Nearly half of the global esophageal cancer deaths are concentrated in China, posing a significant burden on the country's public health system and severely impacting patients' quality of life. Systematically assessing death trends and making predictions is of great reference value for improving esophageal cancer prevention and control strategies.

This study aimed to assess the current status and historical trends in esophageal cancer mortality from 2010 to 2021, with projections to 2030, to inform the optimization of prevention and control strategies.

Data on esophageal cancer deaths from the China Cause of Death Surveillance Dataset(2010-2021)were analyzed. Age standardization was performed using data from the sixth population census. Crude and standardized mortality rates were used to describe mortality patterns among Chinese residents, stratified by age, sex, urban-rural residence, and geographic region. Joinpoint regression models were applied to analyze trends in standardized mortality rates, and the annual percentage change(APC)and average annual percentage change(AAPC)were calculated. Additionally, a GM (1, 1) model was constructed to predict esophageal cancer deaths from 2022 to 2030.

From 2010 to 2021, the crude mortality rate of esophageal cancer in China declined from 12.05/100 000 to 11.70/100 000, representing a 2.90% drop. The standardized mortality rate showed a more significant decrease, falling from 12.65/100 000 to 7.41/100 000, a 41.44% reduction. Clear disparities exist, with males, rural areas, and the eastern region exhibiting higher mortality rates. Age is a key risk factor. Notably, the standardized mortality rate decline was steeper for females (AAPC=-5.18%, P<0.05) than males (AAPC=-3.96%, P<0.05) . In rural areas, the decline was marked (AAPC=-5.58%, P<0.05), while urban areas showed less obvious trends. Central China saw a steeper decline (AAPC=-6.92%, P<0.05) than the east (AAPC=-3.25%, P<0.05) , with the west showing no significant trend. GM (1, 1) model predicted that the crude death rate of esophageal cancer in China would decrease to 11.70/100 000 in 2022-2030. The standardized death rate will drop to 6.06/100 000.

While esophageal cancer mortality in China decreased during the study period, the burden remains heavy. Special attention should be given to males and the elderly. Enhanced screening, diagnosis, and treatment are needed in both urban and rural, as well as eastern and western regions. More targeted prevention and control strategies, considering regional, population, and risk factors, are warranted.