Comparative trends in disease burden of tracheal, bronchial, and lung cancer in china and across socio-demographic index (low, middle and high SDI) countries, 1990–2021_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENG Zhiyang ¹ , WANG Tianyu ² , Praise Audax Rukonge ³ , WEI Qishu ¹ ,  YU Guiping ⁴

1. Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, P. R. China;
2. Department of Thoracic and Cardiovascular Surgery, The Affiliated Jiangyin Hospital of Nantong University, Wuxi, 214400, Jiangsu, P. R. China;
3. Department of Thoracic and Cardiovascular Surgery, International Education College of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, P. R. China;
4. Department of Thoracic and Cardiovascular Surgery, Jiangyin Clinical College of Xuzhou Medical University, Wuxi, 214400, Jiangsu, P. R. China;

Corresponding?author：

YU Guiping, Email: xiaoyuer97103@163.com

Keywords：

Trachea; bronchial; lung cancer; disease burden; Joinpoint; regression analysis.

DOI：

10.7507/1007-4848.202509051

Video：

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Objective To analyze trends in the disease burden of tracheal, bronchial, and lung cancer (TBL) in China and in low, medium, and high socio-demographic index (SDI) countries and regions from 1990 to 2021, with the aim of providing a basis for developing targeted prevention and control strategies. Methods Using the Global Burden of Disease (GBD) 2021 database, we extracted TBL-related data for different genders, age groups, and years from 1990 to 2021. The dominant factors contributing to the disease burden and the relationship between DALYs and SDI were analyzed. Results In 2021, China's overall TBL burden was significantly higher than other groups, with substantially greater increases in the number of cases, deaths, and DALYs compared to other groups. The growth rates of ASPR, ASMR, and ASDR also exceeded the overall levels of other SDI countries.The ASPR for all grouped TBLs showed an overall trend of increasing followed by decreasing with age. However, the ASPR for Chinese and middle-SDI male groups exhibited a downward trend in the age range 80-84 years old. Decomposition analysis revealed that the dominant factors for the increase in disease burden of TBL in each group are different. The growth DALYs in China and middle-SDI countries were primarily driven by population aging, while low-SDI countries were mainly influenced by population growth and high-SDI countries were predominantly affected by epidemiological changes. Global health inequalities in TBL have improved, yet low-SDI countries continue to bear a disproportionately heavy health burden. Conclusion The burden of TBL disease in China has steadily increased from 1990 to 2021, currently ranking among the highest globally. Multiple factors, primarily driven by population aging, continue to exacerbate China's TBL burden. The TBL disease burden is influenced by aging, gender differences, and SDI levels. China and low- middle SDI countries should implement targeted intervention strategies based on epidemiological research, including expanding public health service investments and strengthening healthcare system development, to alleviate the increasingly heavy TBL burden.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Liu X, Yang Q, Pan L, et al. Burden of respiratory tract cancers in China and its provinces, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Reg Health West Pac, 2025, 55: 101485.
3.	Hendriks LEL, Remon J, Faivre-Finn C, et al. Non-small-cell lung cancer. Nat Rev Dis Primers, 2024, 10(1): 71.
4.	Kuang Z, Wang J, Liu K, et al. Global, regional, and national burden of tracheal, bronchus, and lung cancer and its risk factors from 1990 to 2021: findings from the global burden of disease study 2021. EClinicalMedicine, 2024, 75: 102804.
5.	Zhang M, Jin W, Tian Y, et al. Cancer burden variations and convergences in globalization: a comparative study on the Tracheal, Bronchus, and Lung (TBL) and liver cancer burdens among WHO regions from 1990 to 2019. J Epidemiol Glob Health, 2023, 13(4): 696-724.
6.	Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin, 2025, 75(1): 10-45.
7.	World Health Organization. World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization, 2025.
8.	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
9.	Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol, 2023, 9(4): 465-472.
10.	Trussardi Fayh AP, de Sousa IM. Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass. PLoS One, 2021, 16(9): e0257446.
11.	Berry SD, Ngo L, Samelson EJ, et al. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc, 2010, 58(4): 783-787.
