Abstract
BACKGROUND: There are differences between China and globally in the burden of lung cancer attributed to behavioral and metabolic risks. METHODS: This research utilized the Global Burden of Disease (GBD) 2021 database to extract the deaths and disability-adjusted life-years (DALYs) of lung cancer attributed to metabolic and behavioral risks in China and globally, along with the age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR). The age-period-cohort model was used to identify age effects, period effects, cohort effects, as well as local and net drift. Decomposition analysis was used to quantify the relative contributions of aging, epidemiological change, and population to the lung cancer burden. Bayesian age-period-cohort model was used for predictive analysis. RESULTS: From 1990 to 2021, the ASMR of lung cancer attributed to smoking and secondhand smoke significantly decreased globally, but it increased slightly in China. And the ASMR of lung cancer attributed to diet low in fruits significantly decreased, while the ASMR due to high fasting plasma glucose increased both in China and globally. The net drifts of lung cancer deaths attributed to smoking and secondhand smoke were both negative values globally, while the net drifts were small and even close to zero in China. The net drifts attributed to diet low in fruits and high fasting plasma glucose globally were -2.06% and 0.29%, respectively, and the lung cancer deaths among elderly patients has been increasing annually. However, in China, the lung cancer deaths attributed to diet low in fruits has been decreasing annually across all age groups, while the deaths due to high fasting plasma glucose has been increasing year by year. In the next 15 years, the burden of lung cancer attributed to behavioral and metabolic risks was expected to decrease in China and globally, but the burden among Chinese women attributed to smoking and secondhand smoke showed a slow upward trend. CONCLUSIONS: Over the past thirty years, the global burden of lung cancer attributed to behavioral factors has decreased, while it increased slow in attribution to metabolic factors. In China, only the lung cancer burden attributed to diet low in fruits has decrease, others have exhibited a fluctuating trend. In the next 15 years, the burden of lung cancer attributed to behavioral and metabolic risks decreases globally, but the lung cancer burden attributed to smoking and secondhand smoke shows a slow upward trend among Chinese women. That asks a need for greater attention to the tobacco exposure among women.