Geographical and sexual disparities of lung cancer mortality trends in China: A population-based study

Abstract

Lung cancer (LC) is one of the major causes of cancer deaths in China. Death burden and mortality of LC vary according to sexes and regions. We aimed to comprehensively evaluate the geographical and sexual disparities in LC mortality trends in China, and a further age-period-cohort analysis to explore underlying factors. LC mortality data during 2004-2021 were extracted from the Disease Surveillance Points system. Annual age-standardized mortality rates (ASMR) were calculated for 36 sub-populations by sex, urban-rural status and geographical regions. The age-period-cohort model was applied to investigate age, period and cohort effects on mortality trends. Time trends of ASMR for LC overall did not show statistical significance during 2004-2021, but contrasting patterns were observed between cities and countryside, with annual average percent changes of -1.58% (95%CI, -2.11%- -1.05%) and 0.57% (95%CI, 0.07%- 1.07%), respectively. ASMR of LC decreased in eastern and central regions and increased markedly in western region. Cohort effects illustrated a downward trend in cities, but an inverted U-shape curve peaking around the 1950s appeared in the countryside, and the decreasing trends were slower in the western region. There are substantial geographical and sexual disparities in LC mortality trends in China, notably with unfavorable trends in the western countryside. The variation in cohort effects on the mortality trends implies the importance of taking region- and population-specific primary prevention strategies to reduce the disease burden of LC in China.