Comparison of burden trends of tracheal, bronchus, and lung cancer in China and countries with different socio-demographic indices from 1990 to 2021_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENG Zhiyang ¹ , WANG Tianyu ² , Praise Audax Rukonge ³ , WEI Qishu ¹ ,  YU Guiping ⁴

1. Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, P. R. China;
2. Department of Thoracic and Cardiovascular Surgery, The Affiliated Jiangyin Hospital of Nantong University, Wuxi, 214400, Jiangsu, P. R. China;
3. Department of Thoracic and Cardiovascular Surgery, International Education College of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, P. R. China;
4. Department of Thoracic and Cardiovascular Surgery, Jiangyin Clinical College of Xuzhou Medical University, Wuxi, 214400, Jiangsu, P. R. China;

Corresponding?author：

YU Guiping, Email: xiaoyuer97103@163.com

Keywords：

Trachea; bronchus; lung cancer; disease burden; change trend; Joinpoint regression analysis; socio-demographic index

DOI：

10.7507/1007-4848.202509051

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Objective To analyze the trends in the disease burden of tracheal, bronchus, and lung cancer (TBL) in China and in low-, middle-, and high-socio-demographic index (SDI) countries and regions from 1990 to 2021, with the aim of providing evidence for the formulation of targeted prevention and control strategies. Methods Utilizing data from the Global Burden of Disease (GBD) Study 2021, we extracted TBL-related data from 1990 to 2021, stratified by sex, age group, and year. We assessed the disease burden and trends of TBL across different groups, conducted a decomposition analysis to identify the leading contributors to the change in disease burden, and examined the relationship between disability-adjusted life years (DALYs) and SDI. Results In 2021, the overall burden of TBL in China was substantially higher than that in other groups. The fold-increase in the number of prevalent cases, deaths, and DALYs was significantly greater in China. Moreover, the growth rates of the age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) in China were higher than the overall levels in other SDI countries. In all groups, the ASPR of TBL generally followed a pattern of increasing and then decreasing with age; however, for males in China and middle-SDI countries, the ASPR exhibited a decline in the 80-84 age group. Decomposition analysis revealed that the primary drivers of the increasing TBL burden varied among groups: the rise in DALYs in China and middle-SDI countries was mainly driven by population aging, in low-SDI countries by population growth, and in high-SDI countries by epidemiological transition. While global health inequality in TBL showed some improvement, low-SDI countries continued to bear a disproportionately heavy health burden. Conclusion The disease burden of TBL in China has progressively increased from 1990 to 2021, now ranking among the highest globally. Multiple factors, predominantly driven by population aging, are exacerbating this burden. The burden of TBL is influenced by advancing age, sex differences, and SDI levels. China, along with low- and middle-SDI countries, should implement targeted intervention strategies based on epidemiological findings, including expanding investment in public health services and strengthening healthcare systems, to mitigate the growing burden of TBL.

Citation： ZHENG Zhiyang, WANG Tianyu, Praise Audax Rukonge, WEI Qishu, YU Guiping. Comparison of burden trends of tracheal, bronchus, and lung cancer in China and countries with different socio-demographic indices from 1990 to 2021. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(1): 87-96. doi: 10.7507/1007-4848.202509051 Copy

