Abstract
PURPOSE: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study employed a multi-level comparative approach to assess the global, regional, and national burden of early-onset lung cancer (EOLC, diagnosed before age 50) from 1990 to 2021. This design enabled the identification of distinctive epidemiological patterns. Within this framework, the primary objective was to determine and characterize the specific burden of EOLC among young women in China. A secondary objective was to evaluate the corresponding burdens in young women globally and regionally to provide essential context for interpreting the findings from China. PATIENTS AND METHODS: We used data from the Global Burden of Disease (GBD) 2021 to assess trends in EOLC incidence, mortality, disability-adjusted life years (DALYs), and attributable risk factors from 1990 to 2021. Analyses were conducted globally, regionally, and nationally for individuals under 50. Age-standardized incidence and mortality rates (ASIR and ASMR) were calculated, and Joinpoint regression was employed to evaluate temporal changes. RESULTS: In China, EOLC rates declined among men and the overall population but increased significantly among women beginning in 2015 (APC for incidence: +2.0%, 2015-2021). Attribution analysis showed that occupational exposures contributed an increasing share of EOLC deaths among Chinese women, rising from 7.37% in 1990 to 10.47% in 2021, compounded by persistent effects from secondhand smoke and air pollution-particularly particulate matter pollution, which accounted for 25.75% of deaths and 25.58% of DALYs in 2021. From 1990 to 2021, the global burden of EOLC remained substantial. While age-standardized incidence and mortality rates showed a declining trend, tobacco smoking persisted as the predominant risk factor, accounting for the largest proportion of attributable deaths. Marked disparities in this burden were observed across regions and between sexes. CONCLUSION: The EOLC burden is shifting toward low- and middle-SDI regions. Within this transition, a distinct and rising burden among young women in China has emerged as a critical public health concern. These findings highlight the urgent need for targeted prevention strategies that address sex- and region-specific risk factors, particularly occupational and environmental exposures in rapidly developing settings.