The Burden of Trachea, Bronchus, and Lung Cancer Attributable to Occupational Exposure From 1990 to 2019

Our plain-English summary of The Burden of Trachea, Bronchus, and Lung Cancer Attributable to Occupational Exposure From 1990 to 2019, by H. Li, J. Guo, H. Liang, et al (Frontiers in Public Health, 2022).

The study

• Authors: H. Li, J. Guo, H. Liang, T. Zhang, J. Zhang, L. Wei, D. Shi, J. Zhang, Z. Wang
• Journal: Frontiers in Public Health
• Published: 2022;10:928937
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Occupational exposure to carcinogens is associated with trachea, bronchus, and lung (TBL) cancer. The objective of this study was to provide global and regional estimates of the burden of TBL cancer associated with occupational carcinogens (OCs) between 1990 and 2019.

Methods: Age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALYs) rates (ASDR) of TBL cancer related to exposure to OCs at the global and regional levels were extracted for 1990-2019 from the Global Burden of Disease 2019. Joinpoint regression was used to analyze trends in the ASMR and ASDR of TBL cancer burden related to OCs, and the annual percent change and the average annual percent change (AAPC) were recorded.

Results: The mortality from TBL cancer related to exposure to OCs increased globally. The ASMR and ASDR decreased in both sexes and in men between 1990 and 2019. The AAPC of ASMR and ASDR decreased in men between 1990 and 2019, but increased in women. Asbestos accounted for the highest death number and beryllium accounted for the lowest; diesel engine exhaust caused the largest percentage change in death number (145.3%), in ASDR (14.9%), and in all ages DALY rates (57.6%). Asbestos accounted for the largest death number in high social development index (SDI) countries, whereas low-middle SDI countries had the largest percent change (321.4%). Asbestos was associated with decreased ASDR in high SDI countries and increased ASDR in low-middle SDI countries, and similar changes were observed for other OCs.

Conclusions: The overall mortality and DALYs of TBL cancer burden related to OCs showed a decreasing trend between 1990 and 2019, whereas death number increased. Asbestos accounted for the highest death number. TBL cancer burden related to OCs decreased to different degrees in high, low, low-middle, and middle SDI countries, which showed variable levels of TBL cancer burden related to exposure to OCs (except asbestos).

Copyright © 2022 Li, Guo, Liang, Zhang, Zhang, Wei, Shi, Zhang and Wang.

In plain English

This study used Global Burden of Disease 2019 estimates of trachea, bronchus and lung cancer attributed to nine workplace carcinogens, including asbestos, from 1990 to 2019, worldwide and by countries' social development index (SDI). It reported deaths and disability-adjusted life years (DALYs, a measure of healthy life lost) and analyzed trends with joinpoint regression. In 2019 an estimated 289,793.1 of these cancer deaths (95% uncertainty interval 221,524.1 to 359,237.6) were attributed to the nine carcinogens combined. Asbestos accounted for the most: estimated asbestos-attributable deaths rose from 122,205.8 (86,779 to 158,141.8) in 1990 to 198,703 (140,365.9 to 257,408) in 2019. In high-SDI countries they rose from 87,162.1 (62,583.3 to 110,324.8) to 119,560.5 (87,245.8 to 151,754.3). The age-standardized DALY rate there fell from 154.54 (109.2 to 198.9) to 96.1 (68.04 to 123.14) per 100,000. In low-middle SDI countries that rate rose by 62.3%. Age-standardized death rates for the nine combined fell in men and in both sexes together, but rose slightly in women. The authors concluded that asbestos remains the biggest occupational cause of these cancers. They noted that global-level data may not apply to every country.

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 (GBD) 2019 estimates: descriptive analysis plus joinpoint regression of trends
• Who was studied: Global population and countries grouped into five social development index (SDI) levels, plus 21 GBD regions, 1990 to 2019. The cancers studied were trachea, bronchus and lung cancer attributed to occupational carcinogens.
• Exposure: Nine occupational carcinogens from the GBD risk factor list: arsenic, asbestos, beryllium, cadmium, chromium, diesel engine exhaust, nickel, polycyclic aromatic hydrocarbons and silica. Asbestos fiber types were not specified.
• Main results:
  • In 2019, for both sexes worldwide, an estimated 289,793.1 trachea, bronchus and lung cancer deaths (95% UI 221524.1–359237.6) were attributed to the nine occupational carcinogens combined.
  • Among the nine carcinogens, asbestos accounted for the most deaths and beryllium for the fewest.
  • Globally, asbestos-attributable deaths rose from 122,205.8 (95% UI 86779–158141.8) in 1990 to 198,703 (95% UI 140365.9–257408) in 2019. The article states this as a change of 78.8% (see text problems).
  • Globally, the asbestos-attributable age-standardized DALY rate was 62.6 per 100,000 (95% UI 43.98–81.92) in 1990 and 41.71 (29.02–54.99) in 2019.
  • In high-SDI countries, asbestos-attributable deaths rose from 87,162.1 (95% UI 62583.3–110324.8) in 1990 to 119,560.5 (95% UI 87245.8–151754.3) in 2019 (37.2%). This was the largest asbestos death number of any SDI group.
  • In high-SDI countries, the asbestos-attributable age-standardized DALY rate was 154.54 per 100,000 (95% UI 109.2–198.9) in 1990 and 96.1 (95% UI 68.04–123.14) in 2019.
  • Low-middle SDI countries had the largest percentage change in asbestos-attributable deaths: 321.4%, from 1864.2 in 1990 to 7856.3 in 2019 (Table 2).
  • The asbestos-attributable age-standardized DALY rate fell by 37.8% in high-SDI countries and rose by 62.3% in low-middle SDI countries.
  • For all nine carcinogens combined, the average annual percent change in the age-standardized death rate was −0.7 (95% CI −0.9 to −0.6) for both sexes, −1.0 (−1.2 to −0.8) for men and 0.4 (0.3 to 0.4) for women. All three were statistically significant.
  • Diesel engine exhaust had the largest percentage change in deaths among the nine carcinogens (145.3%).
• The authors' conclusion: The authors concluded that age-standardized death and DALY rates from occupational-carcinogen-related trachea, bronchus and lung cancer fell globally, but death numbers rose. They also concluded that asbestos remains the biggest occupational cause of these cancers.
• Limitations the authors state:
  • Aggregate data were obtained at the global level rather than the national level, so the conclusions may not apply to each country.
  • Possible interactions between occupational carcinogens and other risk factors were not considered.
  • The authors state that each occupational carcinogen related to these cancers should be investigated further.

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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• 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 — Y. Zhang, M. Mi, et al. (2023)
• A comparative study of the disease burden attributable to asbestos in Brazil, China, Kazakhstan, and Russia between 1990 and 2019 — J. Chen, C. Wang, et al. (2022)
• Global, regional, and national burden of non-communicable diseases attributable to occupational asbestos exposure 1990-2019 and prediction to 2035: worsening or improving? — X. Miao, T. Yao, et al. (2024)
• Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019 — Z. Chen, Y. Cai, et al. (2024)
• The global burden of cancers attributable to occupational factors, 1990-2021 — B. Zou, P. Wu, et al. (2025)
• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)

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