Disparities in the global burden of tracheal, bronchus, and lung cancer from 1990 to 2019

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Abstract

Background

Tracheal, bronchus, and lung (TBL) cancer imposes a high disease burden globally, and its pattern varies greatly across regions and countries. This study aimed to explore the global burden and temporal trends of TBL cancer from 1990 to 2019.

Methods

Data on incidence, mortality, and disability-adjusted life years (DALYs) metrics (number, crude rate, and age-standardized rates), and the attributable risk fraction of DALY of TBL cancer from 1990 to 2019 in 21 Global Burden of Disease (GBD) regions, four World Bank income regions, 204 countries and territories, and the globe were obtained from the up-to-date GBD 2019 study. We applied estimated annual percentage changes (EAPCs) to the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) to quantify the temporal trends of the TBL cancer burden from 1990–2019. Associations of EAPC of age-standardized rates with universal health coverage (UHC) index at the national level were evaluated with Pearson correlation analysis.

Results

Globally, approximately 2,260,000 new TBL cancer cases, 2,042,600 deaths, and 45,858,000 DALYs were reported in 2019. Combination of all modifiable risk factors, behavioral, environmental, and metabolic risk factors accounted for 79.1%, 66.4%, 33.3%, and 7.9% of global lung cancer DALYs, respectively. The overall ASIR (EAPC: −0.1 [95% confidence interval [CI]: −0.2, −0.1]), ASMR (EAPC: −0.3 [95% CI: −0.4, −0.3]), and ASDR (EAPC: −0.7 [95% CI: −0.7, −0.6]) decreased from 1990 to 2019. The highest mortality rate of TBL cancer occurred in the >85-year-old age group for both sexes among high-income countries (HICs) and upper-middle-income countries (UMCs), and in males aged 80–84 years and females aged >85 years in lower middle-income countries (LMCs). HICs experienced the largest declines in ASIR (−12.6%), ASMR (−20.3%), and ASDR (−27.8%) of TBL cancer between 1990 and 2019, while UMCs had the highest increases in ASIR (16.7%) and ASMR (8.0%) over the period. Eleven (52.4%), 14 (66.7%), and 15 (71.4%) regions of the 21 GBD regions experienced descending trends in ASIR, ASMR, and ASDR of TBL cancer between 1990 and 2019, respectively, with the greatest mean decrease per year (EAPC: −1.7 [95% CI: −2.0, −1.5] for ASIR, −1.9 [95% CI: −2.2, −1.7] for ASMR, and −2.2 [95% CI: −2.5, −2.0] for ASDR) being observed in eastern Europe. The ASIR, ASMR, and ASDR of TBL cancer were deemed to be in decreasing trends in 85, 91, and 104 countries and territories, with the largest decrease in Bahrain (EAPC: −3.0 [95% CI: −3.3, −2.7] for ASIR, −3.0 [95% CI: −3.3, −2.6] for ASMR, and −3.4 [95% CI: −3.8, −3.1] for ASDR). ASIR ( r=0.524), ASMR ( r=0.411), and ASDR ( r=0.353) of TBL cancer were positively associated with UHC index at the national level in 2019.

Conclusions

The TBL cancer burden shows a downward trend at the global level but varies greatly across regions and countries. A decreasing trend in the TBL cancer burden was observed in the most of the 21 GBD regions and 204 countries from 1990 to 2019. UMCs had the highest burden of TBL cancer and showed the largest increases in ASIR and ASMR.

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Cancer statistics, 2022

Rebecca Siegel, Kimberly D Miller, Hannah Fuchs … (2022)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality.

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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

Theo Vos, Stephen S Lim, Cristiana Abbafati … (2023)

Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.

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Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Christopher J L Murray, Aleksandr Y Aravkin, Peng Zheng … (2022)

Summary Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding Bill & Melinda Gates Foundation.

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Author and article information

Contributors

Ni Li

Journal

Journal ID (nlm-ta): Chin Med J Pulm Crit Care Med

Journal ID (iso-abbrev): Chin Med J Pulm Crit Care Med

Title: Chinese Medical Journal Pulmonary and Critical Care Medicine

Publisher: Elsevier

ISSN (Electronic): 2772-5588

Publication date PMC-release: 28 March 2023

Publication date Collection: March 2023

Publication date (Electronic): 28 March 2023

Volume: 1

Issue: 1

Pages: 36-45

Affiliations

[1 ]Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;

[2 ]Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;

[3 ]Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implementation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Author notes

[* ]Correspondence to: Ni Li, Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. nli@ 123456cicams.ac.cn

Article

Publisher Item ID: S2772-5588(23)00006-3

DOI: 10.1016/j.pccm.2023.02.001

PMC ID: 11332827

PubMed ID: 39170872

SO-VID: 68c0c9e4-6463-4cf5-8ca0-0ecb7a05c910

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Disparities in the global burden of tracheal, bronchus, and lung cancer from 1990 to 2019

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Abstract

Background

Methods

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Conclusions

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Inflamed lung in vitro co-culture models

Most cited references 28

Cancer statistics, 2022

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

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

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