Burden of gastrointestinal cancers among working-age population over past thirty years in China

Table 1 Burden of gastrointestinal cancers among working-age population in China 1990-2019

Participants	Type of GI cancers	1990		2019		1990		2019		1990		2019
		Incident case (95%UI)	ASIR (95%UI)	Incident case (95%UI)	ASIR (95%UI)	Mortality case (95%UI)	ASMR (95%UI)	Mortality case (95%UI)	ASMR (95%UI)	DALYs (95%UI)	ASDR (95%UI)	DALYs (95%UI)	ASDR
Overall	Colon and rectum cancer	59982 (51662-69155)	9.19 (7.92-10.58)	283322 (234698-339847)	21.82 (18.09-26.14)	39243 (33370-45379)	6.06 (5.15-7.00)	92784 (76834-111032)	7.08 (5.87-8.46)	1551325 (1321613-1795526)	232.54 (198.14-269.02)	3527247 (2949667-4194243)	276.29 (231.34-328.05)
	Esophageal cancer	83601 (52815-101343)	13.5 (8.53-16.36)	100481 (77654-125529)	7.37 (5.70-9.2)	77754 (48830-94098)	12.57 (7.90-15.21)	82457 (64032-103637)	6.04 (4.70-7.59)	2667461 (1669627-3231928)	427.7 (267.89-518.13)	2776889 (2165721-3490970)	204.47 (159.64-257)
	Gallbladder and biliary tract cancer	5783 (4618-9086)	0.91 (0.72-1.44)	13353 (9311-16517)	1.01 (0.70-1.25)	5089 (4037-8055)	0.80 (0.64-1.28)	10839 (7901-13359)	0.81 (0.59-1.00)	186982 (148524-288642)	28.9 (22.97-45.15)	376720 (275756-464927)	28.53 (20.87-35.2)
	Liver cancer	163523 (133423-200151)	25.3 (20.62-30.98)	122607 (97932-151349)	9.47 (7.58-11.68)	151613 (123716-185529)	23.56 (19.21-28.85)	99340 (80088-122060)	7.61 (6.14-9.35)	5934861 (4849189-7246002)	901.79 (736.1-1102.08)	3735886 (3011992-4586337)	293.91 (237.06-360.47)
	Pancreatic cancer	14947 (12533-17462)	2.35 (1.97-2.75)	47790 (39387-57206)	3.59 (2.96-4.29)	13993 (11678-16500)	2.21 (1.85-2.61)	44372 (36537-53335)	3.32 (2.74-3.99)	510853 (425892-603413)	79.26 (66.09-93.55)	1558243 (1283400-1874362)	118.61 (97.75-142.63)
	Stomach cancer	167983 (143406-194818)	26.54 (22.65-30.79)	258317 (208931-314979)	19.6 (15.89-23.86)	147121 (124564-170800)	23.34 (19.76-27.11)	144177 (117126-174989)	10.8 (8.79-13.09)	5346879 (4534010-6202702)	833.88 (706.71-967.6)	5108526 (4165635-6172708)	389.57 (318.39-469.71)
	All GI cancers	495819 (398457-592016)	77.78 (62.42-92.89)	825870 (667914-1005427)	62.86 (50.91-76.42)	434813 (346195-520361)	68.54 (54.5-82.05)	473970 (382518-578412)	35.67 (28.82-43.49)	16198362 (12948854-19368214)	2504.05 (1997.89-2995.53)	17083512 (13852170-20783548)	1311.38 (1065.04-1593.06)
Female	Colon and rectum cancer	26640 (21308-32353)	8.55 (6.85-10.36)	92647 (71959-117263)	14.32 (11.11-18.15)	17436 (13922-21216)	5.64 (4.50-6.85)	30156 (23607-38017)	4.63 (3.62-5.84)	685852 (548140-836447)	215.63 (172.52-262.39)	1131966 (891965-1417160)	178.33 (140.28-223.35)
	Esophageal cancer	21747 (11072-27418)	7.34 (3.73-9.25)	17032 (12295-22055)	2.54 (1.83-3.29)	19571 (10003-24688)	6.62 (3.38-8.35)	11179 (8317-14480)	1.66 (1.23-2.15)	651951 (335203-823783)	218.91 (112.25-276.38)	367832 (274504-475564)	54.92 (40.95-71.05)
	Gallbladder and biliary tract cancer	2871 (2122-4710)	0.95 (0.70-1.56)	5808 (3487-7731)	0.88 (0.53-1.17)	2536 (1865-4288)	0.84 (0.62-1.43)	4662 (2873-6177)	0.70 (0.43-0.92)	91445 (67071-151766)	29.79 (21.89-49.84)	158513 (98069-210224)	23.94 (14.82-31.8)
	Liver cancer	37701 (28919-48516)	12.26 (9.42-15.74)	21942 (16829-28109)	3.38 (2.59-4.34)	35035 (26803-45164)	11.45 (8.78-14.75)	18356 (14060-23353)	2.80 (2.14-3.56)	1335631 (1016929-1723984)	426.56 (325.5-549.72)	657433 (502843-837012)	102.83 (78.53-131.04)
	Pancreatic cancer	5516 (4430-6670)	1.82 (1.47-2.2)	16130 (12563-20380)	2.42 (1.88-3.05)	5163 (4117-6293)	1.71 (1.37-2.09)	14952 (11725-18767)	2.23 (1.75-2.8)	186134 (148305-227692)	60.64 (48.37-74.03)	510739 (400674-641427)	77.35 (60.62-97.16)
	Stomach cancer	52953 (42468-64157)	17.24 (13.85-20.86)	60640 (47197-76580)	9.45 (7.35-11.94)	46685 (37528-56368)	15.29 (12.31-18.44)	35994 (28087-45498)	5.51 (4.30-6.97)	1750712 (1404045-2120016)	560.77 (450.37-677.79)	1296908 (1014007-1637485)	203.67 (159.06-257.22)
	All GI cancers	147429 (110318-183823)	48.16 (36.01-59.98)	214198 (164329-272118)	32.99 (25.30-41.93)	126426 (94239-158017)	41.56 (30.95-51.89)	115299 (88669-146292)	17.53 (13.47-22.25)	4701725 (3519694-5883688)	1512.29 (1130.89-1890.15)	4123391 (3182062-5218871)	641.05 (494.27-811.61)
Male	Colon and rectum cancer	33342 (26831-40539)	9.77 (7.85-11.88)	190675 (146570-243048)	29.16 (22.47-37.08)	21807 (17394-26522)	6.44 (5.13-7.84)	62628 (48259-79637)	9.49 (7.33-12.03)	865472 (693050-1050247)	248.07 (198.45-301.18)	2395280 (1867748-3008970)	371.97 (290.90-465.92)
	Esophageal cancer	61853 (39574-77609)	19.11 (12.25-23.98)	83449 (62294-107873)	12.13 (9.06-15.67)	58183 (36214-72589)	18.00 (11.22-22.45)	71278 (53690-92312)	10.36 (7.81-13.42)	2015511 (1247431-2515787)	617.82 (382.93-771.08)	2409057 (1823793-3117767)	351.64 (266.55-455.06)
	Gallbladder and biliary tract cancer	2912 (2131-4838)	0.87 (0.64-1.46)	7545 (4975-9893)	1.13 (0.75-1.49)	2552 (1903-4239)	0.77 (0.57-1.29)	6176 (4255-8150)	0.92 (0.63-1.21)	95538 (71137-154166)	28.07 (20.94-45.93)	218207 (150468-287046)	33.00 (22.74-43.35)
	Liver cancer	125821 (98064- 158708)	37.17 (28.94-46.91)	100665 (77103-129041)	15.43 (11.84-19.74)	116577 (91020-147041)	34.58 (26.98-43.66)	80984 (61960- 103400)	12.32 (9.44-15.71)	4599231 (3600710-5786258)	1334.42 (1043.34-1680.88)	3078453 (2361884-3917311)	480.20 (368.89-609.84)
	Pancreatic cancer	9431 (7333-11700)	2.84 (2.21-3.52)	31661 (24192-40467)	4.73 (3.62-6.04)	8830 (6903-11074)	2.67 (2.09-3.35)	29421 (22464-37573)	4.39 (3.36-5.60)	324719 (253742-407077)	96.23 (75.17-120.71)	1047505 (801913-1335710)	158.94 (121.96-202.39)
	Stomach cancer	115030 (92556-139124)	35.04 (28.18-42.4)	197678 (152032-253149)	29.58 (22.80-37.79)	100436 (80334-121207)	30.71 (24.55-37.07)	108183 (82801-137765)	16.01 (12.28-20.36)	3596166 (2885420-4333655)	1082.86 (868.18-1305.91)	3811618 (2935329-4823650)	572.22 (441.97-722.54)
	All GI cancers	348390 (266489-432518)	104.8 (80.06-130.16)	611672 (467167-783471)	92.16 (70.54-117.81)	308387 (233768-382672)	93.16 (70.53-115.66)	358671 (273430-458837)	53.49 (40.85-68.33)	11496637 (8751490-14247189)	3407.47 (2589-4225.69)	12960121 (9941135-16490455)	1967.97 (1513.01-2499.1)

GI: Gastrointestinal; UI: Uncertainty interval; ASIR: Age-standardized mortality rate; ASMR: Age-standardized mortality rate; DALYs: Disability-adjusted life-years; ASDR: Age-standardized disability-adjusted life-years rate.

