	34	0.28
Melanesia	34	1.42	0	0	34	0.72	11	0.48	0	0	11	0.24
Micronesia/Polynesia	0	0	0	0	0	0	0	0	0	0	0	0
HDI
Low HDI	1399	0.61	1307	0.57	2706	0.59	1078	0.47	1048	0.46	2126	0.46
Medium HDI	3295	0.64	3638	0.74	6933	0.69	2271	0.44	2544	0.52	4815	0.48
High HDI	4840	0.83	5798	1	10638	0.91	3072	0.52	3320	0.57	6392	0.54
Very high HDI	2092	0.68	2493	0.81	4585	0.74	1130	0.34	1345	0.43	2475	0.38
World	11629	0.7	13240	0.82	24869	0.76	7551	0.46	8260	0.52	15811	0.48

Table 2
Age-standardized morbidity and mortality rates by age group (40–64), sex, world region and human development index
	Incidence						Mortality
	male		female		both		male		female		both
World region	Number	ASR	Number	ASR	Number	ASR	Number	ASR	Number	ASR	Number	ASR
Africa
Eastern Africa	2491	8.67	2439	7.5	4930	8.04	2087	7.33	2046	6.33	4133	6.79
Middle Africa	991	8.27	833	6.77	1824	7.51	827	6.92	686	5.6	1513	6.25
Northern Africa	2792	10.14	2159	7.53	4951	8.81	2191	7.97	1670	5.83	3861	6.88
Southern Africa	576	8.23	352	4.37	928	6.15	459	6.57	284	3.54	743	4.94
Western Africa	2264	7.87	1799	5.97	4063	6.89	1972	6.87	1547	5.13	3519	5.98
America
Caribbeaen	998	15.89	418	6.24	1416	10.88	755	11.93	321	4.8	1076	8.22
Central America	2870	13.53	2595	10.62	5465	11.97	2191	10.27	1972	8.06	4153	9.08
South America	12183	20.03	6502	9.86	18685	14.7	8858	14.57	4761	7.23	13619	10.73
Northern America	6273	9.86	4166	6.65	10439	8.24	2413	3.8	1486	2.37	3899	3.08
Asia
Eastern Asia	108367	35.41	47084	15.62	155451	25.52	52401	17.18	20559	6.84	72960	12.01
South-Eastern Asia	11940	12.61	7012	7.03	18952	9.73	8969	9.48	5196	5.21	14165	7.28
South Central Asia	34426	13.8	19269	7.83	53695	10.84	31222	12.49	16174	6.58	47396	9.56
Western Asia	6458	18.46	3224	10.05	9682	14.43	5012	14.43	2173	6.78	7185	10.76
Europe
Eastern Europe	14864	29.47	8095	13.85	22959	20.94	9830	19.45	5101	8.75	14931	13.59
Northern Europe	1814	9.64	963	5.07	2777	7.33	999	5.29	538	2.85	1537	4.05
Southern Europe	4539	14.87	2423	7.81	6962	11.25	2750	9.02	1374	4.42	4124	6.67
Western Europe	5424	14.39	2204	5.9	7628	10.1	2664	7.05	1104	2.95	3768	4.98
Oceania
Australia-New Zealand	609	11.99	303	5.83	912	8.85	238	4.67	129	2.47	367	3.55
Melanesia	132	11.97	101	9.2	233	10.59	106	9.74	95	7.65	191	8.69
Micronesia/Polynesia	24	13.69	13	7.79	37	10.79	16	9.55	12	7.1	28	8.34
HDI
Low HDI	7261	8.59	5292	5.92	12553	7.21	6364	7.55	4611	5.18	10975	6.33
Medium HDI	35835	13.47	20578	7.7	56413	10.58	32064	12.07	17981	6.74	50045	9.4
High HDI	116670	26.03	54849	12	171519	18.91	70342	15.76	30915	6.8	101257	11.21
Very high HDI	60195	20.67	31197	1065	91392	15.55	27123	9.32	13681	4.69	40804	6.96
World	220035	20.27	111954	10.13	331989	15.12	135950	12.53	67218	6.09	203168	9.26

