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Importance: Occupational exposure to carcinogens has been shown to pose a serious disease burden at the global, regional, and national levels. Based on epidemiologic studies and clinical observations, working environment appears to have important effects on the occurrence of human malignant tumors; however, to date, no systematic articles have been published that specifically investigated cancer burden due to occupational exposure in an individual and collective manner., Objective: To estimate the degree of exposure and evaluate the cancer burden attributable to occupational carcinogens (OCs) individually and collectively by sex, age, year, and location., Design, Setting, and Participants: Cross-sectional study including data on 195 countries from the Global Burden of Diseases, Injuries, and Risk Factors Study from January 1, 1990, to December 31, 2017. Data were analyzed from June 24, 2020, to July 20, 2020., Exposures: Thirteen OCs (ie, arsenic, asbestos, benzene, beryllium, cadmium, chromium, diesel engine exhaust, formaldehyde, nickel, polycyclic aromatic hydrocarbons, silica, sulfuric acid, and trichloroethylene)., Main Outcomes and Measures: The degree and change patterns of exposure as well as the attributable cancer burden, including deaths and disability-adjusted life years (DALYs), by sex, age, year, and location for 13 OCs. The calculation of the population-attributable fraction was based on past exposure in the population and relative risks., Results: Based on the GBD 2017 study, 13 OCs attributable to 7 cancer types were included. Most summary exposure values for the 13 OCs, particularly those of diesel engine exhaust (35.6% increase; 95% uncertainty interval [UI], 32.4%-38.5%) and trichloroethylene (30.3% increase; 95% UI, 27.3%-33.5%), increased from 1990 to 2017. Only exposure to asbestos decreased by 13.8% (95% UI, -26.7% to 2.2%). In 2017, 319 000 (95% UI, 256 000-382 000) cancer deaths and 6.42 million (95% UI, 5.15 million to 7.76 million) DALYs were associated with OCs combined, accounting for 61.0% (95% UI, 59.6%-62.4%) of the total cancer deaths and 48.3% (46.3% to 50.2%) of the DALYs. Among the 13 OCs, the 3 leading risk factors for cancer burden were asbestos (71.8%), silica (15.4%), and diesel engine exhaust (5.6%). For most OCs, the attributed cancer outcome was tracheal, bronchial, and lung cancer, which accounted for 89.0% of attributable cancer deaths. China (61 644 cancer deaths), the US (42 848), and Japan (20 748) accounted for the largest number of attributable cancer deaths in 2017; for DALYs, China (1.47 million), the US (0.71 million), and India (0.37 million) were the 3 leading countries., Conclusions and Relevance: Results of this study suggest that although OC exposure levels have decreased, the overall cancer burden is continuously increasing.

Background: The epidemiology of esophageal cancer (EC) can elucidate its causes and risk factors and help develop prevention strategies. We aimed to provide an overview of the burden, trends, and risk factors of EC in China from 1990 to 2017. We also investigated the differences between China, Japan, and South Korea and discussed the possible causes of the disparities., Methods: We used the Global Burden of Disease Study 2017 to obtain data on incident cases, deaths, disability-adjusted life-year (DALY) cases, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALY rate of EC in China, Japan, and South Korea from 1990 to 2017. Trend analysis was performed using joinpoint analysis. We measured the associations between ASIR, ASDR, and age-standardized DALY rate and the socio-demographic index (SDI) for 1990-2017. We also analyzed the risk factors associated with EC deaths and DALYs., Results: China recorded 234,624 (95% uncertainty intervals: 223,240-246,036) incident cases of and 212,586 (202,673-222,654) deaths from EC in 2017. The ASIR and ASDR declined from 1990 to 2017. Until 2017, the ASIR was 12.23, and ASDR was 11.25 per 100,000 persons. The DALYs were 4,464,980 (4,247,816-4,690,846) with an age-standardized rate of 222.58 per 100,000 persons in 2017. The ASIR, ASDR, and age-standardized DALY rate in China were twice those of Japan and South Korea. These three indicators showed a decreasing trend, whereas SDI increased, in all three countries from 1990 to 2017. Tobacco and alcohol use remained the major risk factors for EC death and DALYs, especially for men in China and women in Japan and South Korea. High body mass index (BMI) and low-fruit diet were the main risk factors for women in China., Conclusions: The incident cases and deaths of EC in China, Japan, and South Korea increased from 1990 to 2017, whereas the ASIR, ASDR, and age-standardized DALY rate declined. China had the greatest burden of EC among three countries. SDI and aging along with tobacco use, alcohol use, high BMI, and low-fruit diet were the main risk factors of death and DALYs and should be paid more attention.