Table 2 Temporal trends in burden of gastrointestinal cancers among working-age population in China 1990-2019

Measure of burden	Gender	Type of GI cancers	AAPC	P value	Trend 1			Trend 2			Trend 3			Trend 4			Trend 5			Trend 6
					Years	APC	P value	Years	APC	P value	Years	APC	P value	Years	APC	P value	Years	APC	P value	Years	APC	P value
ASIR	Overall	Colon and rectum cancer	3.00	< 0.001	1990-1996	-0.02	0.852	1996-2000	2.99	< 0.001	2000-2004	7.64	< 0.001	2014-2010	4.80	< 0.001	2010-2016	1.00	< 0.001	2016-2019	3.57	< 0.001
		Esophageal cancer	-2.08	< 0.001	1990-1997	-1.29	< 0.001	1997-2004	2.40	< 0.001	2004-2007	-4.68	< 0.001	2007-2014	-6.37	< 0.001	2014-2017	-3.22	< 0.001	2017-2019	0.83	0.129
		Gallbladder and biliary tract cancer	0.33	0.137	1990-1995	-2.52	< 0.001	1995-1998	-1.275	0.236	1998-2001	4.62	0.001	2001-2014	7.719	< 0.001	2014-2007	1.45	0.186	2007-2019	-1.17	< 0.001
		Liver cancer	-3.35	< 0.001	1990-1994	2.2	< 0.001	1994-1998	-2.12	< 0.001	1998-2001	-6.75	< 0.001	2001-2005	-17.96	< 0.001	2005-2010	-2.16	< 0.001	2010-2019	1.36	< 0.001
		Pancreatic cancer	1.43	< 0.001	1990-1995	-0.73	< 0.001	1995-1998	1.48	0.06	1998-2004	3.48	< 0.001	2004-2011	1.78	< 0.001	2011-2016	-0.15	0.512	2016-2019	2.85	< 0.001
		Stomach cancer	-1.05	< 0.001	1990-1996	-2.50	< 0.001	1996-1999	-0.03	0.967	1999-2004	4.00	< 0.001	2004-2010	-2.44	< 0.001	2010-2016	-3.34	< 0.001	2016-2019	0.11	0.756
		All GI cancers	-0.74	< 0.001	1990-1993	-0.20	0.558	1993-1998	-1.11	< 0.001	1998-2002	-0.15	0.658	2002-2016	-1.39	< 0.001	2016-2019	1.61	< 0.001	N/A	N/A	N/A
	Female	Colon and rectum cancer	1.77	< 0.001	1990-1996	-0.31	0.037	1996-2001	1.89	< 0.001	2001-2004	4.72	< 0.001	2014-2010	3.03	< 0.001	2010-2016	0.16	0.399	2016-2019	3.67	< 0.001
		Esophageal cancer	-3.63	< 0.001	1990-1998	-1.36	< 0.001	1998-2004	2.40	< 0.001	2004-2008	-8.67	< 0.001	2008-2013	-10.57	< 0.001	2013-2016	-6.15	< 0.001	2016-2019	0.17	0.81
		Gallbladder and biliary tract cancer	-0.26	0.115	1990-1998	-2.61	< 0.001	1998-2001	4.169	< 0.001	2001-2004	7.40	< 0.001	2004-2007	0.13	0.888	2007-2014	-2.31	< 0.001	2014-2019	-0.81	0.001
		Liver cancer	-4.40	< 0.001	1990-1995	0.06	0.826	1995-1998	-3.90	0.006	1998-2001	-7.45	< 0.001	2001-2005	-16.59	< 0.001	2005-2011	-3.56	< 0.001	2011-2019	-0.17	0.223
		Pancreatic cancer	0.96	< 0.001	1990-1995	-0.05	0.811	1995-1998	0.60	0.515	1998-2002	2.27	< 0.001	2002-2007	1.23	0.001	2007-2016	-0.01	0.892	2016-2019	3.83	< 0.001
		Stomach cancer	-2.04	< 0.001	1990-1998	-2.44	< 0.001	1998-2004	1.35	< 0.001	2004-2015	-4.21	< 0.001	2015-2019	-0.19	0.399	N/A	N/A	N/A	N/A	N/A	N/A
		All GI cancers	-1.29	< 0.001	1990-1993	-0.89	0.009	1993-1998	-1.68	< 0.001	1998-2003	-0.40	0.049	2003-2013	-2.54	< 0.001	2013-2016	-1.51	0.023	2016-2019	1.91	< 0.001
	Male	Colon and rectum cancer	3.82	< 0.001	1990-1996	0.17	0.183	1996-2000	4.04	< 0.001	2000-2004	10.27	< 0.001	2014-2011	5.39	< 0.001	2011-2016	0.91	0.002	2016-2019	3.86	< 0.001
		Esophageal cancer	-1.56	< 0.001	1990-1997	-1.12	< 0.001	1997-2004	2.67	< 0.001	2004-2007	-3.35	< 0.001	2007-2014	-5.28	< 0.001	2017-2017	-3.13	< 0.001	2017-2019	0.8	0.211
		Gallbladder and biliary tract cancer	0.90	< 0.001	1990-1995	-2.23	< 0.001	1995-1998	-0.42	0.596	1998-2001	5.48	< 0.001	2001-2005	7.18	< 0.001	2005-2010	0.64	0.021	2010-2019	-0.93	< 0.001
		Liver cancer	-2.99	< 0.001	1990-1994	2.71	< 0.001	1994-1998	-1.76	< 0.001	1998-2001	-6.38	< 0.001	2001-2005	-18.26	< 0.001	2005-2010	-1.55	< 0.001	2010-2019	1.85	< 0.001
		Pancreatic cancer	1.74	< 0.001	1990-1995	-1.19	< 0.001	1995-1999	2.43	< 0.001	1999-2004	4.65	< 0.001	2004-2012	2.32	< 0.001	2011-2016	-0.53	0.23	2016-2019	2.52	< 0.001
		Stomach cancer	-0.60	< 0.001	1990-1996	-2.39	< 0.001	1996-1999	0.43	0.587	1999-2004	5.16	< 0.001	2004-2010	-1.66	< 0.001	2010-2016	-3.12	< 0.001	2016-2019	-0.06	0.884
		All GI cancers	-0.45	< 0.001	1990-1992	0.51	0.45	1992-1998	-0.78	< 0.001	1998-2001	0.12	0.856	2001-2012	-0.84	< 0.001	2012-2016	-1.25	0.002	2016-2019	1.56	< 0.001
ASMR	Overall	Colon and rectum cancer	0.52	< 0.001	1990-1997	-1.22	< 0.001	1997-2000	1.71	0.009	2000-2004	4.69	< 0.001	2004-2011	0.64	< 0.001	2011-2016	-1.56	< 0.001	2016-2019	1.19	0.001
		Esophageal cancer	-2.49	< 0.001	1990-1998	-1.26	< 0.001	1998-2004	2.43	< 0.001	2004-2007	-5.55	< 0.001	2007-2014	-6.80	< 0.001	2014-2017	-3.63	< 0.001	2017-2019	0.02	0.97
		Gallbladder and biliary tract cancer	-0.01	0.951	1990-1995	-2.73	< 0.001	1995-1998	-1.60	0.136	1998-2001	4.44	0.001	2001-2014	7.45	< 0.001	2004-2007	0.93	0.379	2007-2019	-1.57	< 0.001
		Liver cancer	-3.80	< 0.001	1990-1996	1.11	< 0.001	1996-2000	-4.43	< 0.001	2000-2004	-18.45	< 0.001	2004-2007	-5.81	0.001	2007-2012	-2.34	< 0.001	2012-2019	1.51	< 0.001
		Pancreatic cancer	1.38	< 0.001	1990-1995	-0.77	< 0.001	1995-1998	1.41	0.07	1998-2004	3.49	< 0.001	2004-2011	1.71	< 0.001	2011-2016	-0.23	0.325	2016-2019	2.76	< 0.001
		Stomach cancer	-2.66	< 0.001	1990-1997	-3.04		1997-2000	0.72	0.318	2000-2004	2.9		2004-2015	-5.16	< 0.001	2015-2019	-2.91		N/A	N/A	N/A
		All GI cancers	-2.23	< 0.001	1990-1993	-0.63	0.01	1993-2000	-1.46	< 0.001	2000-2004	-2.79	< 0.001	2004-2014	-3.66	< 0.001	2014-2017	-1.48	0.003	2017-2019	-0.12	0.77
	Female	Colon and rectum cancer	-0.72	< 0.001	1990-1997	-1.7	< 0.001	1997-2001	0.13	0.712	2001-2004	1.67	0.037	2004-2011	-0.98	< 0.001	2011-2015	-2.49	< 0.001	2015-2019	0.61	0.018
		Esophageal cancer	-4.72	< 0.001	1990-1998	-2.23	< 0.001	1998-2004	1.53	0.001	2004-2007	-9.83	< 0.001	2007-2013	-11.69	< 0.001	2013-2016	-7	0.001	2016-2019	-1.32	0.122
		Gallbladder and biliary tract cancer	-0.65	< 0.001	1990-1998	-3.00	< 0.001	1998-2001	3.93	0.001	2001-2004	7.26	< 0.001	2004-2007	-0.55	0.545	2007-2014	-2.77	< 0.001	2014-2019	-1.17	< 0.001
