Abstract
PURPOSE: To explore the global, regional, and country-specific burden of tracheal, bronchus, and lung cancer (TBL) in individuals aged 55 and above due to household air pollution from solid fuels (HAPSF) between 1990 and 2021, and to project its incidence and mortality rates for 2044. METHODS: This study utilized data from the Global Burden of Disease Study 2021 (GBD 2021) to assess the burden of TBL in individuals aged 55 and above due to HAPSF between 1990 and 2021. The Age-Period-Cohort (APC) model, based on Poisson distribution, was used to analyze the impact of age, period, and cohort on TBL mortality trends. Joinpoint regression and decomposition analysis were applied to identify significant changes in trends and assess the contributions of population growth, aging, and epidemiological transitions. Based on the identified trends, projections of TBL incidence and mortality rates for 2044 were made using the Bayesian Age-Period-Cohort (BAPC) model. The analysis was conducted across 204 countries and regions, considering different socio-demographic index (SDI) levels. RESULTS: In 2021, significant disparities in TBL burden attributable to HAPSF were observed across 204 countries. High-SDI countries like the United Arab Emirates had the lowest TBL-related death and DALY rates, while low-SDI countries, such as North Korea, reported the highest. From 1990 to 2021, global TBL-related DALYs declined by 4.17% annually, with more substantial reductions in high-SDI regions. However, a slight resurgence in DALYs was observed between 2019 and 2021. DALY trends showed variations by age and sex, with more pronounced declines in higher-SDI regions, particularly for older age groups. Projections for 2041 indicate continued substantial decreases in TBL burden across all age groups, with the most significant reductions expected among males. Decomposition analysis revealed that population growth primarily contributed to the increase in TBL burden, while epidemiological transitions led to reductions, especially in middle and high-SDI regions. Frontier analysis identified countries with the greatest potential for improvement in TBL burden, including both low-SDI countries and certain high-SDI regions. Projections using the Bayesian Age-Period-Cohort (BAPC) model suggest that DALYs will decrease substantially by 2044, with the most significant reductions in the 70-74 and 65-69 age groups. CONCLUSIONS: Socioeconomic development is negatively correlated with the TBL burden from HAPSF. Lower SDI countries face a heavier burden, while high SDI countries see increased TBL in aging populations. Tailored policies are needed for different SDI regions.