Gastric cancer mortality and premature mortality burden declined substantially in China between 2008 and 2021, but the larger decline in ASMR than in CMR, together with the increasing concentration of deaths among older adults, suggests that population ageing continues to reshape the future burden of gastric cancer.
Key Findings
Results
Gastric cancer crude mortality rate (CMR) declined modestly in China from 2008 to 2021, while the age-standardized mortality rate (ASMR) declined substantially.
CMR decreased from 20.64 to 18.39 per 100,000 over the study period.
ASMR declined from 22.44 to 12.29 per 100,000 over the same period.
ASMRs were standardized to the 2010 Chinese standard population.
The larger decline in ASMR relative to CMR indicates that population ageing partially offset real improvements in mortality risk.
Results
Premature gastric cancer mortality burden, measured by potential years of life lost rate (PYLLR), decreased from 2008 to 2021.
PYLLR decreased from 1.38‰ to 0.83‰ over the study period.
Years of potential life lost (PYLL) were estimated overall and by sex, residence, and region.
The decline in PYLLR indicates reduced premature mortality from gastric cancer nationally.
Results
Males consistently had higher gastric cancer ASMRs and PYLLRs than females throughout the study period.
Sex-based disparities in both ASMR and PYLLR persisted across the entire 2008–2021 period.
These disparities were observed nationwide and analyzed as a consistent demographic pattern.
Results
Rural residents consistently had higher gastric cancer ASMRs and PYLLRs than urban residents.
Urban/rural disparities in ASMR and PYLLR persisted throughout the 2008–2021 study period.
These differences were assessed using data from China's Disease Surveillance Points (DSP) system stratified by residence type.
Results
Regional disparities in gastric cancer mortality persisted, with ASMRs generally higher in eastern and central China than in western China, although the western region showed the steepest relative decline.
Eastern and central regions had generally higher ASMRs compared to the western region.
The western region demonstrated the steepest relative decline in ASMR over the study period.
Regional disparities were assessed across eastern, central, and western China.
Results
Age-period-cohort analysis revealed a strong age effect, with gastric cancer mortality increasing sharply after age 60, alongside declining period and cohort effects over time.
Mortality increased sharply after age 60, indicating a dominant age effect.
Period effects declined over time, consistent with improved detection and treatment.
Cohort effects also declined over time, suggesting improved risk profiles in more recent birth cohorts.
Analysis was conducted using the National Cancer Institute age-period-cohort tool.
Results
The burden of gastric cancer became increasingly concentrated among older adults over the study period.
The concentration of gastric cancer deaths among older adults increased from 2008 to 2021.
This pattern reflects population ageing reshaping the demographic distribution of gastric cancer mortality.
Temporal trends were assessed using Joinpoint regression in addition to age-period-cohort analysis.
Results
Model-based projections suggested continued declines in gastric cancer ASMR through 2036, with increasing uncertainty over longer projection periods.
Projections were generated using a Bayesian age-period-cohort model.
Projected declines in ASMR are expected to continue through 2036.
Uncertainty in projections widened over longer time horizons.
The study covers the projection period from 2022 to 2036.
What This Means
This research suggests that deaths from stomach cancer in China dropped significantly between 2008 and 2021, but the story is more complex than simple improvement. When researchers adjusted the numbers to account for China's aging population, the decline in the true risk of dying from stomach cancer was much larger than the raw death count would suggest. In other words, population aging — meaning a growing share of elderly people in China — is partially masking the real progress being made. Men, rural residents, and people in eastern and central China consistently faced higher risks of dying from stomach cancer throughout the study period, and those gaps persisted even as overall rates fell.
The research also found that stomach cancer deaths are increasingly concentrated among people over 60, and that more recent generations appear to carry lower lifetime risk than older generations. Using a statistical modeling approach, the researchers projected that death rates from stomach cancer will continue to fall through 2036, though predictions become less certain the further into the future they extend.
This research matters because it highlights that even as stomach cancer becomes less deadly overall, an aging population means the total number of older people dying from it could remain substantial. The persistent gaps between men and women, urban and rural areas, and different regions of China suggest that targeted public health efforts — such as improved screening and healthcare access in rural and central/eastern areas — could help reduce remaining inequalities. Understanding these trends is important for planning cancer prevention and healthcare resources in China going forward.
Fang H, Zhang Y, Ning Y, Mu J. (2026). Population ageing and gastric cancer mortality burden in China, 2008-2021: a nationwide analysis with projections to 2036.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1875254