Tobacco-attributable lung cancer burden and trends from 1990 to 2021: A global comparison with focus on China and the United States_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LONG Hai ¹ , WANG Xi ² , LI Fu ³ , BAI Zhichao ⁴ , YAO Mei ⁵ , AN Yijun ⁶ , YANG Kang ¹ , ZENG Teng ¹ ,  HUANG Yunchao ^1,2

1. Department of Thoracic Surgery (Thoracic Tumor Center Subcenter), Northeast Yunnan Central Hospital, Zhaotong, 657000, Yunnan, P. R. China;
2. Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital, Kunming, 650000, P. R. China;
3. The First Clinical College of Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
4. Department of Medical Oncology, Northeast Yunnan Central Hospital, Yunnan Province, Zhaotong, 657000, Yunnan, P. R. China;
5. Department of Respiratory Medicine, Northeast Yunnan Central Hospital, Zhaotong, 657000, Yunnan, P. R. China;
6. Department of Radiotherapy, Northeast Yunnan Central Hospital, Zhaotong, 657000, Yunnan, P. R. China;

Corresponding author：

HUANG Yunchao, Email: huangych2001@aliyun.com

Keywords：

Tobacco; lung cancer; disease burden; change trends; Joinpoint modeling; prediction; China; United States

DOI：

10.7507/1007-4848.202502080

Video：

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Objective To analyze the gender-specific distribution patterns of the disease burden of tracheal, bronchial, and lung cancer (hereinafter referred to as lung cancer) attributed to tobacco from 1990 to 2021 globally and in China and the United States (US), and to predict the trend of disease burden changes from 2022 to 2031, aiming to provide multi-dimensional evidence-based support for optimizing tobacco control strategies and precise lung cancer prevention and control systems. Methods Data on the disease burden of lung cancer attributed to tobacco from 1990 to 2021 globally and in China and the US were extracted and integrated from the Global Burden of Disease (GBD) 2021 database. The Joinpoint 4.9.1.0 software was used to analyze the corresponding trends in disease burden. The Bayesian age-period-cohort (BAPC) prediction model was employed to forecast the disease burden of lung cancer from 2022 to 2031. Results In 2021, China had the highest number of deaths and disability-adjusted life years (DALY) due to lung cancer attributed to tobacco, with 544600 patients and 12.5721 million person-years respectively, followed by the US with 105200 patients and 2.3096 million person-years. The top three risk factors for lung cancer globally and in China and the US from 1990 to 2021 were tobacco, air pollution, and occupational risks. The disease burden of lung cancer patients attributed to tobacco has been decreasing year by year in the global and US populations [the average annual percentage change (AAPC) values of age-standardized mortality rate and DALY rate were: globally: −0.96%, −1.28%; US: −2.33%, −2.72%], while it has been increasing in China (the AAPC values of age-standardized mortality rate and DALY rate were 0.28% and −0.02%, respectively). From a gender perspective, the disease burden of male patients with lung cancer attributed to tobacco was much higher than that of female patients from 1990 to 2021. Compared to the global average, the disease burden of lung cancer attributed to tobacco in China and the US from 1990 to 2021 was still heavy, with China's burden being higher than that of the US. The elderly population aged ≥65 years in both the global context and in China and the US was the primary group affected by the disease burden of lung cancer attributed to tobacco. The BAPC prediction model indicated that from 2022 to 2031, the age-standardized rates of lung cancer attributed to tobacco in the global context and in China and the US would show a declining trend. Conclusion From 1990 to 2021, the disease burden of lung cancer attributed to tobacco in China and the US was still heavy compared to the global average, with China's burden being significantly higher than that of the US. The focus on prevention and control for both countries remains among the middle-aged and elderly population (especially males), which is a key challenge for tobacco-related lung cancer prevention and treatment work in the next 10 years.

