Divergent Trends and Widening Inequalities in Digestive Tract Cancers Among Women of Childbearing Age: A Global Analysis from 1990 to 2021 and Projections to 2050.
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BACKGROUND: Digestive tract cancers (DTCs) impose substantial health risks for women of childbearing age (WCBA), yet their global burden and future trajectories remain incompletely characterized. This study quantified the global burden of five major DTCs among WCBA from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data and projected trends through 2050. METHODS: Incidence and disability-adjusted life-years (DALYs) rates were assessed to characterize global, regional, and age-specific variations in DTCs burden. Temporal trends were estimated using Joinpoint regression, health inequalities quantified via the slope index of inequality (SII) and concentration index (CI), and future burden forecasted using a Bayesian age-period-cohort (BAPC) model. RESULTS: In 2021, colorectal cancer (CRC) accounted for the largest burden among WCBA, with 85,224 incident cases and over 1.6 million DALYs. Regionally, East Asia had the highest burden of gastric cancer (GC) and CRC, whereas South Asia had the greatest burden of esophageal cancer (EC) and lip and oral cavity cancer (LOC). National disparities were pronounced; Afghanistan exhibited the highest GC burden (ASIR: 13.77; ASDR: 630.33 per 100,000), contrasting with Kuwait (ASIR: 0.27; ASDR: 12.12). Between 1990 and 2021, the incidence of GC and EC declined, while LOC showed a persistent increase, with peak burden observed among women aged 45-49 years. Health inequality analyses indicated narrowing global gaps for GC and EC but widening disparities for LOC. Projections to 2050 suggest continued declines for GC, EC, and CRC, alongside an increasing burden of LOC. CONCLUSIONS: The rising burden of LOC, compounded by expanding health inequalities among WCBA, underscores the need for targeted, region-specific interventions. Given that WCBA face distinct challenges including fertility preservation concerns, more aggressive disease phenotypes, and profound impacts on family and economic stability, these findings highlight the critical importance of age-specific cancer control strategies. Strategies, including expanded screening and equitable healthcare access, are critical to mitigate disparities and improve outcomes.