# One cancer, two stories: divergent estimates of gastric cancer burden in Korea

## TL;DR

This paper compares global and national estimates of gastric cancer burden in Korea and Japan, showing how different metrics can lead to different health burden narratives.

## Contribution

The study reveals divergent burden estimates between Global Burden of Disease and national data, highlighting survivorship-related disability in Korea.

## Key findings

- KNBD data showed increasing years lived with disability (YLDs) in Korea, while GBD Korea reported little YLD change.
- GBD estimates for Japan showed negligible changes in YLL and YLD despite declining mortality from screening.
- National data better capture survivorship disability compared to global models like GBD.

## Abstract

Global Burden of Disease (GBD) estimates are widely used for international health comparisons, but their validity in high-data settings remains debated. Gastric cancer provides a critical case, given its high incidence in East Asia and the availability of robust national screening and mortality data.

We compared estimates from the Korean National Burden of Disease (KNBD) study and the GBD for gastric cancer between 2008 and 2018. We additionally examined Japan, another country with nationwide gastric cancer screening and high-quality mortality reporting, to assess whether similar patterns emerged.

KNBD reported declines in years of life lost (YLLs), reflected in the decreasing YLL share of disability-adjusted life years (DALYs), alongside substantial increases in years lived with disability (YLDs), underscoring survivorship-related disability. By contrast, GBD Korea showed a decrease in YLL but virtually no change in YLD. In Japan, where mortality has also declined substantially through national screening programs, GBD nevertheless reported negligible changes in YLL and YLD shares of total DALYs. Although a Japanese national DALY study is not available for direct comparison, these similar patterns across GBD Korea and GBD Japan raise concerns about the capacity of GBD methods to adequately capture survivorship in high-data countries.

Our findings demonstrate that the same disease can generate fundamentally different burden-of-disease narratives depending on the metric framework applied. In Korea, national data highlight survivorship-related disability that is effectively absent in GBD estimates; in Japan, GBD may similarly downplays disability despite declining mortality. Policymakers may consider national burden-of-disease estimates as more appropriate for local planning, while global models could be strengthened by integrating high-quality country-level data to better reflect survivors’ burdens.

The online version contains supplementary material available at 10.1186/s13690-025-01801-2.