Gastric cancer incidence trends in China: 1989-2018 registry data, 2022 Bayesian age-period-cohort estimates, ecological correlates
Li Ren, Wei Zhang, Li Sun, Wen-Wen Li, Jian Xiao, Wei Wang, Cheng-Long Zhao, Chuan Han
Li Ren, Wei Zhang, Wen-Wen Li, Jian Xiao, Wei Wang, Chuan Han, Department of Endocrinology, General Hospital of the Western Theater Command, Chengdu 610038, Sichuan Province, China
Li Sun, Cheng-Long Zhao, Department of Rehabilitation, Emei Rehabilitation and Recuperation Center of Joint Logistic Support Force of the Chinese People’s Liberation Army, Emeishan 614200, Sichuan Province, China
Co-first authors: Li Ren and Wei Zhang.
Co-corresponding authors: Cheng-Long Zhao and Chuan Han.
Author contributions: Zhao CL and Han C conceptualized and designed the study, interpreted the epidemiological and ecological findings, supervised the overall research process, critically revised the manuscript for important intellectual content, approved the final version for publication, and served as co-corresponding authors responsible for academic integrity and journal communication. Ren L, Zhang W and Sun L performed the research and contributed to writing the main manuscript text; Li WW, Xiao J and Wang W prepared and refined the figures and figure legends. All authors participated in manuscript review, contributed to revisions, read and approved the final manuscript, and agreed to be accountable for all aspects of the work. Within the author group, Ren L and Zhang W were identified as co-first authors because they jointly led the day-to-day execution of the study, including collection and cross-checking of the National Cancer Center incidence data and candidate influencing-factor datasets, time-point alignment, quality control of the analytical dataset, interpretation of Joinpoint and correlation outputs, drafting of the core sections of the Abstract, Introduction, Methods, Results and Discussion, preparation of point-by-point responses, and repeated revision after peer review. Their contributions were concurrent, substantive and complementary: Ren L focused on organizing the long-term incidence trend framework and integrating the urban–rural and sex-specific results, whereas Zhang W focused on harmonizing the ecological covariates, verifying analytical consistency, and strengthening the causal-language restraint and limitation statements; both therefore satisfied the criteria for co-first authorship. Zhao CL and Han C were designated as co-corresponding authors because they shared primary responsibility for transforming the clinical/public-health question into a feasible nationwide ecological time-series design, ensuring that the observed 1989-2018 registry data were conceptually separated from the 2022 BAPC-projected estimates, guiding the confounding discussion, and taking final responsibility for the accuracy and integrity of the submitted manuscript. Han C anchored the clinical relevance of the findings and the prevention implications for rural and urban populations, while Zhao CL anchored the cross-institutional coordination, data-source validation and methodological consistency; together they jointly managed correspondence, revision strategy and final approval. This collaboration was essential for completing the manuscript and for aligning the registry-based trend analysis with the ecological correlates and public-health interpretation.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Supported by Sichuan Province Traditional Chinese Medicine Research Special Project of China, No. 2024MS203; Emei Rehabilitation and Recuperation Center of Joint Logistic Support Force of the Chinese People’s Liberation Army Key Projects, No. Elyg20250301; and “Sancai-Yidui” Talent Support Project of Xining Joint Logistics Support Center.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Chuan Han, MD, Chief Physician, Department of Endocrinology, General Hospital of the Western Theater Command, No. 270 Tianhui Road, Chengdu 610038, Sichuan Province, China.
hanchuan3012005173@126.com
Received: July 9, 2026
Revised: August 21, 2026
Accepted: September 22, 2026
Published online: September 24, 2026
Processing time: 76 Days and 18.6 Hours