Table 3
Age-standardized morbidity and mortality rates by age group (65+), sex, world region and human development index
	Incidence						Mortality
	male		female		both		male		female		both
World region	Number	ASR	Number	ASR	Number	ASR	Number	ASR	Number	ASR	Number	ASR
Africa
Eastern Africa	2094	34.76	2155	26.95	4249	30.34	1954	32.55	2007	25.05	3961	28.29
Middle Africa	609	25.92	707	24.46	1316	25.18	575	24.53	685	23.56	1260	24.05
Northern Africa	2384	33.08	1747	20.55	4131	26.35	2060	28.61	1528	17.87	3588	22.82
Southern Africa	559	38.23	392	16.26	951	24.46	447	31.84	441	18.44	888	23.45
Western Africa	1419	26.55	1543	24.49	2962	25.43	1343	25.28	1473	23.47	2816	24.3
America
Caribbeaen	1462	61.38	1136	36.15	2598	47.57	1144	47.17	876	27.02	2020	36.13
Central America	4744	70.69	3916	45.85	8660	56.89	3716	55.16	3155	36.32	6871	44.72
South America	21721	106.85	13207	46.62	34928	72.59	17408	85.13	10594	36.97	28002	57.68
Northern America	11393	36.4	6889	17.62	18282	26.17	5498	16.63	3610	8.22	9108	12
Asia
Eastern Asia	242530	196.34	115477	75.39	358007	131.91	163376	129.41	77934	48.21	241310	85.75
South-Eastern Asia	11057	48.45	7115	23.33	18172	34.07	10131	44.45	6440	20.89	16571	30.87
South Central Asia	33738	51.97	15649	22.45	49387	36.67	29167	45.09	13721	19.58	42888	31.83
Western Asia	7042	87.74	4427	42.38	11469	62.52	6564	79.12	3782	35.18	10146	54.57
Europe
Eastern Europe	23268	123.52	19259	54.58	42527	80.15	17903	94.25	15083	40.76	32986	60.45
Northern Europe	5043	47.06	3032	22.21	8075	33.57	3666	32.98	2326	16	5992	23.7
Southern Europe	13606	82.61	10033	42.42	23639	60.41	10438	59.6	7530	29.03	17968	42.52
Western Europe	11154	55.47	8143	27.72	19297	40.49	7759	35.35	5316	16.65	13705	25.05
Oceania
Australia-New Zealand	1388	51.82	959	29.3	2347	39.99	782	27.12	456	12.87	1238	19.52
Melanesia	164	77.46	109	46.01	273	60.72	135	64.21	91	37.69	226	50.05
Micronesia/Polynesia	35	77.17	31	58.37	66	67.12	28	61.25	23	43.05	51.41	51
HDI
Low HDI	5332	29.48	4921	23.38	10253	26.21	4934	27.27	4565	21.7	9499	24.28
Medium HDI	32244	47.9	16945	22.15	49189	34.23	28660	42.58	15165	19.8	43825	30.49
High HDI	199123	132.87	97832	53.29	296955	90.01	166814	109.63	80832	42.35	247646	73.05
Very high HDI	158609	116.12	96153	48.79	254762	78.31	83396	58.13	56450	26.23	139846	40
World	395410	106.49	215926	45.12	611336	72.97	283894	75.25	157071	31.65	440965	51.25

In addition, among countries with different HDI levels, the ASIR and ASMR in high-HDI countries were the highest across all three age groups. Among them, in the elderly group, the ASIR and ASMR in high-HDI countries were 90.01 and 73.05 per 100,000 people, respectively. Regional differences showed that the burden of GC in the Asian region was the most severe across all three age groups. Among them, the proportion in Eastern Asia was even higher; in the elderly group, the ASIR and ASMR were 131.91 and 85.75 per 100,000 people, respectively (Fig. 1, Table 3).