12.	Su B, Zhong P, Xuan Y, et al. Changing patterns in cancer mortality from 1987 to 2020 in China. Cancers (Basel), 2023, 15(2): 476.
13.	Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 2015, 386(10002): 1447-1456.
14.	宇傳華, 白建軍. 社會人口指數(SDI)的概念及其應用. 公共衛生與預防醫學, 2020, 31(1): 5-10.Yu CH, Bai JJ. The concept of Socio-Demographic Index (SDI) and its application. J Public Health Prev Med, 2020, 31(1): 5-10.
15.	Zhang X, Wu L, Xu Y, et al. Trends in the incidence rate of lung cancer by histological type and gender in Sichuan, China, 1995-2015: A single-center retrospective study. Thorac Cancer, 2018, 9(5): 532-541.
16.	Tu S, Huang X, Fan X, et al. National and subnational burden of brain and central nervous system cancers in China and global from 1990 to 2021: results from the global burden of disease study 2021. Arch Public Health, 2025, 83(1): 195.
17.	劉岳儀, 崔振嶺. 1990—2021年中國歸因于空氣污染的肺癌疾病負擔分析. 中國衛生統計, 2025, 42(3): 350-354.Liu YY, Cui ZL. Analysis of the disease burden of lung cancer attributable to air pollution in China from 1990 to 2021. Chin J Health Stat, 2025, 42(3): 350-354.
18.	Thun M, Peto R, Boreham J, et al. Stages of the cigarette epidemic on entering its second century. Tob Control, 2012, 21(2): 96-101.
19.	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.
20.	He KJ, Xu Z, Xu J, et al. Global and national burden of tracheal, bronchus, and lung cancer attributabled to household air pollution from solid fuels in populations aged 55 and above: an integrated study of frontier and joinpoint regression analysis. BMC Public Health, 2025, 25(1): 1249.
21.	Su X, Tao Y, Chen F, et al. Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021. Sci Rep, 2025, 15(1): 7655.
22.	李富, 張亞楠, 劉斌, 等. 1990—2021年中國歸因于職業致癌物的氣管、支氣管和肺癌疾病負擔及變化趨勢分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1263-1270.Li F, Zhang YN, Liu B, et al. Analysis of the burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens and trends in China from 1990 to 2021. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1263-1270.
23.	馬運, 袁浩冉, 胡昊, 等. 1990-2019年中國歸因于煙草的肺癌疾病負擔變化趨勢分析. 現代預防醫學, 2024, 51(8): 1345-1351.Ma Y, Yuan HR, Hu H, et al. Trends of disease burden of lung cancer attributed to tobacco in China, 1990-2019. Mod Prev Med, 2024, 51(8): 1345-1351.
24.	丁璐璐, 朱健, 張永輝, 等. 1990-2019年中國歸因于吸煙的肺癌疾病負擔研究. 現代腫瘤醫學, 2024, 32(1): 141-146.Ding LL, Zhu J, Zhang YH, et al. Disease burden of lung cancer attributable to smoking in China from 1990 to 2019. Mod Oncol, 2024, 32(1): 141-146.
25.	中華人民共和國國家衛生健康委員會醫療應急司. 健康中國行動——癌癥防治行動實施方案(2023—2030年). 中國腫瘤, 2023, 32(12): 887-890.Medical Emergency Department of the National Health Commission of the People's Republic of China. Healthy China Initiative-Implementation plan for cancer prevention and control (2023-2030). China Cancer, 2023, 32(12): 887-890.
26.	Levy DT, Wijnhoven TMA, Levy J, et al. Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries. Eur J Public Health, 2018, 28(4): 693-701.
27.	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.
28.	Xu H, Wang Q, Zhu H, et al. Related health burden with the improvement of air quality across China. Chin Med J (Engl), 2024, 137(22): 2726-2733.
29.	Hoffman RM, Sanchez R. Lung cancer screening. Med Clin North Am, 2017, 101(4): 769-785.
30.	Ye R, Cao Y, Zhu X, et al. Comparative study of early onset cancer burden between China and the United States from 1990 to 2021. Sci Rep, 2025, 15(1): 28527.
31.	Murray CJL. The Global Burden of Disease Study at 30 years. Nat Med, 2022, 28(10): 2019-2026.
32.	Burton MJ, Ramke J, Marques AP, et al. The lancet global health commission on global eye health: vision beyond 2020. Lancet Glob Health, 2021, 9(4): 489-551.
33.	Ji X, Chen J, Ye J, et al. Epidemiological analysis of global and regional lung cancer mortality: based on 30-year data analysis of Global Burden Disease Database. Healthcare (Basel), 2023, 11(22): 2920.
34.	Zhao Q, Zhang B, Chen X, et al. Global, regional, and national burden of motor neuron disease in adults aged 65 years and older from 1990 to 2021 and forecast to 2040. Front Neurol, 2025, 16: 1641887.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Liu X, Yang Q, Pan L, et al. Burden of respiratory tract cancers in China and its provinces, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Reg Health West Pac, 2025, 55: 101485.
3. Hendriks LEL, Remon J, Faivre-Finn C, et al. Non-small-cell lung cancer. Nat Rev Dis Primers, 2024, 10(1): 71.
4. Kuang Z, Wang J, Liu K, et al. Global, regional, and national burden of tracheal, bronchus, and lung cancer and its risk factors from 1990 to 2021: findings from the global burden of disease study 2021. EClinicalMedicine, 2024, 75: 102804.
