Temporal trends in the burden of tracheal, bronchial, and lung cancer in China and globally: A comprehensive analysis from 1990 to 2021

Abstract

Background

Tracheal, bronchial, and lung (TBL) cancer remains a leading cause of cancer-related deaths globally, with its burden influenced by aging populations, smoking, air pollution, and advances in treatment. China, as one of the most affected countries, faces significant challenges due to rapid industrialization and an aging population. This study aimed to systematically assess the temporal trends and disease burden of tracheal, bronchial, and lung cancer in China from 1990 to 2021, in comparison with global patterns, to provide evidence for targeted prevention and public health policymaking.

Methods

Using data from the Global Burden of Disease (GBD) database (1990–2021), this study analyzed trends in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of TBL cancer in China and globally. Joinpoint regression analysis was applied to identify significant changes in trends over time, and the average annual percentage change (AAPC) was calculated to quantify the overall temporal trends. Statistical significance was evaluated using Permutation tests, with results reported as 95 % confidence intervals (95 % CI).

Results

In 2021, China accounted for 41.0 % (934,704 of 2,280,688) of global incident cases, 38.8 % (1,262,275 of 3,253,729) of global prevalent cases, 40.4 % (814,364 of 2,016,547) of global deaths, and 40.7 % (18,920,203 of 46,536,272) of global DALYs. The AAPC for China’s age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) were 0.9 % (95 % CI: 0.8 % to 1.1 %, P < 0.05), 1.8 % (95 % CI: 1.6 % to 2.0 %, P < 0.05), 0.4 % (95 % CI: 0.2 % to 0.6 %, P < 0.05), and 0.1 % (95 % CI: 0.1 % to 2.0 %, P > 0.05), respectively, while the global AAPCs were −0.3 % (95 % CI: −0.4 % to −0.2 %, P < 0.05), 0.3 % (95 % CI: 0.2 % to 0.4 %, P < 0.05), −0.5 % (95 % CI: −0.7 to −0.4 %, P < 0.05) and −0.9 % (95 % CI: −1.0 % to −0.8 %, P < 0.05). Notably, over the last two decades, the growth rate of China’s ASIR has slowed, the ASMR and ASDR stopped rising and showed a significant decline compared to previous trends. The burden of TBL cancer varied by age and gender; over the past decade, the ASIR, ASMR, and ASDR for males in China have shown a declining trend, whereas the rates for females have increased. Additionally, the peak age of burden has shifted to older age groups compared to 1990.

Conclusion

China bears a significant share of the global burden of TBL cancer. Over the last two decades, the growth rate of China’s ASIR has slowed, while its ASMR and ASDR have declined, potentially attributable to advancements in targeted therapies and immunotherapies.