Comparative study on epidemiological characteristics of lung cancer among adolescents and young adults in China and globally, 1990–2021: Disease burden, trend changes, and influencing factors_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

TIAN Ze ^1,2 , SONG Yingda ^1,2 , LI Jianhui ^1,2 ,  MA Jun ^1,2

1. The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, P. R. China;
2. Department of Thoracic Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, P. R. China;

Corresponding author：

MA Jun, Email: pegasus_2023@126.com

Keywords：

Lung cancer; epidemiology; adolescents and young adults; disease burden

DOI：

10.7507/1007-4848.202412102

Video：

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Objective To analyze and compare the disease burden, trends, and influencing factors of lung cancer in adolescents and young adults (AYAs) in China and globally from 1990 to 2021, providing a reference for the prevention and treatment of lung cancer in China. Methods In GBD2021, indicators of lung cancer disease burden in different genders and age groups in 204 countries or regions from 1990 to 2021 were retrieved and standardized. The Joinpoint regression model was used to calculate the average annual percentage change (AAPC) of the standardized rates of lung cancer in AYAs in China and globally from 1990 to 2021; changes in incidence, mortality, and disability-adjusted life years (DALYs) rates due to population growth, aging, and epidemiological changes were analyzed; differences in lung cancer disease burden in AYAs in different socio-demographic index (SDI) regions were analyzed; and the influencing factors of lung cancer in AYAs in China and globally were explored. Results From 1990 to 2021, the age-standardized incidence rate (ASIR) (AAPC=−0.2%, P<0.001), age-standardized mortality rate (ASMR) (AAPC=−0.6%, P<0.001), and age-standardized DALYs rate (AAPC=−0.6%, P<0.001) of lung cancer in AYAs in China showed a downward trend, consistent with the global trend, but the decline in China was relatively small. During this period, the age-standardized rates of various indicators of lung cancer in males in China and globally were higher than those in females, and the burden of lung cancer in Chinese males was heavier. However, due to the significant downward trend in males, the gap in lung cancer burden between males and females is narrowing. At the same time, from 2013 to 2021, the ASIR (annual percent change [APC]=2.01%, P<0.001), ASMR (APC = 1.46%, P<0.001), and standardized DALYs rate (APC=1.46%, P<0.001) in China showed an upward trend. From 1990 to 2021, aging was the main factor for the increase in incidence, mortality, and DALYs rates of lung cancer in AYAs in China, while the increase in global indicators was mainly attributed to population growth. The global burden of lung cancer in AYAs was overly concentrated in high SDI regions. Although the gap in lung cancer burden between high SDI and low SDI countries was narrowing, it still. Globally, smoking, environmental PM2.5, insufficient fruit intake, secondhand smoke, and indoor air pollution have always been prominent risk factors. Conclusion From 1990 to 2021, the global and Chinese AYAs lung cancer incidence and mortality rates generally showed a downward trend, but the female lung cancer burden relatively increased, especially in young women without a history of smoking. Continued efforts are needed to reduce the burden of lung cancer in AYAs, especially the specific risk for young women.