		Liver cancer	-4.74	< 0.001	1990-1996	-0.31	0.087	1996-2000	-5.65	< 0.001	2000-2004	-16.99	< 0.001	2004-2007	-6.39	< 0.001	2007-2012	-4.25	< 0.001	2012-2019	0.04	0.771
		Pancreatic cancer	0.91	< 0.001	1990-1997	0.01	0.962	1997-2006	1.81	< 0.001	2006-2016	-0.09	0.381	2016-2019	3.75	< 0.001	N/A	N/A	N/A	N/A	N/A	N/A
		Stomach cancer	-3.48	< 0.001	1990-1998	-3.13	< 0.001	1998-2004	0.39	0.011	2004-2014	-6.42	< 0.001	2014-2019	-2.58	< 0.001	N/A	N/A	N/A	N/A	N/A	N/A
		All GI cancers	-2.93	< 0.001	1990-1993	-1.39	0.001	1993-2004	-2.36	< 0.001	2004-2013	-5.21	< 0.001	2013-2016	-2.31	0.003	2016-2019	-0.25	0.455	N/A	N/A	N/A
	Male	Colon and rectum cancer	1.32	< 0.001	1990-1996	-0.99	< 0.001	1996-1999	1.23	0.036	1999-2004	6.53	< 0.001	2004-2011	1.66	< 0.001	2011-2016	-1.25	< 0.001	2016-2019	1.15	0.001
		Esophageal cancer	-1.89	< 0.001	1990-1997	-1.23	< 0.001	1997-2004	2.42	< 0.001	2004-2007	-3.86	< 0.001	2007-2014	-5.73	< 0.001	2014-2017	-3.49	< 0.001	2017-2019	0.14	0.819
		Gallbladder and biliary tract cancer	0.61	< 0.001	1990-1995	-2.31	< 0.001	1995-1998	-0.60	0.449	1998-2001	5.31	< 0.001	2001-2005	6.8	< 0.001	2005-2010	0.25	0.325	2010-2019	-1.33	< 0.001
		Liver cancer	-3.47	< 0.001	1990-1996	1.66	< 0.001	1996-2000	-4.57	< 0.001	2000-2005	-17.1	< 0.001	2005-2012	-1.84	< 0.001	2012-2019	1.92	< 0.001	N/A	N/A	N/A
		Pancreatic cancer	1.69	< 0.001	1990-1995	-1.21	< 0.001	1995-1999	2.41	< 0.001	1999-2004	4.63	< 0.001	2004-2012	2.25	< 0.001	2012-2016	-0.61	0.164	2016-2019	2.43	< 0.001
		Stomach cancer	-2.26	< 0.001	1990-1996	-3.02	< 0.001	1996-1999	-0.43	0.652	1999-2004	3.6	< 0.001	2004-2008	-4.01	< 0.001	2008-2015	-4.97	< 0.001	2015-2019	-3.02	< 0.001
		All GI cancers	-1.92	< 0.001	1990-1993	-0.34	0.436	1993-2000	-1.01	< 0.001	2000-2015	-2.96	< 0.001	2015-2019	-0.75	0.011	N/A	N/A	N/A	N/A	N/A	N/A
ASDR	Overall	Colon and rectum cancer	0.59	< 0.001	1990-1997	-0.99	< 0.001	1997-2000	1.71	0.002	2000-2004	4.09	< 0.001	2004-2011	0.67	< 0.001	2011-2016	-1.29	< 0.001	2016-2019	1.55	< 0.001
		Esophageal cancer	-2.53	< 0.001	1990-1997	-1.43	< 0.001	1997-2004	1.99	< 0.001	2004-2007	-5.58	< 0.001	2007-2014	-6.98	< 0.001	2014-2017	-3.48	< 0.001	2017-2019	0.21	0.71
		Gallbladder and biliary tract cancer	-0.02	0.895	1990-1998	-2.23	< 0.001	1998-2001	4.58	< 0.001	2001-2004	6.58	< 0.001	2004-2007	0.98	0.167	2007-2015	-1.74	< 0.001	2015-2019	-0.97	< 0.001
		Liver cancer	-3.77	< 0.001	1990-1996	1.17	< 0.001	1996-2000	-4.55	< 0.001	2000-2004	-18.41	< 0.001	2004-2007	-5.82	0.001	2007-2012	-2.31	< 0.001	2012-2019	1.6	< 0.001
		Pancreatic cancer	1.37	< 0.001	1990-1995	-0.72	0.001	1995-1998	1.67	0.044	1998-2004	3.27	< 0.001	2004-2011	1.63	< 0.001	2011-2016	-0.17	0.477	2016-2019	2.88	< 0.001
		Stomach cancer	-2.61	< 0.001	1990-1997	-2.89	< 0.001	1997-2000	0.89	0.15	2000-2004	2.51	< 0.001	2004-2015	-5.17	< 0.001	2015-2019	-2.56	< 0.001	N/A	N/A	N/A
		All GI cancers	-2.22	< 0.001	1990-1994	-0.66	0.002	1994-2000	-1.46	< 0.001	2000-2005	-3.33	< 0.001	2005-2013	-3.70	< 0.001	2013-2016	-1.97	0.002	2016-2019	-0.17	0.535
	Female	Colon and rectum cancer	-0.68	< 0.001	1990-1996	-1.22	< 0.001	1996-2005	-0.08	0.108	2005-2011	-0.98	< 0.001	2011-2015	-2.21	< 0.001	2015-2019	0.78	< 0.001	N/A	N/A	N/A
		Esophageal cancer	-4.70	< 0.001	1990-1998	-1.80	< 0.001	1998-2004	1.19	0.001	2004-2007	-10.13	< 0.001	2007-2013	-11.76	< 0.001	2013-2016	-6.92	< 0.001	2016-2019	-1.2	0.081
		Gallbladder and biliary tract cancer	-0.73	< 0.001	1990-1998	-2.59	< 0.001	1998-2001	3.49	< 0.001	2001-2004	5.87	< 0.001	2004-2007	-0.74	0.308	2007-2014	-2.8	< 0.001	2014-2019	-1.12	< 0.001
		Liver cancer	-4.77	< 0.001	1990-1996	0.19	0.214	1996-2000	-5.50	< 0.001	2000-2004	-17.77	< 0.001	2004-2007	-6.54	< 0.001	2007-2012	-4.27	< 0.001	2012-2019	0.03	0.83
		Pancreatic cancer	0.85	< 0.001	1990-1997	0.27	0.042	1997-2001	1.91	0.001	2001-2007	0.84	0.001	2007-2016	-0.11	0.28	2016-2019	3.73	< 0.001	N/A	N/A	N/A
		Stomach cancer	-3.44	< 0.001	1990-1997	-2.79	< 0.001	1997-2004	-0.59	< 0.001	2004-2014	-6.31	< 0.001	2014-2019	-2.41	< 0.001	N/A	N/A	N/A	N/A	N/A	N/A
		All GI cancers	-2.91	< 0.001	1990-1994	-1.31	< 0.001	1994-2000	-1.92	< 0.001	2000-2004	-3.77	< 0.001	2004-2013	-5.03	< 0.001	2013-2016	-2.18	0.001	2016-2019	-0.13	0.601
	Male	Colon and rectum cancer	1.38	< 0.001	1990-1996	-1.03	< 0.001	1996-1999	1.18	0.053	1999-2004	6.46	< 0.001	2004-2011	1.64	< 0.001	2011-2016	-0.99	< 0.001	2016-2019	1.59	< 0.001
		Esophageal cancer	-1.93	< 0.001	1990-1997	-1.18	< 0.001	1997-2004	2.45	< 0.001	2004-2007	-4.15	< 0.001	2007-2014	-5.95	< 0.001	2014-2017	-3.34	< 0.001	2017-2019	0.35	0.572
		Gallbladder and biliary tract cancer	0.53	< 0.001	1990-1995	-2.49	< 0.001	1995-1998	-0.82	0.304	1998-2001	4.94	< 0.001	2001-2004	7.62	< 0.001	2004-2008	1.66	0.001	2008-2019	-1.13	< 0.001
		Liver cancer	-3.44	< 0.001	1990-1996	1.59	< 0.001	1996-2000	-4.74	< 0.001	2000-2005	-16.87	< 0.001	2005-2012	-1.84	< 0.001	2012-2019	2.00	< 0.001	N/A	N/A	N/A
		Pancreatic cancer	1.71	< 0.001	1990-1995	-1.25	< 0.001	1995-1999	2.47	< 0.001	1999-2004	4.66	< 0.001	2004-2012	2.17	< 0.001	2012-2016	-0.49	< 0.001	2016-2019	2.63	< 0.001
		Stomach cancer	-2.21	< 0.001	1990-1996	-3.03	< 0.001	1996-1999	-0.26	0.751	1999-2004	3.67	< 0.001	2004-2008	-4.17	< 0.001	2008-2015	-4.99	< 0.001	2015-2019	-2.66	< 0.001
		All GI cancers	-1.91	< 0.001	1990-1993	-0.15	0.699	1993-2000	-1.13	< 0.001	2000-2014	-3.07	< 0.001	2004-2019	-0.79	< 0.001	N/A	N/A	N/A	N/A	N/A	N/A

GI: Gastrointestinal; AAPC: Average annual percent change; APC: Annual percent change; ASIR: Age-standardized incidence rate; ASMR: Age-standardized mortality rate; ASDR: Age-standardized disability-adjusted life-year rate; N/A: Not applicable.