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18.	Thun M, Peto R, Boreham J, et al. Stages of the cigarette epidemic on entering its second century. Tob Control, 2012, 21(2): 96-101.
19.	Ma J, Song YD, Bai XM. Global, regional, and national burden and trends of early-onset tracheal, bronchus, and lung cancer from 1990 to 2019. Thorac Cancer, 2024, 15(8): 601-613.
20.	He KJ, Xu Z, Xu J, et al. Global and national burden of tracheal, bronchus, and lung cancer attributabled to household air pollution from solid fuels in populations aged 55 and above: an integrated study of frontier and joinpoint regression analysis. BMC Public Health, 2025, 25(1): 1249.
21.	Su X, Tao Y, Chen F, et al. Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021. Sci Rep, 2025, 15(1): 7655.
22.	李富, 張亞楠, 劉斌, 等. 1990—2021年中國歸因于職業致癌物的氣管、支氣管和肺癌疾病負擔及變化趨勢分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1263-1270.Li F, Zhang YN, Liu B, et al. Analysis of the burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens and trends in China from 1990 to 2021. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1263-1270.
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24.	丁璐璐, 朱健, 張永輝, 等. 1990-2019年中國歸因于吸煙的肺癌疾病負擔研究. 現代腫瘤醫學, 2024, 32(1): 141-146.Ding LL, Zhu J, Zhang YH, et al. Disease burden of lung cancer attributable to smoking in China from 1990 to 2019. Mod Oncol, 2024, 32(1): 141-146.
25.	中華人民共和國國家衛生健康委員會醫療應急司. 健康中國行動—癌癥防治行動實施方案(2023—2030年). 中國腫瘤, 2023, 32(12): 887-890.Medical Emergency Department of the National Health Commission of the People's Republic of China. Healthy China Initiative-Implementation plan for cancer prevention and control (2023-2030). China Cancer, 2023, 32(12): 887-890.
26.	Levy DT, Wijnhoven TMA, Levy J, et al. Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries. Eur J Public Health, 2018, 28(4): 693-701.
27.	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
28.	Xu H, Wang Q, Zhu H, et al. Related health burden with the improvement of air quality across China. Chin Med J (Engl), 2024, 137(22): 2726-2733.
29.	Hoffman RM, Sanchez R. Lung cancer screening. Med Clin North Am, 2017, 101(4): 769-785.
30.	Ye R, Cao Y, Zhu X, et al. Comparative study of early onset cancer burden between China and the United States from 1990 to 2021. Sci Rep, 2025, 15(1): 28527.
31.	Murray CJL. The Global Burden of Disease Study at 30 years. Nat Med, 2022, 28(10): 2019-2026.
32.	Burton MJ, Ramke J, Marques AP, et al. The lancet global health commission on global eye health: vision beyond 2020. Lancet Glob Health, 2021, 9(4): 489-551.
33.	Ji X, Chen J, Ye J, et al. Epidemiological analysis of global and regional lung cancer mortality: based on 30-year data analysis of Global Burden Disease Database. Healthcare (Basel), 2023, 11(22): 2920.
34.	Zhao Q, Zhang B, Chen X, et al. Global, regional, and national burden of motor neuron disease in adults aged 65 years and older from 1990 to 2021 and forecast to 2040. Front Neurol, 2025, 16: 1641887.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Liu X, Yang Q, Pan L, et al. Burden of respiratory tract cancers in China and its provinces, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Reg Health West Pac, 2025, 55: 101485.
3. Hendriks LEL, Remon J, Faivre-Finn C, et al. Non-small-cell lung cancer. Nat Rev Dis Primers, 2024, 10(1): 71.
4. Kuang Z, Wang J, Liu K, et al. Global, regional, and national burden of tracheal, bronchus, and lung cancer and its risk factors from 1990 to 2021: findings from the global burden of disease study 2021. EClinicalMedicine, 2024, 75: 102804.
5. Zhang M, Jin W, Tian Y, et al. Cancer burden variations and convergences in globalization: a comparative study on the tracheal, bronchus, and lung (TBL) and liver cancer burdens among WHO regions from 1990 to 2019. J Epidemiol Glob Health, 2023, 13(4): 696-724.
6. Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin, 2025, 75(1): 10-45.
7. World Health Organization. World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization, 2025.
8. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
9. Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol, 2023, 9(4): 465-472.
10. Trussardi Fayh AP, de Sousa IM. Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass. PLoS One, 2021, 16(9): e0257446.
11. Berry SD, Ngo L, Samelson EJ, et al. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc, 2010, 58(4): 783-787.
