Incidence and mortality risks of gastrointestinal cancers during working-age period: Trends and disparities in 204 countries and territories (1990–2021)

 Gastrointestinal (GI) cancers constitute over one-fourth of global cancer morbidity and one-third of mortality. Although lifetime risk estimates guide cancer surveillance, the risk during working age (15–64 years) remains poorly quantified despite its significant socioeconomic implications. Therefore, we aimed to evaluate global incidence and mortality risks of GI cancers during working age (15–64 years) from 1990 to 2021. We employed the adjusted for multiple primaries method to estimate working-age risks of six major GI cancers based on data from the Global Burden of Disease 2021 study. Analyses of risk patterns were stratified by sex, sociodemographic index quintiles, geographic regions, nations, and age intervals. Temporal trends were assessed through joinpoint regression analyses spanning 1990–2021. Our analysis revealed that the 2021 global working-age incidence and mortality risks of GI cancers were 2.19% (95% CI: 2.18–2.20) and 1.37% (95% CI: 1.36–1.37), respectively. Colorectal cancer exhibited the highest incidence risk (0.91%), whereas stomach cancer demonstrated the highest mortality risk (0.35%). Males demonstrated approximately twofold higher risks than females. High-middle SDI countries exhibited the highest risks, with East Asia and Mongolia showing the highest regional and national risks. Age-stratified analysis revealed ages 40–64 representing the high-risk period during working years. Despite an encouraging decline in overall GI cancer risks, the persistent increase in CRC incidence risk emerged as a concerning pattern. In conclusion, the global working-age risk corresponds to one in 46 people developing and one in 73 dying from GI cancers, with marked disparities across demographic, socioeconomic, and geographic dimensions necessitating targeted surveillance strategies.