# Global, regional, and national burden of gastric cancer attributable to smoking and a high-sodium diet from 1990 to 2021: a global burden of disease study 2021

## TL;DR

This study examines how smoking and high-sodium diets contribute to gastric cancer deaths worldwide from 1990 to 2021, highlighting regional differences and trends.

## Contribution

The study provides updated global and regional estimates of gastric cancer burden linked to smoking and high-sodium diets using the latest GBD data.

## Key findings

- Smoking caused over 100,000 gastric cancer deaths in 2021, while high sodium intake caused around 75,000.
- Globally, the age-standardized mortality and DALY rates decreased, but absolute numbers increased due to population growth and aging.
- East Asia, especially China, had the highest burden, with more deaths and DALYs in males compared to females.

## Abstract

This study comprehensively assesses the global, regional, and national burden of gastric cancer (GC) attributable to smoking and a high-sodium diet from 1990 to 2021, aiming to promote healthy lifestyle habits and provide scientific evidence for policy-making.

Data on mortality, disability-adjusted life years (DALYs), the age-standardized mortality rate (ASMR), and the age-standardized DALY rate (ASDR) of GC attributable to smoking and a high-sodium diet were extracted from the Global Burden of Disease (GBD) 2021 study. From 1990 to 2021, the estimated annual percentage change (EAPC) was calculated to clarify the temporal trends in the ASMR and ASDR.

Globally, smoking was responsible for 107,926 (95% UI: 84,603–138,448) deaths from GC in 2021, whereas high sodium intake was associated with 75,661 (95% UI: 0-372,194) deaths. From 1990 to 2021, the number of deaths and DALYs due to GC caused by smoking and a high-sodium diet tended to decrease, with the ASMRs and ASDRs also decreasing. Across all periods and regions, the number of deaths, DALYs, ASMRs, and ASDRs related to smoking and a high-sodium diet were greater in males than in females. East Asia, particularly China, had the highest burden. High- and high-middle-SDI regions experienced decreases, while other regions saw increases.

Despite the global decline in the ASMRs and ASDRs of GC attributable to smoking and a high-sodium diet, the absolute number of gastric cancer deaths caused by a high-sodium diet continues to increase because of population growth and ageing, and significant regional differences persist across age groups and regions. Through a comprehensive analysis on a global scale, this study identified the main modifiable risk factors, providing data support and a theoretical basis for the formulation of risk attribution, stratification, and prevention strategies.

The online version contains supplementary material available at 10.1186/s12876-025-04431-8.