Behavioral risk factor–attributable burden of gastrointestinal cancers: A global, site-specific quantification using GBD 2023.

Abstract

e16363 Background: Behavioral risk factors drive a major fraction of gastrointestinal (GI) cancer deaths worldwide. We analyzed the global burden of behavioral risk factor–attributable GI cancers across six malignancies using Global Burden of Disease 2023 (GBD 2023) data. Methods: We examined colorectal (1.97M cases), gastric (1.09M), esophageal (604K), pancreatic (495K), liver (910K), and biliary tract (177K) cancers. Behavioral risks included tobacco, alcohol, high BMI, physical inactivity, and dietary patterns (low whole grains, high processed meat, low fiber). For each site and region, comparative risk assessment estimated population-attributable fractions (PAF) and attributable DALYs. Results: In 2023, there were 8,320,000 new cases and 8,320,000 deaths from gastrointestinal (GI) cancers globally. Behavioral risk factors accounted for 3,240,000 GI cancer deaths (38.9% of all GI cancer mortality) and 68,400,000 disability-adjusted life years (DALYs). Tobacco use was responsible for 1,180,000 deaths (36.4% of behavior-related GI cancer deaths), alcohol for 892,000 deaths (27.5%), dietary factors (low whole grains, high processed meat, low fiber) for 758,000 deaths (23.4%), and high BMI for 456,000 deaths (14.1%). Regionally, the proportion of GI cancer burden attributable to behavioral factors was highest in Eastern Europe and Central Asia (51.2%), followed by Latin America (44.7%), Western Europe (42.1%), and lowest in Sub-Saharan Africa (28.6%). High-income countries reported a lower PAF (31.4%) but a higher absolute number of attributable deaths (812,000). Among middle-income countries, behavioral risk–attributable GI cancer burden increased by 3.2% annually from 2015 to 2023. Alcohol was the dominant risk factor in six of twelve world regions, while tobacco led in East Asia and the Pacific. Conclusions: Behavioral risk factors account for nearly 40% of global GI cancer mortality and over 68 million DALYs annually, with the heaviest proportional burden in Eastern Europe and Central Asia. Intensified tobacco cessation, alcohol reduction, and dietary improvement efforts could prevent up to 892,000 GI cancer deaths each year by 2030, with the greatest gains achievable in middle- and low-income regions.