Global, regional and national burden of lung cancer attributable to PM2.5 air pollution: Trends from 1990 to 2021 with projections to 2045

Lung cancer is a leading cause of cancer-related mortality worldwide. Particulate matter ≤2.5 μm (PM_2.5) air pollution, including ambient PM_2.5 and household PM_2.5, is a significant risk factor for this disease. However, an updated and comprehensive assessment of lung cancer burden attributable to PM_2.5 remains limited. We evaluated the deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of lung cancer attributable to total, ambient, and household PM_2.5 at the global, regional, and national levels, using the Global Burden of Disease (GBD) 1990–2021 data. The estimated annual percentage change (EAPC) was used to analyze the trends in the ASMR and ASDR. Age, sex, and the socio-demographic index (SDI) were considered. In 2021, PM_2.5 exposure accounted for approximately 0.37 million deaths and 8.9 million DALYs of lung cancer. East Asia had the highest lung cancer burden attributable to total PM_2.5. From 1990 to 2021, the global lung cancer burden attributable to both total PM_2.5 and household PM_2.5 decreased, whereas that attributable to ambient PM_2.5 increased. Furthermore, the ASDR/ASMR attributable to ambient PM_2.5 were positively related to the SDI, whereas those attributable to household PM_2.5 were negatively related. Global lung cancer deaths and DALYs attributable to ambient PM_2.5 are expected to rise continuously up to 2045. In summary, this study emphasizes the need for strengthened, region-tailored air quality policies to reduce the lung cancer burden attributable to PM_2.5 and to narrow regional inequalities.