Global Trends of Early, Middle, and Late-Onset Lung Cancer From 1990 to 2021: Results From the Global Burden of Disease Study 2021

IF 2.9 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2025-02-07 DOI:10.1002/cam4.70639

Zongyuan Li, Cheng Yu, Jianqi Hao, Nanzhi Luo, Haoning Peng, Jian Zhang, Qiang Pu, Lunxu Liu

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Abstract

Background

Although the global burden of lung cancer has generally declined in recent decades, the variation in onset age-related trends remains insufficiently explored. In the current study, we aimed to systematically evaluate the most update temporal trends in incidence, mortality and DALYs of early, middle, and late-onset lung cancer (EOLC, MOLC, and LOLC) from 1990 to 2021, with stratifications of gender, location, and socio-demographic development.

Methods

We retrieved cross-sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The global, regional, and national burden of lung cancer from 1990 to 2021 was evaluated primarily by age-standardized rates of incidence (ASIR), mortality (ASMR), and DALYs (ASDR). Joinpoint regression analysis was employed to assess temporal trends and turning point years. Frontier analysis was applied to examine the lowest achievable DALYs, and cross-country inequalities were evaluated sing the slope index of inequality (SII) and concentration index. We also forecasted the burden from 2022 to 2035.

Results

The global ASIR of EOLC decreased from 4.81 per 100,000 in 1990 to 3.13 in 2021 (AAPC: −1.38, 95% confidence interval [CI]: −1.53 to −1.22, p < 0.001), with a steeper decline in males (AAPC: −1.79) compared to females (AAPC: -0.63). MOLC incidence also declined from 92.77 to 72.47 per 100,000 (AAPC: -0.81, 95% CI: −0.9 to −0.73, p < 0.01), while LOLC demonstrated a slight increase from 195.39 to 225.8 per (AAPC: 0.43, 95% CI: 0.37 to 0.5, p < 0.01). Notably, LOLC in females showed a consistent rise in incidence rate (AAPC: 1.13, 95% CI: 1.05 to 1.21, p < 0.01). In contrast to EOLC and MOLC, 11, 10, and 9 out of 21 GBD regions showed a rising trend for ASIR, ASMR, and ASDR of LOLC, respectively. East Asia showed the steepest increase in ASIR (from 229.26 in 1990 to 375.90 in 2021, AAPC = 1.6, 95% CI: 1.31 to 1.89, p < 0.001) of LOLC. Moreover, according to socio-demographic index (SDI) quintiles, the middle SDI region demonstrated the largest rise in ASIR of LOLC. Frontier analysis revealed that countries with higher SDIs had a greater capacity for reducing lung cancer burdens. Cross-country inequalities of lung cancer burden in females were found to improve much slower than in males. The projections implied that, although lung cancer would generally decline in the next decade, the incidence, mortality, and DALY rates of LOLC in females might remarkably increase.

Conclusions

The global incidence, mortality, and DALY rates of lung cancer showed a general decline from 1990 to 2021. However, concerning trends of LOLC burden, especially among females and in specific regions or countries, were observed in this study. This study could help to guide more targeted prevention and intervention strategies for lung cancer control.

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背景尽管近几十年来肺癌的全球负担普遍下降，但与发病年龄相关的趋势变化仍未得到充分探讨。在本研究中，我们旨在系统评估 1990 年至 2021 年早期、中期和晚期肺癌（EOLC、MOLC 和 LOLC）发病率、死亡率和残疾调整寿命年数的最新时间趋势，并对性别、地点和社会人口发展进行分层。方法我们从《2021 年全球疾病负担、伤害和风险因素研究》（GBD）中获取了横断面数据。主要通过年龄标准化发病率（ASIR）、死亡率（ASMR）和残疾调整寿命年数（ASDR）评估了 1990 年至 2021 年全球、地区和国家的肺癌负担。接合点回归分析用于评估时间趋势和转折点年份。我们采用前沿分析来研究可达到的最低残疾调整寿命年数，并用不平等斜率指数（SII）和集中指数来评估跨国不平等现象。我们还预测了 2022 年至 2035 年的负担。结果癌症早期死亡率的全球 ASIR 从 1990 年的每 10 万人 4.81 例降至 2021 年的 3.13 例（AAPC：-1.38，95% 置信区间 [CI]：-1.53 至-1.22，p < 0.001），与女性（AAPC：-0.63）相比，男性的下降幅度更大（AAPC：-1.79）。MOLC发病率也从每10万人中92.77例降至72.47例（AAPC：-0.81，95% CI：-0.9至-0.73，p < 0.01），而LOLC则从195.39例略微上升至225.8例（AAPC：0.43，95% CI：0.37至0.5，p < 0.01）。值得注意的是，女性 LOLC 的发病率持续上升（AAPC：1.13，95% CI：1.05 至 1.21，p <0.01）。与EOLC和MOLC不同，在21个GBD地区中，分别有11个、10个和9个地区的LOLC ASIR、ASMR和ASDR呈上升趋势。东亚地区的 LOLC ASIR 升幅最大（从 1990 年的 229.26 升至 2021 年的 375.90，AAPC = 1.6，95% CI：1.31 至 1.89，p < 0.001）。此外，根据社会人口指数（SDI）五分法，SDI 中部地区的 LOLC ASIR 升幅最大。前沿分析表明，社会人口指数越高的国家越有能力降低肺癌负担。研究发现，女性肺癌负担的跨国不平等改善速度远低于男性。预测结果表明，虽然肺癌在未来十年中将普遍下降，但女性肺癌的发病率、死亡率和残疾调整生命年率可能会显著增加。结论从 1990 年到 2021 年，全球肺癌发病率、死亡率和残疾调整寿命年数率总体呈下降趋势。然而，本研究观察到了肺癌负担的相关趋势，尤其是女性和特定地区或国家。这项研究有助于为更有针对性的肺癌控制预防和干预策略提供指导。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.