SCIEnTIFIC RepoRtS | (2018) 8:4522 | DOI:10.1038/s41598-018-19819-8
Global Incidence and mortality
of oesophageal cancer and their
correlation with socioeconomic
indicators temporal patterns and
trends in 41 countries
Martin C. S. Wong
, Willie Hamilton
, David C. Whiteman
, Johnny Y. Jiang
, Youlin Qiao
Franklin D. H. Fung
, Harry H. X. Wang
, Philip W. Y. Chiu
, Enders K. W. Ng
, Justin C. Y.
, Jun Yu
, Francis K. L. Chan
& Joseph J. Y. Sung
Oesophageal cancers (adenocarcinomas [AC] and squamous cell carcinomas [SCC]) are characterized by
high incidence/mortality in many countries. We aimed to delineate its global incidence and mortality,
and studied whether socioeconomic development and its incidence rate were correlated. The age-
standardized rates (ASRs) of incidence and mortality of this medical condition in 2012 for 184 nations
from the GLOBOCAN database; national databases capturing incidence rates, and the WHO mortality
database were examined. Their correlations with two indicators of socioeconomic development were
evaluated. Joinpoint regression analysis was used to generate trends. The ratio between the ASR of
AC and SCC was strongly correlated with HDI (r = 0.535 [men]; r = 0.661 [women]) and GDP (r = 0.594
[men]; r = 0.550 [women], both p < 0.001). Countries that reported the largest reduction in incidence
in male included Poland (Average Annual Percent Change [AAPC] = −7.1, 95%C.I. = −12,−1.9) and
Singapore (AAPC = −5.8, 95%C.I. = −9.5,−1.9), whereas for women the greatest decline was seen in
Singapore (AAPC = −12.3, 95%C.I. = −17.3,−6.9) and China (AAPC = −5.6, 95%C.I. = −7.6,−3.4).
The Philippines (AAPC = 4.3, 95%C.I. = 2,6.6) and Bulgaria (AAPC = 2.8, 95%C.I. = 0.5,5.1) had a
signicant mortality increase in men; whilst Columbia (AAPC = −6.1, 95%C.I. = −7.5,−4.6) and
Slovenia (AAPC = −4.6, 95%C.I. = −7.9,−1.3) reported mortality decline in women. These ndings
inform individuals at increased risk for primary prevention.
Globally, oesophageal cancer is one of the most frequently reported malignancies and a leading cause of cancer
. In 2008, the disease accounted for around 4 million disability-adjusted life years
. e cancer is extremely
aggressive and prognosis is oen poor
Majority of oesophageal cancers (80%) are reported in more deprived nations. Most of these cancers belong
to either of the major histologic types: squamous cell carcinoma (SCC) and adenocarcinoma (AC). Although
SCCs historically consist of the majority of all cases of this cancer, in recent years we have observed a rapid rise
of AC in western countries
. e risk factors of AC such as increased age, male sex, obesity, gastro-oesophageal
reux disease, cigarette smoking, and diet low in vegetables and fruit have been widely recognized; whereas for
SCC, cigarette smoking, alcohol consumption, caustic injury, poor oral hygiene, ingestion of caustic agents, and
nutritional deciencies are major risk factors
. As many risk factors of oesophageal cancer could be modied,
The JC School of Public Health and Primary Care, Hong Kong, China.
The Institute of Digestive Disease, Faculty
of Medicine of the Chinese University of Hong Kong (CUHK), Shatin, Hong Kong, China.
University of Exeter,
College House, St Luke’s Campus, Exeter, United Kingdom.
QIMR Berghofer Medical Research Institute, Brisbane,
The Chinese Academy of Medical Sciences, Beijing, China.
The School of Public Health of the Sun Yat-
Sen University, Guangzhou, China.
General Practice and Primary Care, Institute of Health and Wellbeing, University
of Glasgow, Glasgow, G12 9LX, UK.
State Key Laboratory of Digestive Disease, CUHK, Shatin, Hong Kong, China.
Correspondence and requests for materials should be addressed to J.J.Y.S. (email: firstname.lastname@example.org)
Received: 4 July 2017
Accepted: 9 January 2018
Published: xx xx xxxx