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2.	Liu X, Yu Y, Wang M, et al. The mortality of lung cancer attributable to smoking among adults in China and the United States during 1990-2017. Cancer Commun (Lond), 2020, 40(11): 611-619.
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4.	Global Burden of Disease Collaborative Network. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019. Lancet, 2021, 397(10292): 2337-2360.
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7.	胡守财, 陶堰成, 马浩天, 等. 1990—2019年中国非风湿性瓣膜性心脏病疾病负担及变化趋势分析. 中国循环杂志, 2024, 39(8): 806-812.Hu SC, Tao YC, Ma HT, et al. Disease burden and changing trend of non-rheumatic valvular heart disease from 1990 to 2019 in China. Chin Circ J, 2024, 39(8): 806-812.
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9.	胡守财, 杨成龙, 马浩天, 等. 1990—2019年中国饮酒所致的食管癌疾病负担趋势及男女对比分析. 中国胸心血管外科临床杂志, 2025, 32(4): 500-507.Hu SC, Yang CL, Ma HT, et al. Trends in Chinese esophageal cancer burden of disease due to high alcohol use and comparative analysis of males and females from 1990 to 2019. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(4): 500-507.
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12.	Yang D, Liu Y, Bai C, et al. Epidemiology of lung cancer and lung cancer screening programs in China and the United States. Cancer Lett, 2020, 468: 82-87.
13.	Tang S, Meng J, Zhao X, et al. Trends of ischemic heart disease mortality attributable to smoking in the five countries with the highest number of smokers during 1990-2019: An age-period-cohort analysis. Arch Med Sci, 2024, 20(1): 43-53.
14.	Ma J, Jemal A, Fedewa SA, et al. The American Cancer Society 2035 challenge goal on cancer mortality reduction. CA Cancer J Clin, 2019, 69(5): 351-362.
15.	Zhang R, He Y, Wei B, et al. Nasopharyngeal carcinoma burden and its attributable risk factors in China: Estimates and forecasts from 1990 to 2050. Int J Environ Res Public Health, 2023, 20(4): 2926.
16.	Deng Y, Zhao P, Zhou L, et al. Epidemiological trends of tracheal, bronchus, and lung cancer at the global, regional, and national levels: A population-based study. J Hematol Oncol, 2020, 13(1): 98.
17.	Global Burden of Disease Collaborative Network. Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Respir Med, 2021, 9(9): 1030-1049.
18.	Rumgay H, Cabasag CJ, Offman J, et al. International burden of cancer deaths and years of life lost from cancer attributable to four major risk factors: A population-based study in Brazil, Russia, India, China, South Africa, the United Kingdom, and United States. EClinicalMedicine, 2023, 66: 102289.
19.	Hansen MS, Licaj I, Braaten T, et al. Smoking related lung cancer mortality by education and sex in Norway. BMC Cancer, 2019, 19(1): 1132.
20.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
21.	Frick C, Rumgay H, Vignat J, et al. Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: A population-based study. Lancet Glob Health, 2023, 11(11): e1700-e1712.
22.	Catelan D, Biggeri A, Bucchi L, et al. Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969). Int J Cancer, 2023, 153(10): 1746-1757.
23.	Guo L, Zhu C, Cai L, et al. Global burden of lung cancer in 2022 and projected burden in 2050. Chin Med J (Engl), 2024, 137(21): 2577-2582.
24.	Desjardin JT, Chikwe J, Hahn RT, et al. Sex differences and similarities in valvular heart disease. Circ Res, 2022, 130(4): 455-473.
25.	Jin EH, Han K, Shin CM, et al. Sex and tumor-site differences in the association of alcohol intake with the risk of early-onset colorectal cancer. J Clin Oncol, 2023, 41(22): 3816-3825.
26.	Li S, Chen H, Man J, et al. Changing trends in the disease burden of esophageal cancer in China from 1990 to 2017 and its predicted level in 25 years. Cancer Med, 2021, 10(5): 1889-1899.
27.	Turner MC, Andersen ZJ, Baccarelli A, et al. Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. CA Cancer J Clin, 2020, 70(6): 460-479.
28.	Yu G, Gong X, Xu Y, et al. The global burden and trends of four major types of heart disease, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Public Health, 2023, 220: 1-9.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Liu X, Yu Y, Wang M, et al. The mortality of lung cancer attributable to smoking among adults in China and the United States during 1990-2017. Cancer Commun (Lond), 2020, 40(11): 611-619.
3. Fan Y, Jiang Y, Gong L, et al. Epidemiological and demographic drivers of lung cancer mortality from 1990 to 2019: Results from the global burden of disease study 2019. Front Public Health, 2023, 11: 1054200.
4. Global Burden of Disease Collaborative Network. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: A systematic analysis from the Global Burden of Disease Study 2019. Lancet, 2021, 397(10292): 2337-2360.