12. Su B, Zhong P, Xuan Y, et al. Changing patterns in cancer mortality from 1987 to 2020 in China. Cancers (Basel), 2023, 15(2): 476.
13. Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 2015, 386(10002): 1447-1456.
14. 宇傳華, 白建軍. 社會人口指數(SDI)的概念及其應用. 公共衛生與預防醫學, 2020, 31(1): 5-10.Yu CH, Bai JJ. The concept of Socio-Demographic Index (SDI) and its application. J Public Health Prev Med, 2020, 31(1): 5-10.
15. Zhang X, Wu L, Xu Y, et al. Trends in the incidence rate of lung cancer by histological type and gender in Sichuan, China, 1995-2015: a single-center retrospective study. Thorac Cancer, 2018, 9(5): 532-541.
16. Tu S, Huang X, Fan X, et al. National and subnational burden of brain and central nervous system cancers in China and global from 1990 to 2021: results from the global burden of disease study 2021. Arch Public Health, 2025, 83(1): 195.
17. 劉岳儀, 崔振嶺. 1990—2021年中國歸因于空氣污染的肺癌疾病負擔分析. 中國衛生統計, 2025, 42(3): 350-354.Liu YY, Cui ZL. Analysis of the disease burden of lung cancer attributable to air pollution in China from 1990 to 2021. Chin J Health Stat, 2025, 42(3): 350-354.
18. Thun M, Peto R, Boreham J, et al. Stages of the cigarette epidemic on entering its second century. Tob Control, 2012, 21(2): 96-101.
19. Ma J, Song YD, Bai XM. Global, regional, and national burden and trends of early-onset tracheal, bronchus, and lung cancer from 1990 to 2019. Thorac Cancer, 2024, 15(8): 601-613.
20. He KJ, Xu Z, Xu J, et al. Global and national burden of tracheal, bronchus, and lung cancer attributabled to household air pollution from solid fuels in populations aged 55 and above: an integrated study of frontier and joinpoint regression analysis. BMC Public Health, 2025, 25(1): 1249.
21. Su X, Tao Y, Chen F, et al. Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021. Sci Rep, 2025, 15(1): 7655.
22. 李富, 張亞楠, 劉斌, 等. 1990—2021年中國歸因于職業致癌物的氣管、支氣管和肺癌疾病負擔及變化趨勢分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1263-1270.Li F, Zhang YN, Liu B, et al. Analysis of the burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens and trends in China from 1990 to 2021. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1263-1270.
23. 馬運, 袁浩冉, 胡昊, 等. 1990-2019年中國歸因于煙草的肺癌疾病負擔變化趨勢分析. 現代預防醫學, 2024, 51(8): 1345-1351.Ma Y, Yuan HR, Hu H, et al. Trends of disease burden of lung cancer attributed to tobacco in China, 1990-2019. Mod Prev Med, 2024, 51(8): 1345-1351.
24. 丁璐璐, 朱健, 張永輝, 等. 1990-2019年中國歸因于吸煙的肺癌疾病負擔研究. 現代腫瘤醫學, 2024, 32(1): 141-146.Ding LL, Zhu J, Zhang YH, et al. Disease burden of lung cancer attributable to smoking in China from 1990 to 2019. Mod Oncol, 2024, 32(1): 141-146.
25. 中華人民共和國國家衛生健康委員會醫療應急司. 健康中國行動—癌癥防治行動實施方案(2023—2030年). 中國腫瘤, 2023, 32(12): 887-890.Medical Emergency Department of the National Health Commission of the People's Republic of China. Healthy China Initiative-Implementation plan for cancer prevention and control (2023-2030). China Cancer, 2023, 32(12): 887-890.
26. Levy DT, Wijnhoven TMA, Levy J, et al. Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries. Eur J Public Health, 2018, 28(4): 693-701.
27. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1204-1222.
28. Xu H, Wang Q, Zhu H, et al. Related health burden with the improvement of air quality across China. Chin Med J (Engl), 2024, 137(22): 2726-2733.
29. Hoffman RM, Sanchez R. Lung cancer screening. Med Clin North Am, 2017, 101(4): 769-785.
30. Ye R, Cao Y, Zhu X, et al. Comparative study of early onset cancer burden between China and the United States from 1990 to 2021. Sci Rep, 2025, 15(1): 28527.
31. Murray CJL. The Global Burden of Disease Study at 30 years. Nat Med, 2022, 28(10): 2019-2026.
32. Burton MJ, Ramke J, Marques AP, et al. The lancet global health commission on global eye health: vision beyond 2020. Lancet Glob Health, 2021, 9(4): 489-551.
33. Ji X, Chen J, Ye J, et al. Epidemiological analysis of global and regional lung cancer mortality: based on 30-year data analysis of Global Burden Disease Database. Healthcare (Basel), 2023, 11(22): 2920.
34. Zhao Q, Zhang B, Chen X, et al. Global, regional, and national burden of motor neuron disease in adults aged 65 years and older from 1990 to 2021 and forecast to 2040. Front Neurol, 2025, 16: 1641887.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of burden trends of tracheal, bronchus, and lung cancer in China and countries with different socio-demographic indices from 1990 to 2021

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