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2.	Jemal A, Miller KD, Ma J, et al. Higher lung cancer incidence in young women than young men in the United States. N Engl J Med, 2018, 378(21): 1999-2009.
3.	Fidler MM, Gupta S, Soerjomataram I, et al. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: A population-based study. Lancet Oncol, 2017, 18(12): 1579-1589.
4.	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.
5.	GBD 2021 Demographics Collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: A comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 1989-2056.
6.	Wu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: A systematic analysis for the GBD 2021. J Hematol Oncol, 2024, 17(1): 119.
7.	GBD 2021 Tobacco Forecasting Collaborators. Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health, 2024, 9(10): e729-e744.
8.	GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol, 2024, 23(10): 973-1003.
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10.	Song YD, Wang R, Wang JX, et al. Global burden of lung cancer in women of childbearing age attributable to ambient particulate matter pollution: 1990-2021. Cancer Med, 2024, 13(18): e70241.
11.	Delgado-Saborit JM, Stark C, Harrison RM. Carcinogenic potential, levels and sources of polycyclic aromatic hydrocarbon mixtures in indoor and outdoor environments and their implications for air quality standards. Environ Int, 2011, 37(2): 383-392.
12.	Zhang J, Smith KR. Indoor air pollution: A global health concern. Br Med Bull, 2003, 68: 209-225.
13.	Hosgood HD 3rd, Boffetta P, Greenland S, et al. In-home coal and wood use and lung cancer risk: A pooled analysis of the International Lung Cancer Consortium. Environ Health Perspect, 2010, 118(12): 1743-1747.
14.	Zhang JJ, Smith KR. Household air pollution from coal and biomass fuels in China: Measurements, health impacts, and interventions. Environ Health Perspect, 2007, 115(6): 848-855.
15.	Zhou RX, Liao HJ, Hu JJ, et al. Global burden of lung cancer attributable to household fine particulate matter pollution in 204 countries and territories, 1990 to 2019. J Thorac Oncol, 2024, 19(6): 883-897.
16.	Turner MC, Krewski D, Pope CA 3rd, et al. Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers. Am J Respir Crit Care Med, 2011, 184(12): 1374-1381.
17.	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.
18.	陈国飞, 刘远健. 基于人工智能的胸部CT智能辅助诊断系统在LDCT数据集上的应用研究. 现代医用影像学, 2020, 29(1): 72-73.Chen GF, Liu YJ. Application of AI-based intelligent diagnostic system for chest CT in LDCT dataset. Mod Med Imaging, 2020, 29(1): 72-73.
19.	金文忠, 陆耀, 汪阳. 基于人工智能的胸部CT智能辅助诊断系统在LDCT数据集上的应用研究. 中国医学计算机成像杂志, 2018, 24(5): 373-377.Jin WZ, Lu Y, Wang Y. Application of AI-based intelligent diagnostic system for chest CT in LDCT dataset. Chin J Med Comput Imaging, 2018, 24(5): 373-377.
20.	张正, 李颖, 孟哲, 等. 基于人工智能的胸部CT智能辅助诊断系统在LDCT数据集上的应用研究. 中国保健营养, 2020, 30(15): 368.Zhang Z, Li Y, Meng Z, et al. Application of AI-based intelligent diagnostic system for chest CT in LDCT dataset. China Health Nutr, 2020, 30(15): 368.
21.	杨雷, 张希, 刘硕, 等. 2014—2019年北京城市癌症早诊早治项目人群肺癌筛查结果分析. 中华预防医学杂志, 2021, 55(03): 339-345.Yang L, Zhang X, Liu S, et al. Analysis of lung cancer screening results in the Beijing urban cancer early diagnosis and treatment program from 2014 to 2019. Chin J Prev Med, 2021, 55(03): 339-345.
22.	Jemal A, Miller KD, Ma J, et al. Higher lung cancer incidence in young women than young men in the United States. N Engl J Med, 2018, 378(21): 1999-2009.
23.	Brawley OW, Glynn TJ, Khuri FR, et al. The first Surgeon General's report on smoking and health: The 50th anniversary. CA Cancer J Clin, 2014, 64(1): 5-8.
24.	Houston KA, Henley SJ, Li J, et al. Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009. Lung Cancer, 2014, 86(1): 22-28.
25.	Kligerman S, White C. Epidemiology of lung cancer in women: Risk factors, survival, and screening. AJR Am J Roentgenol, 2011, 196(2): 287-295.
26.	Bain C, Feskanich D, Speizer FE, et al. Lung cancer rates in men and women with comparable histories of smoking. J Natl Cancer Inst, 2004, 96(11): 826-834.
27.	Ma Y, Kroemer G. The cancer-immune dialogue in the context of stress. Nat Rev Immunol, 2024, 24(4): 264-281.
28.	Falcinelli M, Thaker PH, Lutgendorf SK, et al. The role of psychologic stress in cancer initiation: Clinical relevance and potential molecular mechanisms. Cancer Res, 2021, 81(20): 5131-5140.
29.	Possenti I, Romelli M, Carreras G, et al. Association between second-hand smoke exposure and lung cancer risk in never-smokers: A systematic review and meta-analysis. Eur Respir Rev, 2024, 33(174): 240077.
30.	蒋磊, 徐国厚, 王丁要, 等. 健康女性低剂量胸部CT检查结果及磨玻璃结节状况的调查. 医学理论与实践, 2019, 32(06): 800-802.Jiang L, Xu GH, Wang DY, et al. Investigation of low-dose chest CT results and ground-glass nodules in healthy women. Med Theory Pract, 2019, 32(06): 800-802.
31.	胡军, 王晓冬. 济南市区域成年健康查体人群胸部CT检出肺局灶性磨玻璃密度结节情况. 中国临床研究, 2021, 34(09): 1190-1193,1198.Hu J, Wang XD. Detection of focal ground-glass density nodules in chest CT of adult health examination population in Jinan. Chin J Clin Res, 2021, 34(09): 1190-1193,1198.
32.	Delgado-Saborit JM, Stark C, Harrison RM. Carcinogenic potential, levels and sources of polycyclic aromatic hydrocarbon mixtures in indoor and outdoor environments and their implications for air quality standards. Environ Int, 2011, 37(2): 383-392.
33.	Turner MC, Krewski D, Pope CA 3rd, Chen Y, et al. Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers. Am J Respir Crit Care Med, 2011, 184(12): 1374-1381.
34.	Shaddick G, Thomas ML, Amini H, Broday D, et al. Data integration for the assessment of population exposure to ambient air pollution for global burden of disease assessment. Environ Sci Technol, 2018, 52(16): 9069-9078.

