Background This study explored the global burden of esophageal cancer mortality and temporal trends, with a focus on premature populations aged 30-69 years.

Methods Esophageal cancer mortality data for premature populations was extracted from the World Health Organisation’s Global Cancer Observatory (GLOBOCAN) database. The age-standardised mortality rate (ASR) was used to demonstrate the cancer mortality burden. The average annual percentage change (AAPC) and 95% confidence intervals (CI) were calculated using the joinpoint regression model to assess temporal trends.

Results In 2022, the global ASR of esophageal cancer for the premature population was 6.8 per 100,000 persons. The ASR was considerably higher in males than females (10.4 vs. 3.4). Medium HDI regions had the highest ASR of 9.7, compared to low, high and very high human development regions (7.1, 6.7 and 3.9, respectively). Temporal trend analysis revealed an overall decline in esophageal cancer mortality in premature populations across most countries. However, some countries demonstrated a clear increase, such as Iran (AAPC: 22.19, 95% CI: 11.08 to 34.42, p<0.001), Antigua and Barbuda (AAPC: 17.43, 95% CI: 14.04 to 20.92, p<0.001), and Greece (AAPC: 16.46, 95% CI: 6.70 to 27.11, p=0.001). While premature male deaths showed a mixed trend, premature female deaths underwent a drastic decline. In the older population, Iran (AAPC: 35.10, 95% CI: 11.15 to 35.10, p<0.001) displayed the most significant increase in esophageal cancer mortality, whereas Greece (AAPC: 49.21, 95% CI: 4.80 to 49.21) showed the greatest increase in the younger population.

Conclusions Esophageal cancer mortality in premature populations has declined globally in the past decade, particularly among females. However, significant regional variations were observed, with certain populations experiencing increasing trends in esophageal cancer mortality in premature populations.