Lung cancer mortality in China: a comparison analysis based on the Global Burden of Disease Study 2017

Abstract

Background: China has a large population and is experiencing a transition period. Comparing lung cancer (LC) deaths and population attributable fractions (PAFs) of risk factors between China and other countries/regions are essential to inform effective control. Global Burden of Disease (GBD) study provides a unique opportunity for the comparison.Methods: We extracted the number of LC deaths, age-standardized death rates (ASDRs), and the PAFs of risk factors between 1990 and 2017 from the GBD 2017. The annual percentage change (APC) was used to quantify the trends of ASDRs in China and other regions. The relationships of the APC with Socio-demographic Index and baseline of ASDRs were assessed among China and other countries.Results: In 2017, LC ASDRs were 35.38 (95% uncertainty interval (UI): 34.39 to 36.35) and 13.94 (95% UI: 13.53 to 14.36) per 100,000 person-years in men and women worldwide, respectively. It decreased significantly in men (APC: -0.66%, 95% confidence interval (CI): -0.69 to -0.62) but increased significantly in women (APC: 0.31%, 95% CI: 0.26 to 0.36) from 1990 to 2017. LC ASDRs in China increased significantly among both men (APC: 1.12%, 95% CI: 1.03 to 1.2) and women (APC: 0.80%, 95% CI: 0.70 to 0.89). The increased LC deaths among men (312,798) and women (139,115) in China accounted for 59.39% and 43.01% of global increases. The risk factors with the highest PAFs in China were smoking and ambient particulate matter (PM) pollution. The PAF of ambient PM pollution in China ranked 2nd globally. Conclusions: The trends of LC ASDRs and the PAFs of risk factors varied markedly by region, which calls for tailored measures to reduce disease burden and improve health equality. China’s LC death rates were among the highest worldwide and remained on the rise. PM and tobacco control should be China’s intervention priorities.