5. Global Burden of Disease Collaborative Network. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: A systematic analysis from the Global Burden of Disease Study 2015. Lancet, 2017, 389(10082): 1885-1906.
6. Global Burden of Disease Collaborative Network. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
7. 胡守财, 陶堰成, 马浩天, 等. 1990—2019年中国非风湿性瓣膜性心脏病疾病负担及变化趋势分析. 中国循环杂志, 2024, 39(8): 806-812.Hu SC, Tao YC, Ma HT, et al. Disease burden and changing trend of non-rheumatic valvular heart disease from 1990 to 2019 in China. Chin Circ J, 2024, 39(8): 806-812.
8. Rehman S, Rehman E, Ikram M, et al. Cardiovascular disease (CVD): Assessment, prediction and policy implications. BMC Public Health, 2021, 21(1): 1299.
9. 胡守财, 杨成龙, 马浩天, 等. 1990—2019年中国饮酒所致的食管癌疾病负担趋势及男女对比分析. 中国胸心血管外科临床杂志, 2025, 32(4): 500-507.Hu SC, Yang CL, Ma HT, et al. Trends in Chinese esophageal cancer burden of disease due to high alcohol use and comparative analysis of males and females from 1990 to 2019. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(4): 500-507.
10. 黄俊, 江晶晶, 邵慧娟, 等. 1990—2019年我国酒精性肝病的疾病负担分析. 现代预防医学, 2023, 50(20): 3800-3811.Huang J, Jiang JJ, Shao HJ, et al. Disease burden analysis of alcoholic liver disease in China, 1990-2019. Mod Prev Med, 2023, 50(20): 3800-3811.
11. 冷雪, 肖文艳, 郑娟, 等. 1990—2019年中国先天性出生缺陷疾病负担分析. 中国循证医学杂志, 2023, 23(4): 386-390.Leng X, Xiao WY, Zheng J, et al. Disease burden analysis of congenital birth defects in China from 1990 to 2019. Chin J Evid-Based Med, 2023, 23(4): 386-390.
12. Yang D, Liu Y, Bai C, et al. Epidemiology of lung cancer and lung cancer screening programs in China and the United States. Cancer Lett, 2020, 468: 82-87.
13. Tang S, Meng J, Zhao X, et al. Trends of ischemic heart disease mortality attributable to smoking in the five countries with the highest number of smokers during 1990-2019: An age-period-cohort analysis. Arch Med Sci, 2024, 20(1): 43-53.
14. Ma J, Jemal A, Fedewa SA, et al. The American Cancer Society 2035 challenge goal on cancer mortality reduction. CA Cancer J Clin, 2019, 69(5): 351-362.
15. Zhang R, He Y, Wei B, et al. Nasopharyngeal carcinoma burden and its attributable risk factors in China: Estimates and forecasts from 1990 to 2050. Int J Environ Res Public Health, 2023, 20(4): 2926.
16. Deng Y, Zhao P, Zhou L, et al. Epidemiological trends of tracheal, bronchus, and lung cancer at the global, regional, and national levels: A population-based study. J Hematol Oncol, 2020, 13(1): 98.
17. Global Burden of Disease Collaborative Network. Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Respir Med, 2021, 9(9): 1030-1049.
18. Rumgay H, Cabasag CJ, Offman J, et al. International burden of cancer deaths and years of life lost from cancer attributable to four major risk factors: A population-based study in Brazil, Russia, India, China, South Africa, the United Kingdom, and United States. EClinicalMedicine, 2023, 66: 102289.
19. Hansen MS, Licaj I, Braaten T, et al. Smoking related lung cancer mortality by education and sex in Norway. BMC Cancer, 2019, 19(1): 1132.
20. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
21. Frick C, Rumgay H, Vignat J, et al. Quantitative estimates of preventable and treatable deaths from 36 cancers worldwide: A population-based study. Lancet Glob Health, 2023, 11(11): e1700-e1712.
22. Catelan D, Biggeri A, Bucchi L, et al. Epidemiologic transition of lung cancer mortality in Italy by sex, province of residence and birth cohort (1920-1929 to 1960-1969). Int J Cancer, 2023, 153(10): 1746-1757.
23. Guo L, Zhu C, Cai L, et al. Global burden of lung cancer in 2022 and projected burden in 2050. Chin Med J (Engl), 2024, 137(21): 2577-2582.
24. Desjardin JT, Chikwe J, Hahn RT, et al. Sex differences and similarities in valvular heart disease. Circ Res, 2022, 130(4): 455-473.
25. Jin EH, Han K, Shin CM, et al. Sex and tumor-site differences in the association of alcohol intake with the risk of early-onset colorectal cancer. J Clin Oncol, 2023, 41(22): 3816-3825.
26. Li S, Chen H, Man J, et al. Changing trends in the disease burden of esophageal cancer in China from 1990 to 2017 and its predicted level in 25 years. Cancer Med, 2021, 10(5): 1889-1899.
27. Turner MC, Andersen ZJ, Baccarelli A, et al. Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. CA Cancer J Clin, 2020, 70(6): 460-479.
28. Yu G, Gong X, Xu Y, et al. The global burden and trends of four major types of heart disease, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Public Health, 2023, 220: 1-9.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesTobacco-attributable lung cancer burden and trends from 1990 to 2021: A global comparison with focus on China and the United States

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