Spatiotemporal co-occurrence patterns and related risk factors of esophageal and lip and oral cavity cancers among older adults across 203 countries and territories - research article

Sep 22, 2026

Background and aim: Characterize how the country-level co-burden of esophageal cancer and lip and oral cavity cancer (LOC) varies among adults aged 55+ worldwide, and identify associated population-level exposures. Methods: Using Global Burden of Disease 2021 data across 203 countries and territories, incidence was classified into quartile co-burden categories and 1990–2021 trends were compared with Socio-demographic Index trajectories. Machine-learning screening (random forests and SHAP) selected key exposures for multivariable negative binomial models with population offsets. Results and conclusion: Distinct dominance patterns emerged and high alcohol use and low-nut/low-seed diets were linked to both cancers, supporting regionally tailored prevention priorities.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Background

Materials and methods

Results

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AnnAls of Medicine 2026, Vol. 58, no. 1, 2721134 [https://doi.org/10.1080/07853890.2026.2721134](https://doi.org/10.1080/07853890.2026.2721134) RESEARCH ARTICLE Spatiotemporal co-occurrence patterns and related risk factors of esophageal and lip and oral cavity cancers among older adults across 203 countries and territories: a machine learning-driven systematic analysis Minsheng Zhenga,b, Chi Zhanga,b, Boyu Yanga,b, Chenxinzi Lina,b, Chongjie Zhua,b, Yawen Chena,b and Qilong Wana,b astate Key laboratory of oral and Maxillofacial Reconstruction and Regeneration, Key laboratory of oral Biomedicine Ministry of education, Hubei Key laboratory of stomatology, school and Hospital of stomatology, Wuhan University, Wuhan, china; bdepartment of orthognathic and cleft lip and Palate Plastic surgery, school and Hospital of stomatology, Wuhan University, Wuhan, china ABSTRACT Background: The country-level co-burden of esophageal cancer and lip and oral cavity cancer (LOC) among older adults remains poorly characterised. We examined global spatiotemporal patterns and associated population-level exposures. Materials and methods: We analyzed Global Burden of Disease 2021 data for adults ≥ 55 years across 203 countries and territories. Incidence rates were classified into quartile-based co-burden categories, comparing 1990–2021 trends with Socio-demographic Index (SDI) trajectories. After screening 58 candidate exposures, random forests and SHapley Additive exPlanations ranked 36. Following variance inflation factor screening, the top 25 entered multivariable negative binomial models with population offsets. Results: Countries and territories were classified as consistent (n=73), esophageal cancer-dominant (n=61), or LOC-dominant (n=69). Increasing SDI generally coincided with declining esophageal cancer incidence, whereas LOC incidence increased in several high-SDI settings. Both cancers were associated with high alcohol use (esophageal RR=1.32, 95% CI: 1.13–1.53; LOC RR=1.27, 95% CI: 1.13–1.43) and diets low in nuts and seeds (esophageal RR=1.16, 95% CI: 1.05–1.27; LOC RR=1.08, 95% CI: 1.01–1.16). Esophageal cancer was additionally associated with iron deficiency (RR=1.31, 95% CI: 1.14–1.52), occupational exposure to particulate matter, gases, and fumes(RR=1.29, 95% CI: 1.13–1.49), and high red meat diets (RR=1.16, 95% CI: 1.02–1.33). LOC was associated with chewing tobacco (RR=1.32, 95% CI: 1.22–1.44) and high-sodium diets (RR=1.10, 95% CI: 1.01–1.20). Conclusions: These ecological associations indicate geographic heterogeneity in cancer co-burden and exposure profiles, informing regionally tailored prevention priorities without establishing individual-level causality. Background ARTICLE HISTORY Received 30 April 2026 Accepted 15 August 2026 KEYWORDS Esophageal cancer; Global Burden of Disease; lip and oral cavity cancer; risk factors; spatiotemporal analysis Esophageal cancer and lip and oral cavity cancer (LOC) constitute a substantial component of the global burden of gastrointestinal and head and neck malignancies [1] . According to the International Agency for Research on Cancer, approximately 511,000 individuals are newly diagnosed with esophageal cancer annually worldwide, and esophageal cancer remains one of the leading causes of cancer-related mortality [2] . LOC is also among the most common head and neck malignancies, with a global age-standardized incidence rate of 4.74 per 100,000 population in 2021 [1] . Despite advances in clinical treatment, both malignancies remain associated with poor survival and severe impairment of swallowing, speech, oral function, and facial integrity [3,4] . CONTACT Q. l. Wan [qilong.wan@whu.edu.cn](qilong.wan@whu.edu.cn) state Key laboratory of oral and Maxillofacial Reconstruction and Regeneration, Key laboratory of oral Biomedicine Ministry of education, Hubei Key laboratory of stomatology, school and Hospital of stomatology, Wuhan University, Wuhan 430021

FAQs

What data and population were used to analyze cancer co-burden patterns?

The study used Global Burden of Disease 2021 data for adults aged 55 years and older across 203 countries and territories, comparing 1990–2021 trends with Socio-demographic Index (SDI) trajectories.

How were potential risk exposures selected before modeling?

After screening 58 candidate exposures, random forests and SHapley Additive exPlanations (SHAP) ranked 36 exposures. Variance inflation factor screening then reduced this set, and the top 25 were entered into multivariable negative binomial models.

Which exposures were associated with esophageal cancer and LOC in this analysis?

Both cancers were associated with high alcohol use and diets low in nuts and seeds. Esophageal cancer additionally related to iron deficiency, occupational exposure to particulate matter/gases/fumes, and high red meat diets, while LOC was associated with chewing tobacco and high-sodium diets.

Sep 22, 2026

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