Li Yi, Li Hui, Tang Lirui, Chen Chuanben, Huang Chaoxiong
Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
Front Oncol. 2025 Jul 25;15:1631356. doi: 10.3389/fonc.2025.1631356. eCollection 2025.
Tobacco exposure substantially increases the global cancer burden; however, studies targeting specific subgroups are scarce. We aimed to investigate global burden trends of tobacco-attributable cancers among people aged ≥40 and the associated cross-national inequalities based on the sociodemographic index (SDI).
We performed secondary analyses on data from the Global Burden of Disease (GBD) Study 2021. The global tobacco-attributable cancer burden was assessed by age-standardized (ASR)-disability adjusted life years (DALYs) and deaths. The estimated annual percentage changes were used to illustrate temporal global and regional trends from 1990 to 2021. Decomposition analyses determined the impact of population growth, aging, and epidemiological changes on disease burden. The slope inequality index (SII) and concentration index (CI) were used to quantify cross-country inequalities in the tobacco-attributable cancer burden.
In 2021, global tobacco-attributable ASR-DALYs among people aged ≥40 were 1,687.49 per 100,000 people, a continuous decline since 1990, and ASR deaths were 72.36 per 100,000 people. By 2030, they are projected to fall to 1,464.68 and 64.59 per 100,000, respectively. Men exhibited higher DALYs and deaths than women (40.8 million DALYs, 1.7 million deaths). The most prominent tobacco exposure was smoking (ASR-DALY: 1,603.98/100000). Among the 16 cancers observed, tracheal, bronchial, and lung cancers had significantly higher ASR-DALYs and ASR-related deaths than other cancers. Population growth was the main cause of the tobacco-attributable cancer burden, followed by epidemiological changes. The highest ASR-DALYs and deaths were observed in the medium-high SDI regions and the lowest in the low SDI regions. Health inequality analyses showed that the DALYs SII declined from 2,654/100,000 in 1990 to 1,178/100,000 in 2021; however, the difference between high and low SDI countries narrowed significantly. The DALYs CI was 0.17 in 1990 and 2021, and the mortality CI increased from 0.17 to 0.18.
The cancer burden attributable to tobacco use varied significantly according to sex, age, region, and SDI. The global tobacco-attributable cancer burden among people aged ≥40 has been declining since 1990, paralleling mitigated yet persistent cross-national inequalities. The study's findings could help to develop strategies for improving the prevention and treatment of cancers.
烟草暴露显著增加了全球癌症负担；然而，针对特定亚组的研究却很匮乏。我们旨在调查40岁及以上人群中烟草所致癌症的全球负担趋势以及基于社会人口学指数（SDI）的相关跨国不平等情况。
我们对《2021年全球疾病负担（GBD）研究》的数据进行了二次分析。通过年龄标准化（ASR）伤残调整生命年（DALYs）和死亡人数评估全球烟草所致癌症负担。使用估计的年度百分比变化来说明1990年至2021年期间全球和区域的时间趋势。分解分析确定了人口增长、老龄化和流行病学变化对疾病负担的影响。斜率不平等指数（SII）和集中指数（CI）用于量化烟草所致癌症负担的跨国不平等情况。
2021年，40岁及以上人群中全球烟草所致ASR-DALYs为每10万人1687.49，自1990年以来持续下降，ASR死亡人数为每10万人72.36。到2030年，预计将分别降至每10万人1464.68和64.59。男性的DALYs和死亡人数高于女性（4080万DALYs，170万死亡）。最主要的烟草暴露是吸烟（ASR-DALY：1603.98/10万）。在观察到的16种癌症中，气管、支气管和肺癌的ASR-DALYs和ASR相关死亡人数显著高于其他癌症。人口增长是烟草所致癌症负担的主要原因，其次是流行病学变化。中高SDI地区的ASR-DALYs和死亡人数最高，低SDI地区最低。健康不平等分析表明，DALYs的SII从1990年的2654/10万降至2021年的1178/10万；然而，高SDI国家和低SDI国家之间的差距显著缩小。1990年和2021年DALYs的CI均为0.17，死亡率CI从0.17增至0.18。
烟草使用所致的癌症负担因性别、年龄、地区和SDI的不同而有显著差异。自1990年以来，40岁及以上人群中全球烟草所致癌症负担一直在下降，同时跨国不平等现象有所缓解但依然存在。该研究结果有助于制定改善癌症预防和治疗的策略。
