Sex differences in gastrointestinal cancers incidence and mortality among adolescents and young adults in China: an age-period-birth cohort study

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Abstract Background and Objectives Early-onset gastrointestinal cancers in adolescents and young adults (< 50 years) from a unique subgroup with unclear epidemiological features. We aimed to estimate the burden of early-onset gastrointestinal cancers in China, focusing on the associations with age, period, and birth cohort effects. Methods Cancer-specific estimates for six major types of early-onset gastrointestinal cancers in China were derived from Global Burden of Disease (GBD) 2021. We analyzed the incidence and mortality, and calculated temporal trends, mortality-to-incidence ratio, and age distributions. We used an age-period-cohort analysis to estimate longitudinal age trends (age effects) and period/birth cohort relative risks (period/birth cohort effects) during 1990–2021, and calculated overall annual percentage changes (net drifts). Results There were 6.52 million incident cases and 4.32 million deaths due to early-onset gastrointestinal cancers in China during 1990–2021. Net drifts in incidence increased for colorectal (1.17% to 1.77%) and Gallbladder cancer (1.16% to 1.81%), while decreases were observed for esophageal cancer (-3.37% to -2.58%), gastric (-1.86% to -1.14%) and liver cancer (-1.75% to -1.06%) during 1990–2021. Period effects on incidence risk decreased for esophageal, gastric, and liver cancers from 1997 to 2021, but increased for colorectal and gallbladder cancers from 1997 to 2021. Birth cohort effects on incidence risk decreased for esophageal cancer (1945–1999), gastric (1945–2004) and liver cancer (1965–2004), whereas increases were seen for colorectal (1945–2004) and gallbladder (1945–2004). For pancreatic cancer, however, birth cohort effects remained largely stable across all cohorts. The age, period, and birth cohort effects on incidence and mortality were similarly consistent. Conclusions These results provided new insights into the temporal trends in early-onset gastrointestinal cancers and their associations with age, period, and birth cohort effects, and may help to guide future public health policies for cancer control in China. The distinct temporal trends and sex-specific disparities identified in this study underscore the need for differentiated prevention and early screening strategies for gastrointestinal cancers among young adults in China.

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