Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019

Our plain-English summary of Global burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019, by Y. Zhang, M. Mi, N. Zhu, et al (Annals of Medicine, 2023).

The study

• Authors: Y. Zhang, M. Mi, N. Zhu, Z. Yuan, Y. Ding, Y. Zhao, Y. Lu, S. Weng, Y. Yuan
• Journal: Annals of Medicine
• Published: 2023;55(1):2206672
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Occupational-related cancers are a substantial global health issue. The largest proportion of occupational-related cancers is tracheal, bronchus, and lung (TBL) cancer. This study aimed to explore the geographical and temporal trends in occupational carcinogens related to TBL cancer.

Methods: Data on TBL cancer attributable to occupational carcinogens were collected from the Global Burden of Disease Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs), and corresponding average annual percentage change (AAPC) were evaluated and stratified by geographic location, socio-demographic index (SDI) quintiles, age, and sex.

Results: Globally, ASRs of deaths and DALYs in TBL cancer attributable to occupational carcinogens showed a downward trend (AAPC = - 0.69%, - 1.01%) while increases were observed in the low, low-middle, and middle SDI quintiles. Although males accounted for 82.4% and 81.5% of deaths and DALYs in 2019, respectively, it showed an upward trend of ASRs in females (AAPC = 0.33%, 0.02%). Occupational exposure to asbestos, silica and diesel engine exhaust were the top three causes of age-standardized TBL cancer deaths and DALYs. Over the past three decades, the percentage of age-standardized TBL cancer deaths and DALYs attributable to occupational asbestos and silica exposure decreased by 18.24, 6.71 and 20.52%, 4.00% globally, but increased significantly in lower SDI regions, while the burden attributable to occupational diesel engine exhaust exposure increased by 32.76, 37.23% worldwide.

Conclusions: Occupational exposure remains an important risk factor for TBL cancer. The burden of TBL cancer attributable to occupational carcinogens showed obvious heterogeneity which decreased in higher SDI but increased in lower SDI regions. The burden of males was significantly higher than females, but the females showed an increasing trend. Occupational exposure to asbestos was the main causes of the burden. Therefore, effective prevention and control measures tailored to local conditions are necessary.

In plain English

This study re-analyzed Global Burden of Disease (GBD) 2019 modeled estimates of tracheal, bronchus and lung (TBL) cancer attributed to nine workplace carcinogens in 204 countries and territories, 1990 to 2019. In 2019, 289,793 deaths (95% interval 221,524 to 359,238) and 5,948,985 disability-adjusted life years, or DALYs (4,520,238 to 7,484,430), were attributed to them worldwide. From 1990 to 2019, deaths rose 70.63% and DALYs 53.73%, but the age-standardized death rate fell 0.69% per year on average (95% CI −0.72% to −0.67%). Rates rose in the low, low-middle and middle socio-demographic index groups. Men accounted for 82.4% of deaths in 2019. Among women, the age-standardized death rate rose 0.33% yearly; their DALY-rate trend (0.02%, 95% CI −0.01% to 0.04%) was not statistically significant. Occupational asbestos exposure accounted for the most DALYs throughout (3,365,428.55 in 2019), followed by silica and diesel engine exhaust. Asbestos was the top risk at ages 60 and over. Estimated asbestos exposure levels declined. Asbestos-attributed rates fell in men, rose slightly in women. The authors named these three the top factors and noted the burden is likely underestimated.

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 Global Burden of Disease 2019 estimates (attributable burden, trend analysis with joinpoint regression, age-period-cohort modeling)
• Who was studied: Estimated TBL cancer deaths and DALYs attributable to occupational carcinogens in 204 countries and territories, 1990 to 2019, broken down by socio-demographic index group, region, age and sex
• Exposure: Nine occupational carcinogens as defined by GBD 2019: arsenic, asbestos, beryllium, cadmium, chromium, diesel engine exhaust, nickel, polycyclic aromatic hydrocarbons and silica. Asbestos fiber types were not specified.
• Main results:
  • Globally in 2019, 289,793 deaths (95% interval, labeled CI in the article, 221524–359238) and 5,948,985 DALYs (4520238–7484430) from TBL cancer were attributed to occupational carcinogens (all nine combined)
  • From 1990 to 2019, global deaths and DALYs attributed to occupational carcinogens increased by 70.63% and 53.73%
  • The global age-standardized death rate fell from 1990 to 2019, with an average annual percentage change of −0.69% (95% CI, −0.72 to −0.67%)
  • Age-standardized death and DALY rates rose in the low, low-middle and middle socio-demographic index groups
  • In 2019, males accounted for 82.4% of attributable deaths and 81.5% of attributable DALYs
  • Among females, the age-standardized death rate rose, with an average annual percentage change of 0.33% (95% CI, 0.29–0.36%). The female age-standardized DALY rate change was 0.02% (95% CI, −0.01–0.04%), and the article's table does not mark it as statistically significant.
  • Occupational asbestos exposure accounted for the largest number of attributable DALYs (2,410,020.29 in 1990; 3,365,428.55 in 2019), followed by silica and then diesel engine exhaust
  • The estimated exposure level (age-standardized summary exposure value) for occupational asbestos showed a downward trend from 1990 to 2019, as did nickel
  • Age-standardized rates of TBL cancer attributed to occupational asbestos exposure fell in males and rose slightly in females
  • Asbestos was the leading occupational risk in the 60–79 and 80-plus age groups; silica led in the 20–39 and 40–59 age groups
  • Asbestos accounted for the highest share of attributable age-standardized deaths and DALYs, especially in Australasia, Western Europe and high-income North America
  • In 2019 the United States, China and Japan had the most TBL cancer deaths and DALYs attributed to occupational asbestos exposure
• The authors' conclusion: The authors concluded that occupational exposure to asbestos, silica and diesel engine exhaust were the top three factors responsible for the burden of occupational TBL cancer, and that trends varied by socio-demographic index group, sex and age
• Limitations the authors state:
  • GBD data depend on the quality and quantity of data collected. The figures likely underestimate the true burden, partly because some less developed regions lack high-quality cancer registries.
  • Workforce data for some countries were extrapolated by modeling from regional data, which would have introduced information bias
  • Only nine of the occupational carcinogens linked to lung cancer were included in GBD 2019. Others, such as welding fumes and radon, were left out, so their burden may have been underestimated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

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

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