| Objective: To analyze and compare the trends of disease burden for lung cancer worldwide and in China from 1990 to 2021, and to decompose the changes in lung cancer deaths and DALYs worldwide and in China comprehensively, aiming to provide scientific evidence for adjusting and optimizing China"s lung cancer prevention and control strategies.
Methods: Data on the disease burden of lung cancer from 1990 to 2021 and population demographics in 1990 and 2021 stratified by sex and age groups for global, five SDI quintiles regions, and eight countries including China, Japan, South Korea, the United Kingdom, France, the United States, Canada, and Australia were extracted from the Global Burden of Disease Study 2021 (GBD2021) database, along with ASMR and ASDR of lung cancer attributable to 7 level-3 risk factors in China for 1990 and 2021. Counterfactual analysis was used to decompose changes in lung cancer deaths and DALYs from 1990 to 2021 into four contributing factors: population size, population structure, lung cancer incidence or prevalence, and lung cancer case fatality (and disease severity). The percentage changes in lung cancer deaths and DALYs attributed to these four factors were calculated respectively.
Results: In 2021, there were 934,704 new cases and 814,364 deaths of lung cancer in China. From 1990 to 2021, the incidence, prevalence, mortality, and DALY rates of lung cancer in China increased rapidly faster than global and high-middle SDI region, which was similar to Japan and South Korea. In contrast, the mortality rates of lung cancer decreased in the United States and the United Kingdom, while the DALY rates of lung cancer decreased in the United States, the United Kingdom, Canada and Australia. From 1990 to 2021, the age-related lung cancer deaths and DALYs in China increased by 193.91% and 146.20%, respectively. The primary contributor to the increase in lung cancer deaths was population aging (102.82%) among men and rising lung cancer incidence (119.00%) among women, while the primary contributor to the increase in DALYs was rising lung cancer prevalence for both men (153.12%) and women (218.77%). In 2021, the top three risk factors contributing to lung cancer ASMR and ASDR in China were smoking, particulate matter pollution and occupational carcinogens. Compared with 1990, the ASMR of lung cancer and its proportion attributable to particulate matter pollution and diet low in fruits decreased, while the proportions in ASDR of lung cancer attributable to smoking and secondhand smoke increased.
Conclusion: Lung cancer is a major public health challenge in China. Compared with global, high-middle SDI region and certain developed countries, China has experienced faster growth in the incidence, prevalence, mortality and DALYs of lung cancer, especially among women. To reduce disease burden, improve quality of life, and ensure public welfare, targeted and sustained efforts on lung cancer prevention and control are urgently required in China. |