Table 3 Temporal trends in burden of gastrointestinal cancers by age group among working-age population in China 1990-2019

Age-group	Gender	Type of GI cancers	CIR			CMR			CDR
			AAPC	95%UI	P value	AAPC	95%UI	P value	AAPC	95%UI	P value
15-19 years	Overall	Colon and rectum cancer	0.75	0.51 to 1.00	< 0.001	-1.58	-1.87 to -1.30	< 0.001	-1.55	-1.85 to -1.25	< 0.001
		Esophageal cancer	NA	NA	NA	NA	NA	NA	NA	NA	NA
		Gallbladder and biliary tract cancer	NA	NA	NA	NA	NA	NA	NA	NA	NA
		Liver cancer	-4.06	-4.47 to -3.65	< 0.001	-4.55	-5.17 to -3.92	< 0.001	-4.55	-5.16 to -3.93	< 0.001
		Pancreatic cancer	-0.14	-0.40 to 0.13	0.31	-0.25	-0.51 to 0.01	0.06	-0.26	-0.51 to 0.00	0.051
		Stomach cancer	-0.64	-0.88 to -0.41	< 0.001	-2.95	-3.16 to -2.73	< 0.001	-2.92	-3.13 to -2.70	< 0.001
		All GI cancers	-1.03	-1.19 to -0.86	< 0.001	-3.05	-3.30 to -2.81	< 0.001	-3.01	-3.26 to -2.77	< 0.001
	Female	Colon and rectum cancer	0.58	0.27 to 0.90	< 0.001	-1.85	-2.05 to -1.65	< 0.001	-1.81	-2.13 to -1.49	< 0.001
		Esophageal cancer	NA	NA	NA	NA	NA	NA	NA	NA	NA
		Gallbladder and biliary tract cancer	NA	NA	NA	NA	NA	NA	NA	NA	NA
		Liver cancer	-4.15	-4.45 to -3.86	< 0.001	-4.77	-5.08 to -4.46	< 0.001	-4.77	-5.07 to -4.46	< 0.001
		Pancreatic cancer	-0.62	-0.97 to -0.27	< 0.001	-0.77	-1.11 to -0.44	< 0.001	-0.78	-1.12 to -0.43	< 0.001
		Stomach cancer	-1.38	-1.84 to -0.91	< 0.001	-3.38	-3.65 to -3.11	< 0.001	-3.35	-3.63 to -3.08	< 0.001
		All GI cancers	-1.18	-1.44 to -0.92	< 0.001	-3.19	-3.46 to -2.91	< 0.001	-3.15	-3.43 to -2.87	< 0.001
	Male	Colon and rectum cancer	0.94	0.49 to 1.39	< 0.001	-1.48	-1.82 to -1.15	< 0.001	-1.51	-1.95 to -1.07	< 0.001
		Esophageal cancer	NA	NA	NA	NA	NA	NA	NA	NA	NA
		Gallbladder and biliary tract cancer	NA	NA	NA	NA	NA	NA	NA	NA	NA
		Liver cancer	-4.09	-4.57 to -3.62	< 0.001	-4.55	-5.27 to -3.83	< 0.001	-4.55	-5.26 to -3.84	< 0.001
		Pancreatic cancer	0.04	-0.31 to 0.39	0.834	-0.07	-0.43 to 0.29	0.697	-0.08	-0.43 to 0.28	0.665
		Stomach cancer	-0.29	-0.54 to -0.04	< 0.05	-2.67	-2.96 to -2.39	< 0.001	-2.64	-2.92 to -2.35	< 0.001
		All GI cancers	-1.00	-1.31 to -0.68	< 0.001	-3.03	-3.29 to -2.77	< 0.001	-2.99	-3.25 to -2.73	< 0.001
20-24 years	Overall	Colon and rectum cancer	2.36	1.73 to 2.99	< 0.001	-0.22	-0.57 to 0.13	0.213	-0.15	-0.49 to 0.20	0.403
		Esophageal cancer	-0.85	-1.66 to -0.04	0.041	-1.85	-2.47 to -1.21	< 0.001	-1.83	-2.46 to -1.20	< 0.001
		Gallbladder and biliary tract cancer	-0.67	-1.28 to -0.05	0.035	-1.4	-1.99 to -0.82	< 0.001	-1.40	-1.98 to -0.81	< 0.001
		Liver cancer	-2.64	-2.95 to -2.32	< 0.001	-3.2	-4.05 to -2.34	< 0.001	-3.20	-4.04 to -2.34	< 0.001
		Pancreatic cancer	0.59	-0.11 to 1.29	0.097	0.48	-0.21 to -1.17	0.17	0.48	-0.20 to 1.17	0.17
		Stomach cancer	0.55	-0.26 to 1.36	0.183	-1.62	-2.44 to -0.79	< 0.001	-1.59	-2.40 to -0.76	< 0.001
		All GI cancers	0.22	-0.38 to 0.82	0.472	-1.79	-2.19 to -1.39	< 0.001	-1.75	-2.15 to -1.35	< 0.001
	Female	Colon and rectum cancer	1.92	1.41 to 2.44	< 0.001	-0.68	-1.54 to 0.19	0.126	-0.60	-1.46 to 0.26	0.173
		Esophageal cancer	-1.08	-2.05 to -0.11	0.029	-3.08	-3.77 to -2.38	< 0.001	-3.04	-3.73 to -2.34	< 0.001
		Gallbladder and biliary tract cancer	-0.87	-1.60 to -0.14	0.019	-1.77	-2.58 to -0.95	< 0.001	-1.76	-2.57 to -0.95	< 0.001
		Liver cancer	-3.25	-3.51 to -3.00	< 0.001	-3.71	-4.97 to -2.44	< 0.001	-3.71	-4.94 to -2.46	< 0.001
		Pancreatic cancer	-0.15	-0.80 to 0.50	0.653	-0.14	-0.80 to 0.52	0.675	-0.14	-0.79 to 0.52	0.675
		Stomach cancer	-0.32	-1.25 to 0.62	0.5	-2.32	-3.25 to -1.38	< 0.001	-2.29	-3.21 to -1.35	< 0.001
		All GI cancers	-0.23	-0.63 to 0.17	0.263	-2.37	-3.45 to -1.29	< 0.001	-2.33	-3.40 to -1.25	< 0.001
	Male	Colon and rectum cancer	2.56	1.89 to 3.23	< 0.001	-0.02	-0.27 to 0.24	0.884	0.07	-0.19 to 0.32	0.612
		Esophageal cancer	-0.79	-1.38 to -0.19	0.01	-1.31	-1.85 to -0.77	< 0.001	-1.31	-1.85 to -0.76	< 0.001
		Gallbladder and biliary tract cancer	-0.56	-1.23 to 0.10	0.097	-1.18	-1.83 to -0.53	< 0.001	-1.18	-1.83 to -0.52	< 0.001
		Liver cancer	-2.47	-2.71 to -2.22	< 0.001	-2.99	-3.45 to -2.53	< 0.001	-2.99	-3.45 to -2.54	< 0.001
		Pancreatic cancer	0.99	0.41 to 1.57	< 0.001	0.89	0.32 to 1.46	0.002	0.89	0.32 to 1.46	0.002
		Stomach cancer	1.13	0.38 to 1.89	0.003	-1.33	-1.95 to -0.71	< 0.001	-1.30	-1.92 to -0.67	< 0.001
		All GI cancers	0.38	-0.15 to 0.91	0.156	-1.63	-2.16 to -1.11	< 0.001	-1.60	-2.12 to -1.07	< 0.001
25-29 years	Overall	Colon and rectum cancer	2.77	2.04 to 3.50	< 0.001	0.30	-0.28 to 0.87	0.31	0.37	-0.19 to 0.95	0.198
		Esophageal cancer	-1.12	-2.35 to 0.13	0.078	-2.09	-3.20 to -0.96	< 0.001	-2.07	-3.19 to -0.95	< 0.001
		Gallbladder and biliary tract cancer	-0.53	-1.72 to 0.68	0.387	-1.26	-2.46 to -0.04	0.043	-1.25	-2.45 to -0.04	0.043
		Liver cancer	-2.40	-2.70 to -2.09	< 0.001	-2.95	-3.76 to -2.13	< 0.001	-2.94	-3.75 to -2.13	< 0.001
		Pancreatic cancer	0.84	-0.03 to 0.71	0.057	0.74	-0.11 to 1.60	0.089	0.74	-0.11 to 1.60	0.089
		Stomach cancer	0.55	-0.31 to 1.41	0.212	-1.75	-2.80 to -0.69	0.001	-1.71	-2.76 to -0.65	0.002
		All GI cancers	0.4	-0.32 to 1.12	0.278	-1.54	-2.14 to -0.94	< 0.001	-1.50	-2.10 to -0.90	< 0.001
