Global burden of digestive diseases reveals alarming trends

The results of a major study across 195 countries, presented in a series of late-breaking talks, indicate that global death rates for pancreatic cancer and incidence rates for colorectal cancer both increased by 10% between 1990 and 2017, and that there is an 84% increase in inflammatory bowel disease (IBD) [1-5].

The Global Burden of Disease study is the first comprehensive worldwide estimation of the burden, epidemiological features, and risk factors of several digestive diseases. Some of the key findings were that the number of pancreatic cancer cases increased by 130% over the 27-year study period, from 195,000 in 1990 to 448,000 in 2017. Also, notably, gastric cancer dropped from being the second leading cause of cancer death worldwide to the third position, behind both lung and colorectal cancer. However, on a worrisome note, the number of cases of IBD increased by 84%, from 3.7 million in 1990 to 6.8 million in 2017.

Pancreatic cancer cases rose, which was not surprising; most experts believe this increase is attributable to a rise in the prevalence of obesity and diabetes, two of the leading risk factors for pancreatic cancer. However, the data indicates that pancreatic cancer patients were more likely to survive in 1990 than they are today. Although some of this increased mortality can be explained by the growing population and improved longevity; after normalising for population changes, age-standardised incidence, and death rates, pancreatic cancer-related deaths increased by 10% in this time period. Of note, the highest incidence and death rates were found in higher-income countries.

From 1990 to 2017, age-standardised incidence rates for colorectal cancer increased 9.5% globally but, by contrast, age-standardised death rates decreased by 13.5%. The researchers believe that this is due to the introduction of colorectal cancer screening programmes, leading to earlier detection and an increased chance of survival. Similarly, in countries where screening programmes were established 2 or 3 decades ago, reductions in death rates were observed, supporting the benefits attributable to screening interventions.

The study also indicated that the risk factors for colorectal cancer are different in males and females, which should therefore be considered in national policy and prevention programmes. Alcohol use, smoking, and diets low in calcium, milk, and fibre had a considerable burden on males. For females, dietary risks, but not alcohol use or smoking, were found to be the most attributable risks.

Age-standardised incidence and death rates for gastric cancer decreased steadily between 1990 and 2017. However, this decline has not necessarily led to a lower burden on the health system in high-risk countries and experts believe that specific local strategies should be tailored to each country's risk factor profile. The results were collectively reported in The Lancet Gastroenterology & Hepatology [6].

1. Alatab S et al. UEG Week 2019, Abstract LB22
2. Kamangar F et al. UEG Week 2019, Abstract LB23.
3. Etemadi A et al. UEG Week 2019, Abstract LB24.
4. Pourshams A et al. UEG Week 2019, Abstract LB25.
5. Safiri S et al. UEG Week 2019, Abstract LB2.
6. GBD 2017 Inflammatory Bowel Disease Collaborators. Lancet Gastroenterol Hepatol. 2020 Jan;5(1):17-30.

Posted on 23 October, 20198 April, 2024