TL;DR
From 1990 to 2021, Iran saw nearly a twofold increase in new GC instances; however, the age-standardized incidence rate (ASIR) significantly fell, and the most significant decreases were observed in the northwestern provinces and among females.
While China has achieved substantial reductions in gastric cancer burden over 34 years, emerging challenges include trend reversals in females and persistent sex disparities, necessitating targeted prevention strategies.
The increasing absolute burden was mainly associated with population aging, while risk-attributable analysis suggested a growing contribution of metabolic factors.
The trends revealed a significant increase in incidence across all macro-regions, particularly in the North and South regions, whereas mortality rates remained stable, whereas mortality rates remained stable in the North and South regions.
Inequality metrics showed that childhood KC mortality and DALYs were disproportionately concentrated in lower-SDI countries, and these disparities widened over time, yet the rising incidence in lower-income regions warrants attention.
Divergent trends between incidence and mortality likely reflect reduced detection during the pandemic rather than true changes in disease burden, and highlight the importance of maintaining continuity of cancer screening and diagnostic services during health-system disruptions.
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