	Female	Colon and rectum cancer	1.55	0.42 to 2.70	0.007	-0.72	-1.68 to 0.25	0.147	-0.65	-1.60 to 0.32	0.187
		Esophageal cancer	-1.67	-4.28 to 1.01	0.22	-3.62	-5.88 to -1.31	< 0.001	-3.58	-5.84 to -1.27	0.003
		Gallbladder and biliary tract cancer	-1.24	-2.94 to 0.49	0.159	-2.04	-4.36 to 0.33	0.091	-2.03	-4.35 to 0.34	0.093
		Liver cancer	-3.76	-4.08 to -3.43	< 0.001	-4.57	-5.94 to -3.18	< 0.001	-4.56	-5.93 to -3.17	< 0.001
		Pancreatic cancer	-0.02	-1.05 to 1.03	0.976	-0.18	-1.20 to 0.86	0.738	-0.17	-1.20 to 0.86	0.738
		Stomach cancer	-0.54	-2.30 to 1.26	0.555	-2.59	-4.44 to -0.71	0.007	-2.56	-4.41 to -0.68	0.008
		All GI cancers	-0.3	-1.22 to 0.63	0.525	-2.43	-4.15 to -0.67	0.007	-2.38	-4.11 to -0.63	0.007
	Male	Colon and rectum cancer	3.52	2.75 to 4.29	< 0.001	0.91	0.27 to 1.55	0.005	0.98	0.35 to 1.62	0.002
		Esophageal cancer	-1.00	-1.34 to -0.62	< 0.001	-1.55	-1.97 to -1.13	< 0.001	-1.55	-1.96 to -1.13	< 0.001
		Gallbladder and biliary tract cancer	-0.02	-0.77 to 0.73	0.96	-0.65	-1.37 to 0.07	0.076	-0.65	-1.37 to 0.07	0.078
		Liver cancer	-1.99	-2.30 to -1.67	< 0.001	-2.61	-2.61 to -2.82	< 0.001	-2.6	-2.81 to -2.39	< 0.001
		Pancreatic cancer	1.52	1.08 to 1.96	< 0.001	1.44	1.01 to 1.87	< 0.001	1.44	1.01 to 1.86	< 0.001
		Stomach cancer	1.44	0.90 to 2.00	< 0.001	-0.94	-1.35 to -0.52	< 0.001	-0.89	-1.30 to -0.48	< 0.001
		All GI cancers	0.85	0.56 to 1.13	< 0.001	-1.18	-1.46 to -0.90	< 0.001	-1.14	-1.41 to -0.86	< 0.001
30-34 years	Overall	Colon and rectum cancer	2.90	2.13 to 3.67	< 0.001	0.43	-0.42 to 1.28	0.324	0.50	-0.34 to 1.35	0.247
		Esophageal cancer	-0.95	-1.57 to -0.33	0.003	-1.74	-2.87 to -0.60	0.003	-1.73	-2.86 to -0.59	0.003
		Gallbladder and biliary tract cancer	-0.14	-0.96 to 0.69	0.737	-0.84	-1.64 to -0.04	0.038	-0.84	-1.63 to -0.04	0.041
		Liver cancer	-2.54	-2.75 to -2.34	< 0.001	-3.06	-3.76 to -2.36	< 0.001	-3.06	-3.75 to -2.36	< 0.001
		Pancreatic cancer	1.39	0.86 to 1.92	< 0.001	1.29	0.78 to 1.81	< 0.001	1.29	0.78 to 1.81	< 0.001
		Stomach cancer	0.37	-0.57 to 1.32	0.443	-2.02	-3.18 to -0.84	0.001	-1.98	-3.14 to -0.80	0.001
		All GI cancers	0.24	-0.46 to 0.94	0.508	-1.71	-2.59 to -0.82	< 0.001	-1.67	-2.56 to -0.78	< 0.001
	Female	Colon and rectum cancer	1.36	0.28 to 2.46	0.013	-1.28	-2.63 to 0.08	0.064	-1.21	-2.56 to 0.16	0.082
		Esophageal cancer	-1.93	-3.57 to -0.26	0.023	-3.87	-5.22 to -2.51	< 0.001	-3.84	-5.20 to -2.47	< 0.001
		Gallbladder and biliary tract cancer	-0.78	-1.96 to 0.41	0.197	-1.72	-2.84 to -0.58	0.003	-1.71	-2.84 to -0.57	0.003
		Liver cancer	-4.05	-4.34 to -3.76	< 0.001	-4.69	-5.73 to -3.63	< 0.001	-4.83	-6.60 to -3.04	< 0.001
		Pancreatic cancer	0.26	-1.31 to 1.85	0.751	0.11	-1.47 to 1.70	0.897	0.11	-1.48 to 1.72	0.896
		Stomach cancer	-0.97	-2.63 to 0.73	0.261	-3.18	-4.63 to -1.71	< 0.001	-3.15	-4.60 to -1.67	< 0.001
		All GI cancers	-0.65	-1.31 to 0.01	0.052	-2.89	-4.52 to -1.22	0.001	-2.86	-4.26 to -1.44	< 0.001
	Male	Colon and rectum cancer	3.88	2.99 to 4.78	< 0.001	1.25	0.63 to 1.87	< 0.001	1.32	0.70 to 1.94	< 0.001
		Esophageal cancer	-0.8	-1.52 to -0.08	0.029	-1.39	-2.39 to -0.38	0.007	-1.39	-2.38 to -0.38	0.007
		Gallbladder and biliary tract cancer	0.33	-0.59 to 1.26	0.485	-0.31	-1.20 to 0.59	0.494	-0.31	-1.20 to 0.59	0.502
		Liver cancer	-2.16	-2.39 to -1.94	< 0.001	-2.73	-3.31 to -2.14	< 0.001	-2.72	-3.30 to -2.14	< 0.001
		Pancreatic cancer	2.00	1.38 to 2.62	< 0.001	1.92	1.31 to 2.53	< 0.001	1.92	1.31 to 2.53	< 0.001
		Stomach cancer	1.27	0.50 to 2.05	0.001	-1.19	-1.79 to -0.59	< 0.001	-1.15	-1.75 to -0.54	< 0.001
		All GI cancers	0.65	0.14 to 1.16	0.013	-1.32	-2.01 to -0.61	< 0.001	-1.28	-1.97 to -0.58	< 0.001
35-39 years	Overall	Colon and rectum cancer	3.27	2.73 to 3.81	< 0.001	0.55	0.25 to 0.85	< 0.001	0.64	0.34 to 0.93	< 0.001
		Esophageal cancer	-1.73	-2.86 to -0.59	0.003	-2.23	-2.57 to -1.88	< 0.001	-2.22	-2.55 to -1.88	< 0.001
		Gallbladder and biliary tract cancer	-0.84	-1.63-0.04	0.041	-0.63	-0.93 to -0.32	< 0.001	-0.62	-0.92 to -0.31	< 0.001
		Liver cancer	-3.06	-3.75 to -2.36	< 0.001	-3.57	-3.95 to -3.18	< 0.001	-3.56	-3.94 to -3.18	< 0.001
		Pancreatic cancer	1.57	1.23 to 1.92	< 0.001	1.47	1.11 to 1.83	< 0.001	1.47	1.12 to 1.83	< 0.001
		Stomach cancer	-0.19	-0.56 to 0.19	0.332	-2.26	-2.47 to -2.04	< 0.001	-2.22	-2.44 to -2.01	< 0.001
		All GI cancers	-1.67	-2.56 to -0.78	< 0.001	-2.1	-2.36 to -1.83	< 0.001	-2.06	-2.42 to -1.69	< 0.001
	Female	Colon and rectum cancer	1.54	1.27 to 1.82	< 0.001	-1.12	-1.40 to -0.84	< 0.001	-1.04	-1.32 to -0.76	< 0.001
		Esophageal cancer	-3.84	-5.20 to -2.47	< 0.001	-4.16	-4.58 to -3.74	< 0.001	-4.13	-4.56 to -3.70	< 0.001
		Gallbladder and biliary tract cancer	-1.71	-2.84 to -0.57	0.003	-1.67	-2.13 to -1.20	< 0.001	-1.66	-2.14 to -1.18	< 0.001
		Liver cancer	-4.83	-6.60 to -3.04	< 0.001	-5.10	-5.41 to -4.79	< 0.001	-5.07	-5.41 to -4.73	< 0.001
		Pancreatic cancer	0.47	0.23 to 0.71	< 0.001	0.32	0.08 to 0.55	0.008	0.32	0.08 to 0.55	0.008
		Stomach cancer	-1.51	-1.94 to -1.08	< 0.001	-3.37	-3.80 to -2.93	< 0.001	-3.34	-3.79 to -2.89	< 0.001
		All GI cancers	-2.86	-4.26 to -1.44	< 0.001	-3.07	-3.35 to -2.78	< 0.001	-3.03	-3.31 to -2.74	< 0.001