These results highlight the urgency of delving deeper into the influencing mechanisms of age, gender factors, and regional differences on GC diseases, so as to formulate more targeted prevention and control strategies and reduce the global health burden caused by GC.

3.2 Gender distribution of countries with high disease burden by age group

To identify countries with a high disease burden among different age groups worldwide, the top 10 countries with the highest GC ASIR and ASMR for different genders in different age groups were presented in the figure. In the young age group, the countries with the highest ASIR for males and females were Mongolia (3.6 per 100,000) and Guyana (4.3 per 100,000), respectively; the countries with the highest ASMR for males and females were still Mongolia (1.9 per 100,000) and Guyana (3.3 per 100,000), respectively (Fig. 2A). In the middle-aged group, the countries with the highest ASIR for males and females were Mongolia (102.8 per 100,000) and the Republic of Korea (34.6 per 100,000), respectively; the country with the highest ASMR for males was still Mongolia (81.2 per 100,000), and the countries with the highest ASMR for females were Mongolia and Mali (26.6 per 100,000) (Fig. 2B). In the elderly group, the countries with the highest ASIR for males and females were Japan (397.3 per 100,000) and Mongolia (177.7 per 100,000), respectively; the country with the highest ASMR for both males and females was Mongolia (366.1 per 100,000; 181.2 per 100,000) (Fig. 2C). Overall, Mongolia was the country with the highest ASIR and ASMR across all three age groups. This indicated that a precise and targeted prevention and control system for GC in response to the differences in regions, ages, and genders, so as to effectively reduce the disease burden.

3.3 The predicted trends of GC cases and deaths globally by 2050

In the young age group, it is anticipated to the count of new cases of GC in males worldwide would reach 22,282 in 2050. Compared with 11,629 cases in 2022, it was estimated to increase by approximately 91.6% (10,653/11,629). Moreover, for females, the number of new cases of GC would reach 25,301 in 2050. Compared with 13,240 cases in 2022, it was estimated to increase by approximately 91.1% (12,061/13,240) (Fig. 3A, Supplementary Table 1). In terms of the deaths, assuming that the global mortality rate remained unchanged in 2022, the number of deaths due to GC in males was estimated to increase from 7,551 in 2022 to 14,445 in 2050, an increase of approximately 91.3% (6,894/7,551). Furthermore, for females, the count of deaths due to GC was projected to increase from 8,260 in 2022 to 15,785 in 2050, an increase of approximately 91.1% (7,525/8,260) (Fig. 3A, Supplementary Table 1).

In the middle-aged group, assuming that the global incidence rate remained stable in 2022, it was anticipated that the count of new cases of GC in males worldwide would reach 534,158 in 2050. Compared with 220,035 cases in 2022, it was estimated to increase by approximately 142.8% (314,123/220,035). Moreover, for females, the number of new cases of GC would reach 259,190 in 2050. Compared with 111,954 cases in 2022, it was estimated to increase by approximately 131.5% (147,236/111,954) (Fig. 3B, Supplementary Table 2). In terms of the deaths, assuming that the global mortality rate remained unchanged in 2022, the number of deaths due to GC in males was estimated to increase from 135,950 in 2022 to 329,479 in 2050, an increase of approximately 142.4% (193,529/135,950). Furthermore, for females, the count of deaths due to GC was projected to increase from 67,218 in 2022 to 155,717 in 2050, an increase of approximately 131.7% (88,499/67,218) (Fig. 3B, Supplementary Table 2).