1. 赫捷, 李霓, 陈万青, 等. 中国肺癌筛查与早诊早治指南(2021, 北京). 中国肿瘤, 2021, 30(2): 81-111.He J, Li N, Chen WQ, et al. Guidelines for lung cancer screening and early diagnosis and treatment in China (2021, Beijing). China Cancer, 2021, 30(2): 81-111.
2. Jemal A, Miller KD, Ma J, et al. Higher lung cancer incidence in young women than young men in the United States. N Engl J Med, 2018, 378(21): 1999-2009.
3. Fidler MM, Gupta S, Soerjomataram I, et al. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: A population-based study. Lancet Oncol, 2017, 18(12): 1579-1589.
4. 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.
5. GBD 2021 Demographics Collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: A comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 1989-2056.
6. Wu Z, Xia F, Lin R. Global burden of cancer and associated risk factors in 204 countries and territories, 1980-2021: A systematic analysis for the GBD 2021. J Hematol Oncol, 2024, 17(1): 119.
7. GBD 2021 Tobacco Forecasting Collaborators. Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health, 2024, 9(10): e729-e744.
8. GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol, 2024, 23(10): 973-1003.
9. Wen YF, Chen MX, et al. The global, regional, and national burden of cancer among adolescents and young adults in 204 countries and territories, 1990–2019: A population-based study. J Hematol Oncol, 2021, 14: 89.
10. Song YD, Wang R, Wang JX, et al. Global burden of lung cancer in women of childbearing age attributable to ambient particulate matter pollution: 1990-2021. Cancer Med, 2024, 13(18): e70241.
11. Delgado-Saborit JM, Stark C, Harrison RM. Carcinogenic potential, levels and sources of polycyclic aromatic hydrocarbon mixtures in indoor and outdoor environments and their implications for air quality standards. Environ Int, 2011, 37(2): 383-392.
12. Zhang J, Smith KR. Indoor air pollution: A global health concern. Br Med Bull, 2003, 68: 209-225.
13. Hosgood HD 3rd, Boffetta P, Greenland S, et al. In-home coal and wood use and lung cancer risk: A pooled analysis of the International Lung Cancer Consortium. Environ Health Perspect, 2010, 118(12): 1743-1747.
14. Zhang JJ, Smith KR. Household air pollution from coal and biomass fuels in China: Measurements, health impacts, and interventions. Environ Health Perspect, 2007, 115(6): 848-855.
15. Zhou RX, Liao HJ, Hu JJ, et al. Global burden of lung cancer attributable to household fine particulate matter pollution in 204 countries and territories, 1990 to 2019. J Thorac Oncol, 2024, 19(6): 883-897.
16. Turner MC, Krewski D, Pope CA 3rd, et al. Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers. Am J Respir Crit Care Med, 2011, 184(12): 1374-1381.
17. 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.
18. 陈国飞, 刘远健. 基于人工智能的胸部CT智能辅助诊断系统在LDCT数据集上的应用研究. 现代医用影像学, 2020, 29(1): 72-73.Chen GF, Liu YJ. Application of AI-based intelligent diagnostic system for chest CT in LDCT dataset. Mod Med Imaging, 2020, 29(1): 72-73.
19. 金文忠, 陆耀, 汪阳. 基于人工智能的胸部CT智能辅助诊断系统在LDCT数据集上的应用研究. 中国医学计算机成像杂志, 2018, 24(5): 373-377.Jin WZ, Lu Y, Wang Y. Application of AI-based intelligent diagnostic system for chest CT in LDCT dataset. Chin J Med Comput Imaging, 2018, 24(5): 373-377.
