Global burden of esophageal cancer attributable to diet low in vegetables: an analysis of the Global Burden of Disease Study 2021

Background Low vegetable intake is a significant risk factor for esophageal cancer (EC). Using data from the Global Burden of Disease Study 2021 (GBD 2021), this study examines global trends in EC attributable to diet low in vegetables to support preventive strategies. Methods Data on EC burden due to low vegetable intake were extracted from GBD 2021. Analyses included mortality, disability-adjusted life years (DALYs), and their age-standardized rates (ASMR and ASDR), along with trends, influencing factors, age-sex variations, and projections through 2046. Results In 2021, EC deaths attributable to low vegetable intake were 56,940, down from 74,450 in 1990, with the highest mortality among adults aged 65–74. DALYs decreased from 2,026,110 in 1990 to 1,396,850 in 2021, peaking in the 55–64 age group. Men bore over twice the DALY burden of women. In 2021, middle SDI regions recorded the highest absolute number of deaths (17,130) and DALYs (418,460), while low SDI regions had the highest ASMR and ASDR. Although ASMR is projected to decline to 0.62 per 100,000 by 2046, annual deaths are expected to rise to 92,881, driven largely by population growth and aging, partially offset by epidemiological improvements. Conclusions Despite a declining global burden, EC due to low vegetable intake remains a public health concern with heterogeneous demographic and geographic distribution. Targeted interventions are essential to mitigate future burden and improve outcomes.