In the elderly group, assuming that the global incidence rate remained stable in 2022, it was anticipated that the count of new cases of GC in males worldwide would reach 1,439,426 in 2050. Compared with 395,410 cases in 2022, it was estimated to increase by approximately 264% (1,044,016/395,410). Moreover, for females, the number of new cases of GC would reach 795,283 in 2050. Compared with 215,926 cases in 2022, it was estimated to increase by approximately 268.3% (579,357/215,926) (Fig. 3C, Supplementary Table 3). In terms of the deaths, assuming that the global mortality rate remained unchanged in 2022, the number of deaths due to GC in males was estimated to increase from 283,894 in 2022 to 1,065,584 in 2050, an increase of approximately 275.3% (781,690/283,894). Furthermore, for females, the count of deaths due to GC was projected to increase from 157,071 in 2022 to 595,570 in 2050, an increase of approximately 279.2% (438,499/157,071) (Fig. 3C, Supplementary Table 3). This trend served as a warning that it was urgently necessary to implement comprehensive prevention and control strategies covering disease screening, intervention, and treatment as soon as possible to alleviate the disease burden of GC and reduce the future disease risks.

Discussion

Based on GLOBOCAN 2022 data, this study compares the global gastric cancer burden by age group and gender, revealing regional disparities in GC burden. The disease demonstrates distinct age characteristics, with gender disparities in disease burden becoming increasingly pronounced after age 40, showing a more severe impact on males. Projections of GC burden from 2022 to 2050 indicate an upward trend. Reducing incidence and mortality rates is essential to alleviate the future GC burden. These findings enhance the understanding of GC epidemiology and will contribute to developing more scientific and rational disease prevention strategies.

Although the incidence and mortality rates of GC have shown a declining trend in recent years, the current situation in certain regions—particularly in East Asian countries—remains characterized by high incidence rates, a higher proportion of advanced-stage disease, and a significant gap in prognosis compared to developed countries^[1]. It is projected that by 2050, the number of new cases and deaths will increase significantly. GC will continue to be one of the most burdensome malignancies, posing a serious threat to residents' lives and health.

Our findings indicate that in the young adult group with GC, the number of female cases and deaths is slightly higher than that of males—a phenomenon potentially related to etiological differences. It is reported that diffuse-type GC (Lauren classification) may account for a relatively higher proportion of cases in younger groups^{[3, 11]}. This subtype is more closely associated with genetic factors (such as CDH1 gene mutations), autoimmune factors, and hormone levels (e.g., estrogen signaling pathways), rendering women more susceptible^[12–14]. However, in middle-aged and elderly groups (after age 40), the disease burden becomes significantly higher in men, with the number of cases and deaths nearly twice that of women. This is likely attributed to the more pronounced and cumulative effects of traditional risk factors predominant in men, such as smoking, high-salt diets, alcohol abuse, and a higher tendency toward Helicobacter pylori exposure^[15].

In this study, countries with high HDI exhibited the highest age-standardized rates (ASIR and ASMR) across all age groups. This finding may be driven by multiple factors. On one hand, high-HDI countries generally possess more comprehensive cancer registration systems and advanced diagnostic technologies (such as the widespread use of endoscopic screening), leading to higher case detection rates, particularly at early and asymptomatic stages^[16]. On the other hand, populations in high-HDI countries experience more pronounced aging, and since GC risk increases significantly with age, this demographic shift elevates ASRs. This perspective is also supported by other research. This article finds that although the global incidence rate of GC shows a declining trend, the absolute number of cases follows different trajectories across regions due to population growth and aging^[17].. Furthermore, certain lifestyle-related risk factors prevalent in high-HDI nations, including obesity and gastroesophageal reflux disease (GERD), may be linked to the development of cardia GC, partially offsetting the protective effect conferred by declining Helicobacter pylori infection rates^[18]. This suggests that while economic development and medical advances bring health benefits, they may also be accompanied by shifts in cancer patterns, particularly in subtype distribution.

