Abstract:  Objective    To analyze the incidence and mortality trends of gastric cancer from 2000 to 2019 in China. Methods    The descriptive epidemiologic method was conducted. Based on the Global Burden of Disease data from Institute for Health Metrics and Evaluation, the incidence rates, mortality rates, age-standardized incidence rates, age-standardized mortality rates of gastric cancer from 2000 to 2019 in China were collected. Observation indicators: (1) the incidence and mortality of gastric cancer in 2019 in China; (2) the age-standardized incidence and mortality of gastric cancer in 2019 in China; (3) the incidence trend of gastric cancer from 2000 to 2019 in China; (4) the mortality trend of gastric cancer from 2000 to 2019 in China. Count data were represented as absolute numbers, percentages with fractions. The incidence and mortality rates of gastric cancer were standardized by world standard population composition of Global Burden of Disease. Joinpoint software was used to construct a log-linear model for analysis of the changing trends of incidence and mortality rates over time in gastric cancer. Results    (1) The incidence and mortality of gastric cancer in 2019 in China: 612 821 gastric cancer cases occurred in China in 2019. The crude incidence rate was 43.1/100 000, and the age-standardized incidence rate was 30.6/100 000. There were 451 332 males, with the crude incidence rate of 62.3/100 000 and age-standardized incidence rate of 47.4/100 000. There were 161 489 females, with the crude incidence rate of 23.2/100 000 and age-standardized incidence rate of 15.8/100 000. The number of gastric cancer death was 421 539 in China in 2019, with the crude mortality rate of 29.6/100 000 and age-standardized mortality rate of 21.7/100 000. There were 298 514 males, with the crude mortality rate of 41.2/100 000 and age-standardized mortality rate of 33.1/100 000. There were 123 025 females, with the crude mortality rate of 17.6/100 000 and age-standardized mortality rate of 12.2/100 000, respectively. (2) The age-standardized incidence and mortality of gastric cancer in 2019 in China: the number of gastric cancer cases aged<40 years was 20 855 in China in 2019, of which there were 14 005 males and 6 850 females, accounting for 3.1% (14 005/451 332) and 4.2%(6 850/161 489), respectively. The number of gastric cancer cases aged 40-49 years was 45 903 in China in 2019, of which there were 34 659 males and 11 244 females, accounting for 7.7%(34 659/451 332) and 7.0%(11 244/161 489), respectively. The number of gastric cancer cases aged 50-59 years was 111 975 in China in 2019, of which there were 87 156 males and 24 819 females, accounting for 19.3%(87 156/451 332) and 15.4%(24 819/161 489), respectively. The number of gastric cancer cases aged 60-69 years was 180 434 in China in 2019, of which there were 137 939 males and 42 495 females, accounting for 30.6%(137 939/451 332) and 26.3%(42 495/161 489), respectively. The number of gastric cancer cases aged 70-79 years was 172 541 in China in 2019, of which there were 126 345 males and 46 196 females, accounting for 28.0%(126 345/451 332) and 28.6%(46 196/161 489), respectively. The number of gastric cancer cases aged >80 years was 81 113 in China in 2019, of which there were 51 228 males and 29 885 females, accounting for 11.4%(51 228/451 332) and 18.5%(29 885/161 489), respectively. The number of gastric cancer death cases aged<40 years was 8 463 in China in 2019, of which there were 5 508 males and 2 955 females, accounting for 1.8%(5 508/298 514) and 2.4%(2 955/123 025), respectively. The number of gastric cancer death cases aged 40-49 years was 22 651 in China in 2019, of which there were 16 780 males and 5 871 females, accounting for 5.6%(16 780/298 514) and 4.8%(5 871/123 025), respectively. The number of gastric cancer death cases aged 50-59 years was 63 870 in China in 2019, of which there were 48 638 males and 15 232 females, accounting for 16.3%(48 638/298 514) and 12.4%(15 232/123 025), respectively. The number of gastric cancer death cases aged 60-69 years was 115 771 in China in 2019, of which there were 86 240 males and 29 531 females, accounting for 28.9%(86 240/298 514) and 24.0%(29 531/123 025), respectively. The number of gastric cancer death cases aged 70-79 years was 130 623 in China in 2019, of which there were 92 917 males and 37 706 females, accounting for 31.1%(92 917/298 514) and 30.6%(37 706/123 025), respectively. The number of gastric cancer death cases aged >80 years was 80 161 in China in 2019, of which there were 48 431 males and 31 730 females, accounting for 16.2%(48 431/298 514) and 25.8%(31 730/123 025), respectively. (3) The incidence trend of gastric cancer from 2000 to 2019 in China: the crude incidence rate of gastric cancer in China increased from 30.5/100 000 in 2000 to 43.1/100 000 in 2019, with an average annual percentage change (AAPC) of 1.9% (95% confidence interval as 1.5 to 2.3, P<0.05). The crude incidence rate of gastric cancer in males increased from 39.9/100 000 in 2000 to 62.3/100 000 in 2019, with an AAPC of 2.4% (95% confidence interval as 1.9 to 2.8, P<0.05). The crude incidence rate of gastric cancer in females increased from 20.5/100 000 in 2000 to 23.2/100 000 in 2019, with an AAPC of 0.6%(95% confidence interval as 0.4 to 0.9, P<0.05). The age-standardized incidence rate of gastric cancer in China decreased from 35.7/100 000 in 2000 to 30.6/100 000 in 2019, with an AAPC of -0.8% (95% confidence interval as -1.2 to -0.3, P<0.05). The age-standardized incidence rate of gastric cancer in males decreased from 49.8/100 000 in 2000 to 47.4/100 000 in 2019, with an AAPC of -0.3% (95% confidence interval as -0.6 to 0.0, P<0.05). The age-standardized incidence rate of gastric cancer in females decreased from 22.8/100 000 in 2000 to 15.8/100 000 in 2019, with an AAPC of -1.9% (95% confidence interval as -2.2 to -1.7, P<0.05). (4) The mortality trend of gastric cancer from 2000 to 2019 in China: the crude motality rate of gastric cancer in China increased from 27.9/100 000 in 2000 to 29.6/100 000 in 2019, with an AAPC of 0.3% (95% confidence interval as 0.0 to 0.6, P<0.05). The crude motality rate of gastric cancer in males increased from 35.9/100 000 in 2000 to 41.2/100 000 in 2019, with an AAPC of 0.7% (95% confidence interval as 0.3 to 1.1, P<0.05). The crude motality rate of gastric cancer in females decreased from 19.4/100 000 in 2000 to 17.6/100 000 in 2019, with an AAPC of -0.5% (95% confidence interval as -0.8 to -0.2, P<0.05). The age-standardized mortality rate of gastric cancer in China decreased from 34.1/100 000 in 2000 to 21.7/100 000 in 2019, with an AAPC of -2.4% (95% confidence interval as -2.7 to -2.1, P<0.05). The age-standardized mortality rate of gastric cancer in China in males decreased from 47.5/100 000 in 2000 to 33.1/100 000 in 2019, with an AAPC of -1.9% (95% confidence interval as -2.2 to -1.7, P<0.05). The standardized mortality rate of gastric cancer in females decreased from 22.4/100 000 in 2000 to 12.2/100 000 in 2019, with an AAPC of -3.2% (95% confidence interval as -3.4 to -2.9, P<0.05). Conclusions    The incidence and mortality rates of gastric cancer in China from 2000 to 2019 present a downward trend. Male patients aged 60-69 years are at high risk of gastric cancer.