	Male	Colon and rectum cancer	4.29	3.72 to 4.87	< 0.001	1.42	0.83 to 2.01	< 0.001	1.51	0.93 to 2.10	< 0.001
		Esophageal cancer	-1.39	-2.38 to -0.38	0.007	-1.84	-2.29 to -1.39	< 0.001	-1.84	-2.28 to -1.39	< 0.001
		Gallbladder and biliary tract cancer	-0.31	-1.20 to 0.59	0.502	-0.01	-0.41 to 0.40	0.98	0.00	-0.40 to 0.41	0.992
		Liver cancer	-2.72	-3.30 to -2.14	< 0.001	-3.26	-3.80 to -2.70	< 0.001	-3.25	-3.80 to -2.70	< 0.001
		Pancreatic cancer	1.98	1.42 to 2.55	< 0.001	1.89	1.33 to 2.45	< 0.001	1.89	1.33 to 2.45	< 0.001
		Stomach cancer	0.61	0.12 to 1.09	0.014	-1.54	-1.94 to -1.14	< 0.001	-1.51	-1.91 to -1.11	< 0.001
		All GI cancers	-1.28	-1.97 to -0.58	< 0.001	-1.73	-2.08 to -1.39	< 0.001	-1.70	-2.04 to -1.35	< 0.001
40-44 years	Overall	Colon and rectum cancer	3.39	3.06 to 3.72	< 0.001	0.61	0.24 to 0.97	0.001	0.70	0.34 to 1.06	< 0.001
		Esophageal cancer	-2.47	-2.89 to -2.05	< 0.001	-3.07	-3.47 to -2.68	< 0.001	-3.06	-3.46 to -2.66	< 0.001
		Gallbladder and biliary tract cancer	0.52	0.19 to 0.85	0.002	-0.21	-0.48 to 0.06	0.122	-0.21	-0.48 to 0.07	0.141
		Liver cancer	-2.98	-3.23 to -2.74	< 0.001	-3.66	-4.08 to -3.24	< 0.001	-3.65	-4.07 to -3.23	< 0.001
		Pancreatic cancer	2.15	1.91 to 2.40	< 0.001	2.05	1.81 to 2.29	< 0.001	2.05	1.81 to 2.29	< 0.001
		Stomach cancer	-0.42	-0.82 to -0.01	0.042	-2.59	-2.97 to -2.21	< 0.001	-2.56	-2.94 to -2.18	< 0.001
		All GI cancers	-0.47	-0.94 to 0.01	0.057	-2.37	-2.71 to -2.03	< 0.001	-2.33	-2.68 to -1.98	< 0.001
	Female	Colon and rectum cancer	1.66	1.30 to 2.02	< 0.001	-1.02	-1.31 to -0.72	< 0.001	-0.93	-1.23 to -0.63	< 0.001
		Esophageal cancer	-3.26	-3.66 to -2.86	< 0.001	-5.02	-5.56 to -4.49	< 0.001	-5.01	-5.45 to -4.56	< 0.001
		Gallbladder and biliary tract cancer	-0.45	-0.60 to -0.30	< 0.001	-1.34	-1.55 to -1.13	< 0.001	-1.33	-1.55 to -1.12	< 0.001
		Liver cancer	-4.54	-4.81 to -4.26	< 0.001	-5.20	-5.56 to -4.84	< 0.001	-5.20	-5.56 to -4.84	< 0.001
		Pancreatic cancer	1.05	0.56 to 1.55	< 0.001	0.89	0.38 to 1.41	0.001	0.89	0.38 to 1.40	0.001
		Stomach cancer	-1.63	-1.91 to -1.35	< 0.001	-3.63	-3.89 to -3.37	< 0.001	-3.61	-3.86 to -3.35	< 0.001
		All GI cancers	-1.12	-1.34 to -0.89	< 0.001	-3.26	-3.75 to -2.77	< 0.001	-3.22	-3.70 to -2.73	< 0.001
	Male	Colon and rectum cancer	4.46	4.03 to 4.88	< 0.001	1.63	1.15 to 2.11	< 0.001	1.72	1.25 to 2.20	< 0.001
		Esophageal cancer	-2.24	-2.70 to -1.77	< 0.001	-2.71	-3.15 to -2.26	< 0.001	-2.70	-3.14 to -2.25	< 0.001
		Gallbladder and biliary tract cancer	1.15	0.94 to 1.36	< 0.001	0.53	0.34 to 0.73	< 0.001	0.54	0.35 to 0.77	< 0.001
		Liver cancer	-2.62	-2.89 to -2.35	< 0.001	-3.26	-3.43 to -2.79	< 0.001	-3.26	-3.72 to -2.78	< 0.001
		Pancreatic cancer	2.63	2.34 to 2.91	< 0.001	2.53	2.25 to 2.82	< 0.001	2.54	2.25 to 2.82	< 0.001
		Stomach cancer	0.07	-0.30 to 0.44	0.702	-2.04	-2.51 to -1.57	< 0.001	-2.01	-2.48 to -1.53	< 0.001
		All GI cancers	-0.18	-0.68 to 0.33	0.488	-2.03	-2.40 to -1.67	< 0.001	-2.00	-2.37 to -1.63	< 0.001
45-49 years	Overall	Colon and rectum cancer	2.96	2.43 to 3.49	< 0.001	0.54	0.14 to 0.94	0.008	0.63	0.23 to 1.02	0.002
		Esophageal cancer	-2.14	-2.91 to -1.37	< 0.001	-2.82	-3.50 to -2.13	< 0.001	-2.81	-3.49 to -2.12	< 0.001
		Gallbladder and biliary tract cancer	0.10	-0.25 to 0.45	0.591	-0.25	-0.60 to 0.11	0.174	-0.24	-0.60 to 0.11	0.182
		Liver cancer	-3.43	-3.88 to -2.97	< 0.001	-3.93	-4.77 to -3.08	< 0.001	-3.92	-4.76 to -3.08	< 0.001
		Pancreatic cancer	1.61	1.34 to 1.88	< 0.001	1.54	1.27 to 1.82	< 0.001	1.55	1.27 to 1.82	< 0.001
		Stomach cancer	-1.04	-1.61 to -0.46	< 0.001	-2.87	-3.62 to -2.11	< 0.001	-2.84	-3.59 to -2.08	< 0.001
		All GI cancers	-0.93	-1.22 to -0.65	< 0.001	-2.51	-2.96 to -2.05	< 0.001	-2.47	-2.93 to -2.02	< 0.001
	Female	Colon and rectum cancer	1.76	1.01 to 2.51	< 0.001	-0.75	-1.40 to -0.09	0.025	-0.66	-1.32 to -0.01	0.047
		Esophageal cancer	-3.07	-3.64 to -2.50	< 0.001	-4.72	-5.18 to -4.26	< 0.001	-4.69	-5.15 to -4.22	< 0.001
		Gallbladder and biliary tract cancer	-0.58	-1.48 to 0.33	0.211	-1.01	-1.92 to -0.10	0.03	-1.01	-1.92 to -0.09	< 0.05
		Liver cancer	-4.72	-4.92 to -4.51	< 0.001	-5.02	-6.14 to -3.89	< 0.001	-5.02	-6.13 to -3.90	< 0.001
		Pancreatic cancer	0.88	0.06 to 1.71	0.035	0.79	-0.04 to 1.61	0.061	0.79	-0.04 to 1.62	0.061
		Stomach cancer	-1.98	-3.07 to -0.89	< 0.001	-3.56	-4.61 to -2.50	< 0.001	-3.53	-4.59 to -2.47	< 0.001
		All GI cancers	-1.4	-2.26 to -0.54	0.001	-3.04	-3.76 to -2.32	< 0.001	-3.00	-3.72 to -2.28	< 0.001
	Male	Colon and rectum cancer	3.66	2.87 to 4.45	< 0.001	1.14	0.62 to 1.67	< 0.001	1.23	0.71 to 1.75	< 0.001
		Esophageal cancer	-1.91	-2.30 to -1.51	< 0.001	-2.39	-2.80 to -1.97	< 0.001	-2.38	-2.79 to -1.97	< 0.001
		Gallbladder and biliary tract cancer	0.6	0.30 to 0.89	< 0.001	0.31	0.02 to 0.61	0.037	0.32	0.02 to 0.61	0.035
		Liver cancer	-3.14	-3.56 to -2.71	< 0.001	-3.63	-4.16 to -3.09	< 0.001	-3.62	-4.15 to -3.09	< 0.001
		Pancreatic cancer	2.06	1.52 to 2.59	< 0.001	1.91	1.32 to 2.52	< 0.001	1.92	1.32 to 2.52	< 0.001
		Stomach cancer	-0.69	-1.33 to -0.04	0.038	-2.46	-3.11 to -1.81	< 0.001	-2.43	-3.08 to -1.78	< 0.001