Our findings also indicate that the age distribution of GC cases and deaths will evolve over the next two decades alongside demographic transitions, with the burden remaining concentrated predominantly in high-HDI regions^[15]. As a highly heterogeneous malignancy of the digestive tract involving multifactorial etiology, the incidence of GC is driven by the interplay of Helicobacter pylori infection, dietary habits, genetic background, and environmental factors^{[19, 20]}. Promoting healthy lifestyles, identifying at-risk populations, and implementing screening and H. pylori eradication programs are crucial for reducing the incidence of GC.

Geographically, Asia bears the most severe burden of GC across all three age groups, with Eastern Asia experiencing the heaviest burden, while the African continent has the lowest incidence rates^[7]. Particularly in China, Japan, South Korea, and Mongolia, the age-standardized incidence and mortality rates (ASIR and ASMR) among the elderly reach strikingly high levels. This pattern strongly aligns with well-established regional high-risk factors, including traditional dietary cultures high in salt and preserved foods, high prevalence of Helicobacter pylori infection, specific eating habits (such as the consumption of scalding-hot foods), and potential genetic susceptibility^[21]. Our analysis of countries with the highest incidence rates within each age group further refines this understanding. This highlights the existence of significant country-specific variations even within the high-risk region of Eastern Asia, warranting more in-depth etiological comparative studies.

Finally, this study projects the global number of new GC cases and deaths by age group from 2022 to 2050. Based on global population growth and aging trends, even if current incidence rates remain unchanged, the number of new GC cases and deaths is expected to increase significantly by 2050. These projections clearly demonstrate that merely maintaining the status quo is far from sufficient. Without strong and effective interventions to reduce incidence and mortality rates, healthcare systems worldwide will face an extremely heavy burden in the future.

Helicobacter pylori infection is a Group 1 carcinogen for GC (particularly non-cardia gastric adenocarcinoma)^[22]. Substantial epidemiological evidence indicates that eradicating H. pylori can effectively reduce the incidence and mortality risk of GC^[23]. The WHO-IARC recommends that countries explore population-based H. pylori screening and treatment programs^[24]. Large-scale efforts and practices of H. pylori eradication in Japan, Taiwan (China), and Shandong (China) have all significantly reduced the incidence of precancerous lesions and GC, and are predicted to potentially lead to a substantial reduction in GC mortality^[25] .

Overall, effective prevention of GC requires a multi-faceted strategy. Primary prevention should focus on reducing modifiable risk factors; besides promoting H. pylori screening and eradication, reducing salt intake, increasing the consumption of fresh produce, and discouraging tobacco and alcohol use should also be considered^[26]. Secondary prevention through endoscopic screening in high-risk populations is cost-effective and can reduce GC mortality^{[27, 28]}, as demonstrated by nationwide screening programs in countries like Japan and South Korea, which have achieved earlier diagnosis and higher survival rates^[29–31]. However, endoscopic screening is resource-intensive and may not be feasible in many low-income settings. There is a pressing need for non-invasive risk stratification tools and more cost-effective screening strategies to prioritize high-risk individuals for endoscopic examination.

However, this study has several limitations. First, the estimates in the GLOBOCAN database rely on the quality of cancer registration in each country, and data from some low- and middle-income countries may be less accurate or incomplete. Second, our prediction model is based on 2022 incidence rates and does not account for future trends in risk factor prevalence—such as changes in Helicobacter pylori infection rates or shifts in dietary patterns—nor the potential impacts from breakthroughs in screening and treatment technologies. Additionally, we were unable to perform stratified analyses by thr anatomical subsite or histological subtype of GC, which may exhibit distinct epidemiological characteristics.

In summary, this study demonstrates that the epidemiological features of GC are complexly influenced by age, sex, geography, and socioeconomic development. Future prevention and control efforts must be multi-level and precision-oriented. At the global level, continued support should be provided to low- and middle-income countries to strengthen cancer registration systems and promote cost-effective H. pylori screening and eradication programs. At the national and regional levels, high-burden areas (such as East Asia) should persist in promoting healthy diets, tobacco control, and exploring tailored endoscopic screening programs suited to local conditions. At the research level, studies should be encouraged on the etiology of GC in young women, subtype-specific risk factors, and comparative effectiveness of various intervention strategies. Only through such comprehensive efforts can we potentially reverse the projected disease burden trend by 2050 and effectively alleviate the threat of GC to global health.

