Fu Guohao, Li Dan, Wu Wenhao, Yan Minghua
Xuzhou Central Hospital, China; Xuzhou Clinical School of Nanjing Medical University, China.
Xuzhou Central Hospital, China; Xuzhou Clinical School of Nanjing Medical University, China.
Cancer Epidemiol. 2025 Feb;94:102734. doi: 10.1016/j.canep.2024.102734. Epub 2024 Dec 30.
The young onset Tracheal, Bronchus, and Lung Cancer (TBLC) exhibits distinct gene mutations and clinical characteristics. With worsening air pollution, the incidence of young onset TBLC is increasing, resulting in significant economic burdens. The specific epidemiology of the disease burden remains elusive.
The updated Global Burden of Disease (GBD) 2021 study was employed. This study reports on the disease burden trends of young TBLC (≤54 years) and its risk factors. Data is presented as counts and age-standardized rates (ASRs) per 100,000 people across different age groups, years, sexes, sociodemographic levels (SDI), and geographic locations (global, regional, and national). An age-period-cohort (APC) model was used to analyze longitudinal curves on age, period, and cohort effects for young TBLC. Decomposition analysis broke down temporal changes into three factors: population aging, population growth, and epidemiological change, to quantify the changes and identify their causes. An inequality index was applied to examine the inequality of disease burden of young TBLC by sex across different SDI levels between 1990 and 2021.
From 1990-2021, the global number of individuals under 55 diagnosed with TBLC increased from 320,715 to 489,080, representing a 52 % rise. However, the age-standardized rates of prevalence (Average annual percentage changes (AAPC) -0.05 %), incidence (AAPC -0.59 %), mortality (AAPC -0.88 %), and disability-adjusted life-years (DALYs) (AAPC -0.92 %) all showed a notable decline tendency. In 2021, there were 258,360 new diagnoses and 207,000 deaths from young TBLC, with ASRs of incidence and mortality at 6.43 and 5.49 per 100,000, respectively. Regionally, East Asia bore the highest burden, with about 117,730 new young TBLC cases and an ASR of 12.01 per 100,000 people. Decomposition analysis indicated that population growth was the primary driver for the increased prevalence of young TBLC. While tobacco-related DALYs for young TBLC decreased globally, tobacco remains the leading risk factor. In contrast, air pollution-related DALYs have significantly increased in middle and lower SDI regions. Over the past two decades, the burden of young TBLC among females has grown substantially, with increased inequality observed in 2021. Tobacco was the largest contributor to the PAF of young female DALYs in high SDI regions, whereas air pollution was the leading contributor in other SDI regions.
While the total number of young TBLC cases has been on the rise trend, primarily due to population changes, the ASRs of young TBLC burdens have decreased over the past two decades. In 2021, East Asia recorded the highest ASRs for young TBLC in terms of prevalence, incidence, and mortality. Tobacco remains the primary risk factor for young TBLC, and the DALYs burden from tobacco use has significantly decreased. However, the incidence of TBLC among non-smoking young females has grown rapidly over the past two decades, mainly due to air pollution, leading to increased inequality.
青年期气管、支气管和肺癌（TBLC）表现出独特的基因突变和临床特征。随着空气污染的加剧，青年期TBLC的发病率不断上升，造成了巨大的经济负担。该疾病负担的具体流行病学情况仍不明确。
采用了更新后的《2021年全球疾病负担（GBD）研究》。本研究报告了青年期TBLC（≤54岁）的疾病负担趋势及其风险因素。数据以不同年龄组、年份、性别、社会人口学水平（SDI）和地理位置（全球、区域和国家）的计数和每10万人的年龄标准化率（ASR）呈现。使用年龄-时期-队列（APC）模型分析青年期TBLC在年龄、时期和队列效应方面的纵向曲线。分解分析将时间变化分解为三个因素：人口老龄化、人口增长和流行病学变化，以量化这些变化并确定其原因。应用不平等指数来研究1990年至2021年间不同SDI水平下青年期TBLC疾病负担的性别不平等情况。
1990年至2021年期间，全球55岁以下诊断为TBLC的人数从320,715人增加到489,080人，增长了52%。然而，患病率（年均变化百分比（AAPC）-0.05%）、发病率（AAPC -0.59%）、死亡率（AAPC -0.88%）和伤残调整生命年（DALYs）（AAPC -0.92%）的年龄标准化率均呈现出显著下降趋势。2021年，青年期TBLC有258,360例新发病例和207,000例死亡，发病率和死亡率的ASR分别为每10万人6.43例和5.49例。在区域方面，东亚负担最重，约有117,730例青年期TBLC新发病例，ASR为每10万人12.01例。分解分析表明，人口增长是青年期TBLC患病率上升的主要驱动因素。虽然全球青年期TBLC与烟草相关的DALYs有所下降，但烟草仍然是主要风险因素。相比之下，空气污染相关的DALYs在中低SDI地区显著增加。在过去二十年中，青年期TBLC在女性中的负担大幅增加，2021年不平等现象加剧。在高SDI地区，烟草是青年女性DALYs人群归因分值（PAF）的最大贡献因素，而在其他SDI地区，空气污染是主要贡献因素。
虽然青年期TBLC病例总数呈上升趋势，主要是由于人口变化，但在过去二十年中青年期TBLC负担的ASR有所下降。2021年，东亚在青年期TBLC的患病率、发病率和死亡率方面的ASR最高。烟草仍然是青年期TBLC的主要风险因素，且烟草使用导致的DALYs负担显著下降。然而，在过去二十年中，非吸烟青年女性的TBLC发病率迅速上升，主要原因是空气污染，导致不平等加剧。