		All GI cancers	-0.7	-1.03 to -0.36	< 0.001	-2.26	-2.73 to -1.79	< 0.001	-2.23	-2.70 to -1.76	< 0.001
50-54 years	Overall	Colon and rectum cancer	2.92	2.65 to 3.20	< 0.001	0.45	0.22 to 0.67	< 0.001	0.54	0.32 to 0.75	< 0.001
		Esophageal cancer	-2.18	-2.47 to -1.88	< 0.001	-2.61	-2.90 to -2.32	< 0.001	-2.60	-2.89 to -2.31	< 0.001
		Gallbladder and biliary tract cancer	0.21	-0.04 to 0.45	0.094	-0.04	-0.28 to 0.20	0.734	-0.04	-0.27 to 0.20	0.752
		Liver cancer	-3.70	-4.01 to -3.39	< 0.001	-4.10	-4.38 to -3.82	< 0.001	-4.10	-4.38 to -3.82	< 0.001
		Pancreatic cancer	1.03	0.71 to 1.36	< 0.001	0.98	0.66 to 1.30	< 0.001	0.98	0.67 to 1.30	< 0.001
		Stomach cancer	-1.40	-1.74 to -1.09	< 0.001	-2.92	-3.20 to -2.64	< 0.001	-2.89	-3.17 to -2.61	< 0.001
		All GI cancers	-1.07	-1.29 to -0.86	< 0.001	-2.54	-2.73 to -2.35	< 0.001	-2.51	-2.70 to -2.32	< 0.001
	Female	Colon and rectum cancer	1.48	1.22 to 1.73	< 0.001	-1.01	-1.45 to -0.58	< 0.001	-0.92	-1.33 to -0.50	< 0.001
		Esophageal cancer	-3.93	-4.36 to -3.49	< 0.001	-5.18	-5.72 to -4.63	< 0.001	-5.15	-5.70 to -4.60	< 0.001
		Gallbladder and biliary tract cancer	-0.60	-1.27 to 0.08	0.084	-0.92	-1.57 to -0.25	0.007	-0.91	-1.57 to -0.25	0.007
		Liver cancer	-4.68	-4.87 to -4.48	< 0.001	-5.00	-5.44 to -4.56	< 0.001	-5.00	-5.42 to -4.57	< 0.001
		Pancreatic cancer	0.63	0.23 to 1.04	0.002	0.57	0.16 to 0.98	0.006	0.57	0.18 to 0.97	0.005
		Stomach cancer	-2.39	-2.67 to -2.10	< 0.001	-3.71	-3.96 to -3.46	< 0.001	-3.69	-3.93 to -3.45	< 0.001
		All GI cancers	-1.58	-1.83 to -1.32	< 0.001	-3.21	-3.56 to -2.87	< 0.001	-3.18	-3.51 to -2.85	< 0.001
	Male	Colon and rectum cancer	3.93	3.65 to 4.21	< 0.001	1.47	1.21 to 1.73	< 0.001	1.52	1.14 to 1.89	< 0.001
		Esophageal cancer	-1.61	-1.85 to -1.36	< 0.001	-1.99	-2.30 to -1.69	< 0.001	-1.99	-2.29 to -1.68	< 0.001
		Gallbladder and biliary tract cancer	0.82	0.37 to 1.27	< 0.001	0.65	0.44 to 0.86	< 0.001	0.65	0.45 to 0.86	< 0.001
		Liver cancer	-3.34	-3.65 to -3.02	< 0.001	-3.74	-4.05 to -3.43	< 0.001	-3.74	-4.04 to -3.43	< 0.001
		Pancreatic cancer	1.36	0.93 to 1.79	< 0.001	1.31	0.88 to 1.75	< 0.001	1.31	0.88 to 1.74	< 0.001
		Stomach cancer	-0.94	-1.31 to -0.57	< 0.001	-2.55	-2.81 to -2.28	< 0.001	-2.52	-2.79 to -2.25	< 0.001
		All GI cancers	-0.78	-0.97 to -0.58	< 0.001	-2.21	-2.44 to -1.97	< 0.001	-2.18	-2.41 to -1.95	< 0.001
55-59years	Overall	Colon and rectum cancer	2.81	2.14 to 3.49	< 0.001	0.37	-0.16 to 0.89	0.169	0.46	-0.06 to 0.98	0.081
		Esophageal cancer	-2.27	-2.73 to -1.80	< 0.001	-2.65	-3.11 to -2.19	< 0.001	-2.65	-3.11 to -2.18	< 0.001
		Gallbladder and biliary tract cancer	0.391	-0.22 to 1.01	0.209	0.09	-0.54 to 0.71	0.788	0.08	-0.55 to 0.72	0.797
		Liver cancer	-3.59	-3.81 to -3.38	< 0.001	-3.92	-4.47 to -3.37	< 0.001	-3.92	-4.46 to -3.37	< 0.001
		Pancreatic cancer	1.13	0.84 to 1.41	< 0.001	1.08	0.80 to 1.36	< 0.001	1.08	0.79 to 1.36	< 0.001
		Stomach cancer	-1.50	-2.06 to -1.94	< 0.001	-2.89	-3.45 to -2.33	< 0.001	-2.87	-3.43 to -2.31	< 0.001
		All GI cancers	-1.00	-1.26 to -0.75	< 0.001	-2.37	-2.68 to -2.07	< 0.001	-2.34	-2.65 to -2.04	< 0.001
	Female	Colon and rectum cancer	1.74	0.72 to 2.78	< 0.001	-0.56	-1.25 to 0.12	0.108	-0.47	-1.15 to 0.21	0.176
		Esophageal cancer	-4.12	-4.71 to -3.52	< 0.001	-4.99	-5.71 to -4.26	< 0.001	-4.97	-5.70 to -4.24	< 0.001
		Gallbladder and biliary tract cancer	-0.43	-1.58 to 0.74	0.471	-0.79	-1.96 to 0.40	0.193	-0.79	-1.97 to 0.41	0.197
		Liver cancer	-4.47	-4.63 to -4.30	< 0.001	-4.71	-5.23 to -4.18	< 0.001	-4.71	-5.23 to -4.18	< 0.001
		Pancreatic cancer	0.91	0.30 to 1.52	< 0.001	0.85	0.24 to 1.47	0.006	0.85	0.23 to 1.47	0.007
		Stomach cancer	-2.43	-3.22 to -1.63	< 0.001	-3.59	-4.41 to -2.76	< 0.001	-3.57	-4.40 to -2.74	< 0.001
		All GI cancers	-1.54	-2.14 to -0.94	< 0.001	-3.05	-3.59 to -2.51	< 0.001	-3.01	-3.55 to -2.47	< 0.001
	Male	Colon and rectum cancer	3.64	3.31 to 3.97	< 0.001	1.25	0.84 to 1.66	< 0.001	1.33	0.77 to 1.89	< 0.001
		Esophageal cancer	-1.68	-2.00 to -1.36	< 0.001	-1.97	-2.30 to -1.65	< 0.001	-1.97	-2.30 to -1.64	< 0.001
		Gallbladder and biliary tract cancer	1.09	0.88 to 1.29	< 0.001	0.76	0.42 to 1.09	< 0.001	0.75	0.41 to 1.09	< 0.001
		Liver cancer	-3.25	-3.50 to -3.00	< 0.001	-3.60	-4.17 to -3.03	< 0.001	-3.6	-4.16 to -3.04	< 0.001
		Pancreatic cancer	1.37	1.09 to 1.65	< 0.001	1.33	1.05 to 1.61	< 0.001	1.33	1.05 to 1.61	< 0.001
		Stomach cancer	-1.00	-1.28 to -0.73	< 0.001	-2.55	-2.84 to -2.26	< 0.001	-2.53	-2.82 to -2.23	< 0.001
		All GI cancers	-0.76	-1.14 to -0.38	< 0.001	-2.04	-2.29 to -1.79	< 0.001	-2.01	-2.26 to -1.76	< 0.001
60-64 years	Overall	Colon and rectum cancer	3.02	2.65 to 3.40	< 0.001	0.66	0.27 to 1.06	0.001	0.77	0.38 to 1.15	< 0.001
		Esophageal cancer	-1.90	-2.10 to -1.70	< 0.001	-2.28	-2.48 to -2.09	< 0.001	-2.28	-2.47 to -2.08	< 0.001
		Gallbladder and biliary tract cancer	0.61	0.21 to 1.01	0.003	0.37	0.15 to 0.59	0.001	0.37	0.14 to 0.59	0.001
		Liver cancer	-3.27	-3.50 to -3.04	< 0.001	-3.65	-4.13 to -3.16	< 0.001	-3.65	-4.13 to -3.16	< 0.001
		Pancreatic cancer	1.69	1.55 to 1.83	< 0.001	1.65	1.48 to 1.82	< 0.001	1.64	1.48 to 1.81	< 0.001