Data Availability

All data used in this analysis are publicly available. The original disease burden data of GC were downloaded from the GLOBOCAN 2022 database (https://gco.iarc.who.int/en), encompassing data from 185 countries or territories, segmented by gender and age.

DISCLOSURE

GLOBOCAN 2022 database (https://gco.iarc.who.int/en) belong to public databases. GLOBOCAN estimates are based on data from population-based cancer registries and vital statistics registries from around the world, including LMICs, and are relevant to all countries. Users can download relevant data for free for research and publish relevant articles. Our study is based on open source data, so there are no ethical issues and other conflicts of interest. The authorship team jointly contributed international expertise in gastric cancer. Roles and responsibilities were agreed upon by all authors.

Author Contribution

**Ye Chen** : Writing - review and editing; funding acquisition; supervision; methodology; investigation; formal analysis; conceptualization. **Bingyun Lu** : Writing - original draft; Methodology; validation; visualization; software; formal analysis; writing - review and editing. **Dongjing Zhang** : Conceptualization; methodology; visualization; validation; investigation. **Qizhen Liu** : Methodology; validation; data curation; software. **Xuanxuan Zuo** : Conceptualization; investigation; validation.

Acknowledgement

The authors acknowledge all contributing cancer registries worldwide and the IARC team for their data and critical review of the estimates.

参考文献

[1] Tan N, Wu H, Cao M, et al. Global, regional, and national burden of early-onset gastric cancer[J]. Cancer Biology & Medicine,2024:1–12.

[2] Yang W, Zhao H, Yu Y, et al. Updates on global epidemiology, risk and prognostic factors of gastric cancer[J]. World Journal of Gastroenterology,2023,29(16):2452–2468.

[3] Sundar R, Nakayama I, Markar S R, et al. Gastric cancer[J]. The Lancet,2025,405(10494):2087–2102.

[4] Zhou Y, Song K, Chen Y, et al. Burden of six major types of digestive system cancers globally and in China[J]. Chinese Medical Journal,2024,137(16):1957–1964.

[5] Ajani J A, D'Amico T A, Bentrem D J, et al. Gastric Cancer, Version 2.2025[J]. JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK,2025,23(5):169–191.

[6] Morgan E, Arnold M, Camargo M C, et al. The current and future incidence and mortality of gastric cancer in 185 countries, 2020–40: A population-based modelling study[J]. EClinicalMedicine,2022,47:101404.

[7] Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA: A Cancer Journal for Clinicians,2024,74(3):229–263.

[8] Li M, Wen X, Liang X, et al.

Global, regional, and national lifetime risk of developing and dying from lung cancer in 2022: A population-based study in 185 countries[J]. Chinese Medical Journal,2024,137(24):3101–3107.

[9] Zhang Y, Rumgay H, Li M, et al. Nasopharyngeal Cancer Incidence and Mortality in 185 Countries in 2020 and the Projected Burden in 2040: Population-Based Global Epidemiological Profiling[J]. JMIR Public Health Surveill,2023,9:e49968.

[10] Qi L, Sun M, Liu W, et al. Global esophageal cancer epidemiology in 2022 and predictions for 2050: A comprehensive analysis and projections based on GLOBOCAN data[J]. Chinese Medical Journal,2024,137(24):3108–3116.

[11] Mamun T I, Younus S, Rahman M H. Gastric cancer—Epidemiology, modifiable and non-modifiable risk factors, challenges and opportunities: An updated review[J]. Cancer Treatment and Research Communications,2024,41:100845.

[12] Decourtye-Espiard L, Guilford P. Hereditary Diffuse Gastric Cancer[J]. Gastroenterology,2023,164(5):719–735.