20. 张正, 李颖, 孟哲, 等. 基于人工智能的胸部CT智能辅助诊断系统在LDCT数据集上的应用研究. 中国保健营养, 2020, 30(15): 368.Zhang Z, Li Y, Meng Z, et al. Application of AI-based intelligent diagnostic system for chest CT in LDCT dataset. China Health Nutr, 2020, 30(15): 368.
21. 杨雷, 张希, 刘硕, 等. 2014—2019年北京城市癌症早诊早治项目人群肺癌筛查结果分析. 中华预防医学杂志, 2021, 55(03): 339-345.Yang L, Zhang X, Liu S, et al. Analysis of lung cancer screening results in the Beijing urban cancer early diagnosis and treatment program from 2014 to 2019. Chin J Prev Med, 2021, 55(03): 339-345.
22. Jemal A, Miller KD, Ma J, et al. Higher lung cancer incidence in young women than young men in the United States. N Engl J Med, 2018, 378(21): 1999-2009.
23. Brawley OW, Glynn TJ, Khuri FR, et al. The first Surgeon General's report on smoking and health: The 50th anniversary. CA Cancer J Clin, 2014, 64(1): 5-8.
24. Houston KA, Henley SJ, Li J, et al. Patterns in lung cancer incidence rates and trends by histologic type in the United States, 2004-2009. Lung Cancer, 2014, 86(1): 22-28.
25. Kligerman S, White C. Epidemiology of lung cancer in women: Risk factors, survival, and screening. AJR Am J Roentgenol, 2011, 196(2): 287-295.
26. Bain C, Feskanich D, Speizer FE, et al. Lung cancer rates in men and women with comparable histories of smoking. J Natl Cancer Inst, 2004, 96(11): 826-834.
27. Ma Y, Kroemer G. The cancer-immune dialogue in the context of stress. Nat Rev Immunol, 2024, 24(4): 264-281.
28. Falcinelli M, Thaker PH, Lutgendorf SK, et al. The role of psychologic stress in cancer initiation: Clinical relevance and potential molecular mechanisms. Cancer Res, 2021, 81(20): 5131-5140.
29. Possenti I, Romelli M, Carreras G, et al. Association between second-hand smoke exposure and lung cancer risk in never-smokers: A systematic review and meta-analysis. Eur Respir Rev, 2024, 33(174): 240077.
30. 蒋磊, 徐国厚, 王丁要, 等. 健康女性低剂量胸部CT检查结果及磨玻璃结节状况的调查. 医学理论与实践, 2019, 32(06): 800-802.Jiang L, Xu GH, Wang DY, et al. Investigation of low-dose chest CT results and ground-glass nodules in healthy women. Med Theory Pract, 2019, 32(06): 800-802.
31. 胡军, 王晓冬. 济南市区域成年健康查体人群胸部CT检出肺局灶性磨玻璃密度结节情况. 中国临床研究, 2021, 34(09): 1190-1193,1198.Hu J, Wang XD. Detection of focal ground-glass density nodules in chest CT of adult health examination population in Jinan. Chin J Clin Res, 2021, 34(09): 1190-1193,1198.
32. Delgado-Saborit JM, Stark C, Harrison RM. Carcinogenic potential, levels and sources of polycyclic aromatic hydrocarbon mixtures in indoor and outdoor environments and their implications for air quality standards. Environ Int, 2011, 37(2): 383-392.
33. Turner MC, Krewski D, Pope CA 3rd, Chen Y, et al. Long-term ambient fine particulate matter air pollution and lung cancer in a large cohort of never-smokers. Am J Respir Crit Care Med, 2011, 184(12): 1374-1381.
34. Shaddick G, Thomas ML, Amini H, Broday D, et al. Data integration for the assessment of population exposure to ambient air pollution for global burden of disease assessment. Environ Sci Technol, 2018, 52(16): 9069-9078.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesComparative study on epidemiological characteristics of lung cancer among adolescents and young adults in China and globally, 1990–2021: Disease burden, trend changes, and influencing factors

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