Kuang Ziyu, Wang Jiaxi, Liu Kexin, Wu Jingyuan, Ge Yuansha, Zhu Guanghui, Cao Luchang, Ma Xinyi, Li Jie
Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 10053, China.
Graduate School, Beijing University of Chinese Medicine, Beijing, 10029, China.
EClinicalMedicine. 2024 Sep 5;75:102804. doi: 10.1016/j.eclinm.2024.102804. eCollection 2024 Sep.
Studies from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021 can guide screening and prevention strategies for tracheal, bronchus, and lung (TBL) cancer. We aim to provide global, regional, and national estimates of the TBL cancer burden and its attributable risk from 1990 to 2021, including during the coronavirus disease 2019 (COVID-19) pandemic.
Incidence, age-standardised incidence rate (ASIR), deaths, age-standardised mortality rate (ASMR), disability-adjusted life years (DALYs), age-standardised rate of DALYs (ASDR), and the burden due to risk factors associated with TBL cancer were analysed from 1990 to 2021. Trends in ASIR, ASMR, and ASDR of TBL cancer during the COVID-19 pandemic (2019-2021) were also determined. All statistical analyses were performed using Join-point software (version 4.9.1.0).
Between 1990 and 2021, the global incidence, deaths, and DALYs of TBL cancer to varying degrees. However, the ASIR (Average Annual Percent Change [AAPC], -0.3 [-0.4 to -0.2]), ASMR (AAPC, -0.5 [-0.7 to -0.4]), and ASDR (AAPC, -0.9 [-1.0 to -0.7]) all showed a decreasing trend. However, the ASIR, ASMR, and ASDR of TBL cancer in males all showed a decreasing trend from 1990 to 2021. In contrast, the ASIR and ASMR of TBL cancer in females showed an increasing trend, while the ASDR showed a relatively stable trend. During the COVID-19 pandemic, the trends for ASIR, ASMR, and ASDR remained stable across both sexes combined, females, males, five socio-demographic index (SDI) quintiles, and the 21 GBD regions. In 2021, smoking was a major risk factor for TBL cancer DALYs, but the attributable ASDR for smoking decreased from 1990 to 2021 in both sexes combined, as well as individually for males and females. Conversely, the attributable ASDR for secondhand smoke, high fasting plasma glucose and occupational exposure factors increased primarily among females. Furthermore, the attributable ASDR for ambient particulate matter pollution, household air pollution from solid fuels, and low-fruit diets increased primarily in regions with lower SDI quintiles from 1990 to 2021.
The burden attributable to TBL cancer has increased in some populations from 1990 to 2021, highlighting the importance of implementing targeted measures to mitigate this trend. No significant change in the burden of TBL cancer was observed during the COVID-19 pandemic; however, post-COVID-19 rates still require further observation.
This study was supported by National Key Research and Development Program of China (2023YFC3503300, 2023YFC3503305), and High Level Chinese Medical Hospital Promotion Project (HLCMHPP2023085, HLCMHPP2023001, HLCMHPP2023097).
全球疾病、伤害及风险因素负担研究（GBD）2021的相关研究可为气管、支气管和肺癌（TBL）的筛查及预防策略提供指导。我们旨在提供1990年至2021年期间TBL癌症负担及其归因风险的全球、区域和国家估计数，包括2019冠状病毒病（COVID-19）大流行期间的数据。
分析了1990年至2021年期间TBL癌症的发病率、年龄标准化发病率（ASIR）、死亡率、年龄标准化死亡率（ASMR）、伤残调整生命年（DALY）、年龄标准化DALY率（ASDR）以及与TBL癌症相关的风险因素导致的负担。还确定了COVID-19大流行期间（2019 - 2021年）TBL癌症的ASIR、ASMR和ASDR趋势。所有统计分析均使用Join-point软件（版本4.9.1.0）进行。
1990年至2021年期间，TBL癌症的全球发病率、死亡率和DALY均有不同程度变化。然而，ASIR（年均变化百分比[AAPC]，-0.3[-0.4至-0.2]）、ASMR（AAPC，-0.5[-0.7至-0.4]）和ASDR（AAPC，-0.9[-1.0至-0.7]）均呈下降趋势。不过，1990年至2021年期间男性TBL癌症的ASIR、ASMR和ASDR均呈下降趋势。相比之下，女性TBL癌症的ASIR和ASMR呈上升趋势，而ASDR呈相对稳定趋势。在COVID-19大流行期间，男女合计、女性、男性、五个社会人口指数（SDI）五分位数以及21个GBD区域的ASIR、ASMR和ASDR趋势保持稳定。2021年，吸烟是TBL癌症DALY的主要风险因素，但1990年至2021年期间，男女合计以及男性和女性个体中吸烟的归因ASDR均有所下降。相反，二手烟、高空腹血糖和职业暴露因素的归因ASDR主要在女性中增加。此外，1990年至2021年期间，环境颗粒物污染、固体燃料造成的家庭空气污染以及低水果饮食的归因ASDR主要在SDI五分位数较低的地区增加。
1990年至2021年期间，部分人群中TBL癌症所致负担有所增加，凸显了采取针对性措施缓解这一趋势的重要性。COVID-19大流行期间未观察到TBL癌症负担有显著变化；然而，COVID-19后的发病率仍需进一步观察。
本研究得到中国国家重点研发计划（2023YFC3503300、2023YFC3503305）以及高水平中国医院提升项目（HLCMHPP2023085、HLCMHPP2023001、HLCMHPP2023097）的支持。