[13] Pilonis N D, Tischkowitz M, Fitzgerald R C, et al. Hereditary Diffuse Gastric Cancer: Approaches to Screening, Surveillance, and Treatment[J]. Annual review of medicine,2021,72(1):263–280.

[14] Xing Y, Hosaka H, Moki F, et al. Gender Differences in Patients with Gastric Adenocarcinoma[J]. Journal of Clinical Medicine,2024,13(9):2524.

[15] Yan C, Shan F, Ying X, et al. Global burden prediction of gastric cancer during demographic transition from 2020 to 2040[J]. Chinese Medical Journal,2023,136(4):397–406.

[16] Bizuayehu H M, Ahmed K Y, Kibret G D, et al. Global Disparities of Cancer and Its Projected Burden in 2050[J]. JAMA Network Open,2024,7(11):e2443198.

[17] Soerjomataram I, Bray F. Planning for tomorrow: global cancer incidence and the role of prevention 2020–2070[J]. Nat Rev Clin Oncol,2021,18(10):663–672.

[18] Camilleri M, Malhi H, Acosta A. Gastrointestinal Complications of Obesity[J]. Gastroenterology,2017,152(7):1656–1670.

[19] Mukaisho K, Nakayama T, Hagiwara T, et al. Two distinct etiologies of gastric cardia adenocarcinoma: interactions among pH, Helicobacter pylori, and bile acids[J]. Frontiers in Microbiology,2015,6.

[20] Shah S C, Mckinley M, Gupta S, et al. Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Age 50 Years and Older[J]. Gastroenterology,2020,159(5):1705–1714.

[21] Morais S, Costa A, Albuquerque G, et al. Salt intake and gastric cancer: a pooled analysis within the Stomach cancer Pooling (StoP) Project[J]. Cancer Causes & Control,2022,33(5):779–791.

[22] Wizenty J, Sigal M. Helicobacter pylori, microbiota and gastric cancer — principles of microorganism-driven carcinogenesis[J]. Nature Reviews Gastroenterology & Hepatology,2025,22(5):296–313.

[23] Ford A C, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis[J]. Gut,2020,69(12):2113–2121.

[24] Park J Y. Population-Based Helicobacter pylori Screen-and-Treat Strategies for Gastric Cancer Prevention: Guidance on Implementation[M]. International Agency for Research on Cancer,2025.7–443.

[25] Chiang T, Chang W, Chen S L, et al. Mass eradication ofHelicobacter pylori to reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands[J]. Gut,2021,70(2):243–250.

[26] Chiang T, Cheng H, Chuang S, et al. Mass screening and eradication of Helicobacter pylori as the policy recommendations for gastric cancer prevention[J]. Journal of the Formosan Medical Association,2022,121(12):2378–2392.

[27] Xia R, Zeng H, Liu W, et al. Estimated Cost-effectiveness of Endoscopic Screening for Upper Gastrointestinal Tract Cancer in High-Risk Areas in China[J]. JAMA Network Open,2021,4(8):e2121403.

[28] Kapteijn N E A, Mülder D T, Lansdorp-Vogelaar I. Cost-effectiveness of upper endoscopy for gastric cancer screening and surveillance in Western populations[J]. Best Practice & Research Clinical Gastroenterology,2025,75:101982.

[29] Huang R J, Laszkowska M, In H, et al. Controlling Gastric Cancer in a World of Heterogeneous Risk[J]. Gastroenterology,2023,164(5):736–751.

[30] Suh Y S, Lee J, Woo H, et al. National cancer screening program for gastric cancer in Korea: Nationwide treatment benefit and cost[J]. Cancer,2020,126(9):1929–1939.

[31] Mabe K, Inoue K, Kamada T, et al. Endoscopic screening for gastric cancer in Japan: Current status and future perspectives[J]. Digestive Endoscopy,2022,34(3):412–419.

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