		Stomach cancer	-1.07	-1.39 to -0.74	< 0.001	-2.43	-2.67 to -2.19	< 0.001	-2.41	-2.64 to -2.17	< 0.001
		All GI cancers	-0.67	-0.90 to -0.43	< 0.001	-1.97	-2.14 to -1.80	< 0.001	-1.93	-2.10 to -1.76	< 0.001
	Female	Colon and rectum cancer	2.09	1.45 to 2.74	< 0.001	-0.41	-0.85 to 0.03	0.07	-0.31	-0.75 to 0.13	0.167
		Esophageal cancer	-3.61	-4.18 to -3.04	< 0.001	-4.48	-5.06 to -3.89	< 0.001	-4.46	-5.05 to -3.87	< 0.001
		Gallbladder and biliary tract cancer	0.10	-0.40 to 0.60	0.694	-0.23	-0.71 to 0.26	0.359	-0.23	-0.71 to 0.26	0.363
		Liver cancer	-3.99	-4.15 to -3.83	< 0.001	-4.23	-4.47 to -3.98	< 0.001	-4.23	-4.47 to -3.98	< 0.001
		Pancreatic cancer	1.4	1.19 to 1.61	< 0.001	1.35	1.11 to 1.59	< 0.001	1.33	1.13 to 1.53	< 0.001
		Stomach cancer	-2.21	-2.70 to -1.71	< 0.001	-3.30	-3.78 to -2.82	< 0.001	-3.29	-3.77 to -2.81	< 0.001
		All GI cancers	-1.32	-1.61 to -1.02	< 0.001	-2.67	-3.00 to -2.34	< 0.001	-2.63	-2.96 to -2.31	< 0.001
	Male	Colon and rectum cancer	3.77	3.43 to 4.12	< 0.001	1.43	1.09 to 1.77	< 0.001	1.53	1.20 to 1.86	< 0.001
		Esophageal cancer	-1.26	-1.41 to -1.10	< 0.001	-1.55	-1.72 to -1.39	< 0.001	-1.57	-1.70 to -1.44	< 0.001
		Gallbladder and biliary tract cancer	1.14	0.86 to 1.43	< 0.001	0.90	0.60 to 1.19	< 0.001	0.90	0.60 to 1.19	< 0.001
		Liver cancer	-2.94	-3.32 to -2.56	< 0.001	-3.35	-4.02 to -2.68	< 0.001	-3.35	-4.01 to -2.68	< 0.001
		Pancreatic cancer	1.93	1.74 to 2.12	< 0.001	1.88	1.69 to 2.07	< 0.001	1.88	1.69 to 2.07	< 0.001
		Stomach cancer	-0.58	-0.97 to -0.19	0.004	-2.08	-2.31 to -1.85	< 0.001	-1.98	-2.24 to -1.73	< 0.001
		All GI cancers	-0.32	-0.56 to -0.09	0.006	-1.62	-1.82 to -1.43	< 0.001	-1.59	-1.77 to -1.40	< 0.001
15-64 years	Overall	Colon and rectum cancer	0.77	0.38 to 1.15	< 0.001	2.11	2.00 to 2.23	< 0.001	1.98	1.89 to 2.07	< 0.001
		Esophageal cancer	-0.23	-0.39 to -0.07	0.004	-0.64	-0.83 to -0.46	< 0.001	-0.72	-0.88 to -0.56	< 0.001
		Gallbladder and biliary tract cancer	2.05	1.85 to 2.26	< 0.001	1.79	1.51 to 2.07	< 0.001	1.59	1.26 to 1.93	< 0.001
		Liver cancer	-1.82	-2.09 to -1.56	< 0.001	-2.24	-2.75 to -1.72	< 0.001	-2.38	-2.84 to -1.91	< 0.001
		Pancreatic cancer	3.18	2.98 to 3.37	< 0.001	3.15	2.95 to 3.35	< 0.001	3.02	2.80 to 3.24	< 0.001
		Stomach cancer	0.63	0.46 to 0.80	< 0.001	-0.93	-1.13 to -0.73	< 0.001	-1.03	-1.15 to -0.90	< 0.001
		All GI cancers	0.88	0.72 to 1.03	< 0.001	-0.57	-0.73 to -0.41	< 0.001	-0.69	-0.83 to -0.56	< 0.001
	Female	Colon and rectum cancer	-0.31	-0.75 to 0.13	0.167	0.96	0.84 to 1.08	< 0.001	0.80	0.70 to 0.91	< 0.001
		Esophageal cancer	-1.78	-2.10 to -1.46	< 0.001	-2.84	-3.19 to -2.49	< 0.001	-2.89	-3.19 to -2.58	< 0.001
		Gallbladder and biliary tract cancer	1.56	1.21 to 1.91	< 0.001	1.22	0.87 to 1.57	< 0.001	1.01	0.87 to 1.14	< 0.001
		Liver cancer	-2.77	-3.12 to -2.43	< 0.001	-3.04	-3.43 to -2.65	< 0.001	-3.24	-3.61 to -2.86	< 0.001
		Pancreatic cancer	2.84	2.67 to 3.00	< 0.001	2.80	2.63 to 2.96	< 0.001	2.61	2.40 to 2.83	< 0.001
		Stomach cancer	-0.42	-0.52 to -0.32	< 0.001	-1.79	-1.88 to -1.70	< 0.001	-1.90	-2.15 to -1.65	< 0.001
		All GI cancers	0.38	0.15 to 0.60	0.001	-1.23	-1.31 to -1.15	< 0.001	-1.37	-1.48 to -1.25	< 0.001
	Male	Colon and rectum cancer	1.53	1.20 to 1.86	< 0.001	2.87	2.72 to 3.01	< 0.001	2.74	2.59 to 2.89	< 0.001
		Esophageal cancer	0.21	0.03 to 0.39	0.023	-0.15	-0.36 to -0.06	0.174	-0.23	-0.43 to -0.03	0.022
		Gallbladder and biliary tract cancer	2.51	2.31 to 2.72	< 0.001	2.28	2.06 to 2.51	< 0.001	2.06	1.78 to 2.34	< 0.001
		Liver cancer	-1.54	-1.85 to -1.23	< 0.001	-2.00	-2.43 to -1.56	< 0.001	-2.11	-2.50 to -1.72	< 0.001
		Pancreatic cancer	3.40	3.17 to 3.62	< 0.001	3.37	3.15 to 3.59	< 0.001	3.26	3.03 to 3.49	< 0.001
		Stomach cancer	1.06	0.85 to 1.28	< 0.001	-0.57	-0.80 to -0.33	< 0.001	-0.62	-0.84 to -0.40	< 0.001
		All GI cancers	1.12	0.96 to 1.28	< 0.001	-0.33	-0.49 to -0.17	< 0.001	-0.41	-0.57 to -0.25	< 0.001

GI: Gastrointestinal; CIR: Crude incidence rate; CMR: Crude mortality rate; CDR: Crude disability-adjusted life-years rate; AAPC: Average annual percent change; 95%UI: 95% uncertainty interval; NA: Not available.

Table 4 Male-to-female ratio in burden of the specific gastrointestinal cancers among working-age population in China between 1990 and 2019

	Incident cases		ASIR		Mortality		ASMR		DALYs		ASDR
Type of GI cancers	1990	2019	1990	2019	1990	2019	1990	2019	1990	2019	1990	2019
Colon and rectum cancer	1.25	2.06	1.14	2.04	1.25	2.08	1.14	2.05	1.26	2.12	1.15	2.09
Esophageal cancer	2.84	4.90	2.60	4.78	2.97	6.38	2.72	6.24	3.09	6.55	2.82	6.4
Gallbladder and biliary tract cancer	1.01	1.30	0.92	1.28	1.01	1.32	0.92	1.31	1.04	1.38	0.94	1.38
Liver cancer	3.34	4.59	3.03	4.57	3.33	4.41	3.02	4.4	3.44	4.68	3.13	4.67
Pancreatic cancer	1.71	1.96	1.56	1.95	1.71	1.97	1.56	1.97	1.74	2.05	1.59	2.05
Stomach cancer	2.17	3.26	2.03	3.13	2.15	3.01	2.01	2.91	2.05	2.94	1.93	2.81
All GI cancers	2.36	2.86	2.18	2.19	2.44	3.11	2.24	3.05	2.45	3.14	2.25	3.07

GI: Gastrointestinal; ASIR: Age-standardized incidence rate; ASMR: Age-standardized mortality rate; DALYs: Disability-adjusted life-years; ASDR: Age-standardized disability-adjusted life-year rate.