Evolving trends in lung cancer risk factors in the ten most populous countries: an analysis of data from the 2019 Global Burden of Disease Study

Our plain-English summary of Evolving trends in lung cancer risk factors in the ten most populous countries: an analysis of data from the 2019 Global Burden of Disease Study, by C.T. Jani, S.A. Kareff, D. Morgenstern-Kaplan, et al (EClinicalMedicine, 2025).

The study

• Authors: C.T. Jani, S.A. Kareff, D. Morgenstern-Kaplan, A.S. Salazar, G. Hanbury, J.D. Salciccioli, D.C. Marshall, J. Shalhoub, H. Singh, E. Rodriguez, G. Lopes
• Journal: EClinicalMedicine
• Published: 2025;79:103033
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Amid shifting tobacco policies and escalating air pollution levels, Lung Cancer (LC) risk factors have changed notably. Continuous assessment of these risk factors is necessary. This study compares trends in tobacco, air pollution, and asbestos-associated Age-Standardized Mortality Rates (ASMR) from Trachea, Bronchus, and Lung (TBL) Cancer across the top ten most populated countries (2023 censuses) and globally.

Methods: We extracted overall and risk-factor-associated TBL cancer ASMR of the ten most populated countries for 1990-2019 from the Global Burden of Disease (GBD) database using the dedicated results tool (http://ghdx.healthdata.org/gbd-results-tool). GBD mapped the mortality data related to ICD codes (C33-C34, D02.1-D02.2, D38.1, 162-162.9, 231.1, 231.2, 231.8, 235.7 from ICD10 and B101 from ICD9). Tobacco, occupational exposure to asbestos and air pollution (ambient particulate matter and household air pollution) associated TBL cancer mortality data were extracted to evaluate the trends based on risk factors. We calculated relative changes in ASMRs between 1990 and 2019 for each sex in each country for each risk factor. Joinpoint regression analysis was performed to calculate the Estimated Annual Percentage Change (EAPC) and its corresponding 95% confidence interval (CI) for each line segment, allowing for trend assessment.

Findings: Globally, TBL Cancer mortality has decreased by 8%, with a decrease for males but an increase for females. Globally, both tobacco and air pollution-associated TBL cancer ASMR have decreased. While tobacco-associated ASMR has increased in China and Indonesia, air pollution-associated ASMR has also increased in China, India, Pakistan, and Nigeria. On stratification, while PM-associated mortality increased by 25% globally, household-associated TBL cancer ASMR decreased by 62%. China had the highest PM-associated TBL Cancer in 2019 (8.8/100,000), twice higher than the global average. Despite a decline in asbestos-associated TBL cancer ASMR from 8.91/100,000 to 6.0/100,000, the rate in the United States remained twice higher than the global average for the entire study period.

Interpretation: Tobacco-associated TBL cancer mortality is declining but still predominant. Ambient particulate matter-associated TBL cancer mortality is rising, requiring policy and awareness efforts. Expanding access to preventive services and addressing underlying risk factors are essential steps required toward reducing lung cancer mortality at the global level.

Funding: This study did not receive any funding support.

© 2024 The Authors.

In plain English

This observational analysis used estimates from the Global Burden of Disease (GBD) 2019 database. The authors extracted age-standardized trachea, bronchus and lung (TBL) cancer death rates for 1990 to 2019, worldwide and in the ten most populous countries, including rates that GBD associates with tobacco, air pollution and occupational asbestos exposure. Fiber types were not specified. Worldwide, the overall rate fell from 27.3 to 25.2 per 100,000. The asbestos-associated rate fell from 3.4 to 2.5 per 100,000, mainly among males (7.3 to 5.1), while the female rate stayed at 0.6. Males in the USA had by far the highest asbestos-associated rate (20.2 in 1990, 11.9 in 2019). Among males, asbestos-associated rates rose in India, China, Indonesia and Pakistan. Among females, they held steady or rose in every country except Mexico. The tobacco-associated share fell from 72% to 66%. The authors concluded that tobacco-associated mortality is declining but still predominant, while mortality associated with ambient particulate matter is rising. They described the work as observational and based on estimates.

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: Observational trend analysis of modeled Global Burden of Disease (GBD) 2019 estimates, using joinpoint regression to estimate annual percentage changes
• Who was studied: Populations of the whole world and of the ten most populous countries (by 2023 estimates): India, China, USA, Indonesia, Pakistan, Nigeria, Brazil, Bangladesh, Russia and Mexico, 1990 to 2019, by sex. The data are population-level estimates, not individual patients.
• Exposure: Tobacco, air pollution (ambient particulate matter and household air pollution from solid fuels) and occupational asbestos exposure, as modeled by GBD. Occupational asbestos exposure was estimated as the proportion of people aged 15 and older ever exposed, and an asbestos impact ratio derived from mesothelioma mortality was used in the calculations. No fiber types were specified.
• Main results:
  • Worldwide, the overall TBL cancer age-standardized mortality rate fell from 27.3 per 100,000 in 1990 to 25.2 per 100,000 in 2019.
  • Worldwide, the asbestos-associated TBL cancer rate fell from 3.4 per 100,000 in 1990 to 2.5 per 100,000 in 2019.
  • The worldwide fall was mainly among males (7.3 to 5.1 per 100,000). The worldwide rate among females stayed at 0.6 per 100,000 in both 1990 and 2019.
  • Among males in the USA, the asbestos-associated rate was by far the highest of the ten countries throughout the period: 20.2 per 100,000 in 1990 and 11.9 per 100,000 in 2019.
  • In the USA, asbestos-associated rates stayed twice as high as the global average for both males and females throughout the period.
  • Among males, asbestos-associated rates fell in 6 of the 10 countries and rose in India, China, Indonesia and Pakistan.
  • Among females, asbestos-associated rates were maintained or increased in every country except Mexico, which had a marginal reduction (0.3 to 0.2 per 100,000).
  • In the joinpoint analysis, recent asbestos-associated trends for males were rising in the USA (estimated annual percentage change 0.8%, 2016 to 2019). Recent trends for females were rising in all countries except Mexico and Brazil, with the highest increase in India (estimated annual percentage change 4.9%, 2010 to 2019).
  • Worldwide, the share of TBL cancer mortality associated with tobacco fell from 72% to 66%.
  • Worldwide, mortality associated with ambient particulate matter increased, while mortality associated with household air pollution fell (2.5 to 1.0 per 100,000).
• The authors' conclusion: The authors concluded that tobacco-associated TBL cancer mortality is declining globally but remains the most significant factor, and that mortality associated with ambient particulate matter is increasing and needs policy and awareness efforts.
• Limitations the authors state:
  • Disease coding changed over the study period, including the switch from ICD9 to ICD10.
  • The data vary between sources and countries, and death certification is unreliable, with global error rates of 39% to 61%.
  • The GBD data could not be split by the histologic type or stage of lung cancer.
  • The study is observational and based on estimates, so no causal inferences can be drawn beyond the risk-factor-associated rates.
  • Measurement bias in the risk exposure data may remain after GBD's adjustments.
  • The GBD database cannot link incidence directly to specific risk factors.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Bronchus, Occupational Exposure, confidence interval.

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