Abstract: Objective To analyze the changes in disease burden and risk factors of esophageal cancer in China and globally from 1990 to 2019, and to provide the scientific references for the prevention and treatment of esophageal cancer in China. Methods Based on the Global Burden of Disease 2019 (GBD 2019) database, the number of esophageal cancer incidences, deaths, disability-adjusted life years (DALYs), and their standardized rates were extracted. The estimated annual percentage change (EAPC) was used to assess the trend in esophageal cancer from 1990 to 2019. Additionally, the impact of risk factors on esophageal cancer was quantitatively analyzed using the population attributable proportion (PAF). Results From 1990 to 2019, both China and the global community experienced a declining trend in the age-standardized incidence rate of esophageal cancer, with EAPCs of -1.58% (95% CI: -2.03% - -1.13%) and -0.90% (95% CI: -1.18% - -0.62%), respectively. Similarly, the age-standardized mortality rate showed a downward trend, with EAPCs of -1.96% (95% CI: -2.42% - -1.49%) and -1.19% (95% CI: -1.47% - -0.91%), respectively. The age-standardized DALYs rate also decreased, with EAPCs of -2.27% (95% CI: -2.76% - -1.78%) and -1.41% (95% CI: -1.70%- -1.12%), respectively. The extent of the decline in age-standardized rates was greater in China compared to the global average, and more pronounced in females than in males. The burden of esophageal cancer in Asia was significantly higher than in Africa, Europe, and the Americas. The age-standardized incidence rate, mortality rate, and DALYs rate in Asia all demonstrated a declining trend, with EAPCs of -1.36% (95% CI: -1.71% - -1.01%), -1.71% (95% CI: -2.07% - -1.36%), and -1.91% (95% CI: -2.28% - -1.54%), respectively. In 2019, the primary risk factors for esophageal cancer, ranked by PAF, were smoking, alcohol consumption, high BMI, insufficient fruit intake, tobacco chewing, and insufficient vegetable intake. Conclusions The burden of esophageal cancer has decreased in China and globally. It is recommended that residents maintain a balanced diet, consume fruits and vegetables actively, quit smoking, limit alcohol consumption, engage in regular physical activity, strengthen esophageal cancer screening and regular physical examination, and actively promote early detection, diagnosis, and treatment.

Key words: Esophageal cancer, Disease burden, Disability-adjusted life years, Population attributable proportion, Estimated annual percentage change