Burden of Lung Cancer Attributable to Occupational Carcinogens from 1990 to 2019 and Projections until 2044 in China

Our plain-English summary of Burden of Lung Cancer Attributable to Occupational Carcinogens from 1990 to 2019 and Projections until 2044 in China, by Y. Fan, Y. Jiang, X. Li, et al (Cancers, 2022).

The study

• Authors: Y. Fan, Y. Jiang, X. Li, X. Li, Y. Li, H. Wu, H. Pan, Y. Wang, Z. Meng, Q. Zhou, Y. Qiao
• Journal: Cancers
• Published: 2022;14(16)
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Little is known about trends in the lung cancer burden from the disease that can be attributed to occupational carcinogens in China.

Methods: Data regarding the lung cancer burden that can be attributed to occupational carcinogens in China were extracted from the Global Burden of Disease (GBD) study in 2019. Joinpoint regression analysis and an age-period-cohort (APC) analysis were conducted to estimate the trend of lung cancer burden as a result of occupational carcinogens from 1990 to 2019. A Bayesian APC model was used to predict the disease burden until 2044.

Results: The average annual percentage changes of age-standardized summary exposure values (SEVs) of occupational lung carcinogens, as well as the age-standardized population attributable fraction (PAF) of lung cancer due to occupational carcinogens, were 0.5% (95% confidence interval (CI): 0.4-0.5%) and 0.1% (95% CI: 0-0.2%), respectively. In addition, both the joinpoint regression analysis and APC analysis demonstrated significantly increased trends of age-standardized lung cancer mortality (ASMR) and age-standardized disability-adjusted life years (ASDR) as a result of occupational carcinogens. Asbestos and silica accounted for the two most important occupational lung carcinogens in China. The absolute burden is expected to increase, mainly due to population aging and the age-specific rate of illness.

Conclusions: The lung cancer burden that could be attributed to occupational carcinogens significantly increased from 1990 to 2019 in China, and the absolute burden will continue to increase in the next 25 years.

In plain English

This study reanalyzed Global Burden of Disease (GBD) 2019 estimates of lung cancer in China attributed to nine workplace carcinogens, including asbestos and silica, from 1990 to 2019, and projected the burden to 2044. In 2019, 62,861 such lung cancer deaths were estimated, 93.5% of the 67,264 cancer deaths the GBD attributed to occupational carcinogens. The age-standardized lung cancer death rate from these carcinogens rose by an average of 0.9% a year (95% CI 0.7–1.1%). It increased from 1990 to 2011 and decreased afterwards. Silica and asbestos were the two leading carcinogens. Asbestos replaced silica as the leading one for the age-standardized death rate and the attributable fraction of deaths. In an age-period-cohort analysis, asbestos was the only single carcinogen with a significantly increasing burden. Asbestos was reported as one category, without estimates by fiber type. Projected age-standardized rates fell, but the number of deaths in 2044 was 111,195 higher than in 1990, mainly because of population aging. The authors concluded the absolute burden will keep rising. They noted the exposure data came mainly from European Union countries.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Secondary analysis of publicly available Global Burden of Disease 2019 estimates, using joinpoint regression, age-period-cohort analysis, a Bayesian age-period-cohort projection to 2044, and decomposition analysis
• Who was studied: Population of China, GBD 2019 estimates for lung cancer (tracheal, bronchial and lung cancer) attributed to occupational carcinogens, 1990 to 2019, with projections to 2044; the age-period-cohort analysis covered ages 25 to 95-plus
• Exposure: Nine occupational carcinogens as modeled by GBD 2019: arsenic, asbestos (one combined category, no fiber-specific estimates), beryllium, cadmium, chromium, diesel engine exhaust, nickel, polycyclic aromatic hydrocarbons and silica, individually and combined
• Main results:
  • China, 2019: of 67,264 deaths and 1,639,492 DALYs from cancer attributed to occupational carcinogens (all carcinogens and cancer types assessed), lung cancer made up 93.5% (62,861) of the deaths and 92.1% (1,509,863) of the DALYs
  • Percentage change 1990 to 2019, printed as 0.31 (95% UI: 0.01–0.71) for the age-standardized death rate (ASMR), which was significant, and 0.14 (95% UI: −0.12–0.50) for the age-standardized DALY rate (ASDR), which was not
  • Joinpoint regression, average annual percentage changes 1990 to 2019: ASMR 0.9% (95% CI: 0.7–1.1%), ASDR 0.4% (95% CI: 0.2–0.7%), age-standardized PAF for deaths 0.1% (95% CI: 0–0.3%), age-standardized PAF for DALYs 0.1% (95% CI: 0–0.2%); age-standardized exposure value (SEV) 0.5% (95% CI: 0.4–0.5%)
  • Age-standardized death and DALY rates rose significantly from 1990 to 2011, most steeply from 1998 to 2002, and then showed significant decreasing trends
  • Age-period-cohort analysis, all occupational carcinogens combined: net drift in lung cancer deaths was 0.79 (95% CI: 0.48–1.10) per year, a significant increase after removing age and birth-cohort effects
  • Silica and asbestos were the two leading occupational lung carcinogens, followed by diesel engine exhaust. Over 1990 to 2019, asbestos replaced silica as the leading carcinogen for age-standardized PAF and ASMR of deaths, while silica remained highest for age-standardized PAF and ASDR of DALYs
  • Among individual carcinogens, a significantly increased burden was seen only for asbestos: net drifts of ASMR 2.39 (95% CI: 0.99, 3.81) and ASDR 2.42 (95% CI: 1.56, 3.29)
  • For silica, the net drifts of ASMR and ASDR were not statistically significant
  • Projection to 2044: ASMR and ASDR were projected to decrease gradually, but the number of deaths in 2044 was projected to be 111,195 higher than in 1990, an increase of 540.5%. This increase was attributed to population aging (332.0%), age-specific rate (148.8%) and population growth (59.7%)
  • Projected DALYs rose from 586,721 in 1990 to 1,672,111 in 2044 (printed as 285.0%), driven by population aging (195.2%), age-specific rate (48.0%) and population growth (41.8%)
• The authors' conclusion: The authors concluded that the lung cancer burden from occupational carcinogens in China still increased from 1990 to 2019. They also concluded that, although projected age-standardized rates decline, the absolute number will still increase over the next 25 years because of rapid population aging.
• Limitations the authors state:
  • The burden from erionite, chloromethyl methyl ether and bis(chloromethyl) ether was not estimated
  • Exposure prevalence came mainly from the CAREX database, built from 15 European Union countries in 1990 to 1993
  • The relative risks used came from studies conducted in developed countries
  • Interactions between occupational carcinogens and other risk factors, such as asbestos and smoking, were not taken into account
  • Projections over longer time spans were less precise

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Population Attributable Fraction (PAF), confidence interval.

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