Abstract
BACKGROUND: While global gastric cancer incidence has declined, trends in early-onset gastric cancer (EOGC, age 15-49) remain unclear. This study evaluates EOGC's global burden (1990-2021), projects trends to 2030, and identifies epidemiological drivers. METHODS: Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized incidence, mortality, disability-adjusted life years (DALYs), and estimated annual percentage change for EOGC globally and by sex, region, and income level. A Bayesian age-period-cohort model and decomposition analysis assessed temporal trends, epidemiological drivers (eg, aging, population growth), and projected burden through 2030. RESULTS: In 2021, EOGC caused 125 120 new cases and 78 871 deaths globally. From 1990 to 2021, age-standardized mortality, incidence, and DALYs declined worldwide. East Asia and high-middle-income regions bore the highest burden. Decomposition identified epidemiological changes as the primary driver of reduced EOGC burden. Males exhibited higher incidence, mortality, and DALYs than females. Projections suggest declining incidence and mortality rates by 2030 for both sexes, yet rising absolute case numbers due to population growth. CONCLUSIONS: Early-onset gastric cancer burden shows complex patterns: while rates have decreased over 3 decades, absolute cases and deaths increased due to demographic expansion. Disparities persist across gender, geography, and development levels. These findings highlight the need for targeted interventions in high-risk populations and regions to address inequities. Policymakers should prioritize surveillance and prevention strategies tailored to evolving epidemiological trends.