5. Zhang M, Jin W, Tian Y, et al. Cancer burden variations and convergences in globalization: a comparative study on the Tracheal, Bronchus, and Lung (TBL) and liver cancer burdens among WHO regions from 1990 to 2019. J Epidemiol Glob Health, 2023, 13(4): 696-724.
6. Siegel RL, Kratzer TB, Giaquinto AN, et al. Cancer statistics, 2025. CA Cancer J Clin, 2025, 75(1): 10-45.
7. World Health Organization. World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization, 2025.
8. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
9. Chen S, Cao Z, Prettner K, et al. Estimates and projections of the global economic cost of 29 cancers in 204 countries and territories from 2020 to 2050. JAMA Oncol, 2023, 9(4): 465-472.
10. Trussardi Fayh AP, de Sousa IM. Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass. PLoS One, 2021, 16(9): e0257446.
11. Berry SD, Ngo L, Samelson EJ, et al. Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc, 2010, 58(4): 783-787.
12. Su B, Zhong P, Xuan Y, et al. Changing patterns in cancer mortality from 1987 to 2020 in China. Cancers (Basel), 2023, 15(2): 476.
13. Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 2015, 386(10002): 1447-1456.
14. 宇傳華, 白建軍. 社會人口指數(SDI)的概念及其應用. 公共衛生與預防醫學, 2020, 31(1): 5-10.Yu CH, Bai JJ. The concept of Socio-Demographic Index (SDI) and its application. J Public Health Prev Med, 2020, 31(1): 5-10.
15. Zhang X, Wu L, Xu Y, et al. Trends in the incidence rate of lung cancer by histological type and gender in Sichuan, China, 1995-2015: A single-center retrospective study. Thorac Cancer, 2018, 9(5): 532-541.
16. Tu S, Huang X, Fan X, et al. National and subnational burden of brain and central nervous system cancers in China and global from 1990 to 2021: results from the global burden of disease study 2021. Arch Public Health, 2025, 83(1): 195.
17. 劉岳儀, 崔振嶺. 1990—2021年中國歸因于空氣污染的肺癌疾病負擔分析. 中國衛生統計, 2025, 42(3): 350-354.Liu YY, Cui ZL. Analysis of the disease burden of lung cancer attributable to air pollution in China from 1990 to 2021. Chin J Health Stat, 2025, 42(3): 350-354.
18. Thun M, Peto R, Boreham J, et al. Stages of the cigarette epidemic on entering its second century. Tob Control, 2012, 21(2): 96-101.
19. 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.
20. He KJ, Xu Z, Xu J, et al. Global and national burden of tracheal, bronchus, and lung cancer attributabled to household air pollution from solid fuels in populations aged 55 and above: an integrated study of frontier and joinpoint regression analysis. BMC Public Health, 2025, 25(1): 1249.
21. Su X, Tao Y, Chen F, et al. Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021. Sci Rep, 2025, 15(1): 7655.
22. 李富, 張亞楠, 劉斌, 等. 1990—2021年中國歸因于職業致癌物的氣管、支氣管和肺癌疾病負擔及變化趨勢分析. 中國胸心血管外科臨床雜志, 2025, 32(9): 1263-1270.Li F, Zhang YN, Liu B, et al. Analysis of the burden of tracheal, bronchus, and lung cancer attributable to occupational carcinogens and trends in China from 1990 to 2021. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(9): 1263-1270.
23. 馬運, 袁浩冉, 胡昊, 等. 1990-2019年中國歸因于煙草的肺癌疾病負擔變化趨勢分析. 現代預防醫學, 2024, 51(8): 1345-1351.Ma Y, Yuan HR, Hu H, et al. Trends of disease burden of lung cancer attributed to tobacco in China, 1990-2019. Mod Prev Med, 2024, 51(8): 1345-1351.
24. 丁璐璐, 朱健, 張永輝, 等. 1990-2019年中國歸因于吸煙的肺癌疾病負擔研究. 現代腫瘤醫學, 2024, 32(1): 141-146.Ding LL, Zhu J, Zhang YH, et al. Disease burden of lung cancer attributable to smoking in China from 1990 to 2019. Mod Oncol, 2024, 32(1): 141-146.
25. 中華人民共和國國家衛生健康委員會醫療應急司. 健康中國行動——癌癥防治行動實施方案(2023—2030年). 中國腫瘤, 2023, 32(12): 887-890.Medical Emergency Department of the National Health Commission of the People's Republic of China. Healthy China Initiative-Implementation plan for cancer prevention and control (2023-2030). China Cancer, 2023, 32(12): 887-890.
26. Levy DT, Wijnhoven TMA, Levy J, et al. Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries. Eur J Public Health, 2018, 28(4): 693-701.
27. 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.
28. Xu H, Wang Q, Zhu H, et al. Related health burden with the improvement of air quality across China. Chin Med J (Engl), 2024, 137(22): 2726-2733.
29. Hoffman RM, Sanchez R. Lung cancer screening. Med Clin North Am, 2017, 101(4): 769-785.
30. Ye R, Cao Y, Zhu X, et al. Comparative study of early onset cancer burden between China and the United States from 1990 to 2021. Sci Rep, 2025, 15(1): 28527.
31. Murray CJL. The Global Burden of Disease Study at 30 years. Nat Med, 2022, 28(10): 2019-2026.
32. Burton MJ, Ramke J, Marques AP, et al. The lancet global health commission on global eye health: vision beyond 2020. Lancet Glob Health, 2021, 9(4): 489-551.
33. Ji X, Chen J, Ye J, et al. Epidemiological analysis of global and regional lung cancer mortality: based on 30-year data analysis of Global Burden Disease Database. Healthcare (Basel), 2023, 11(22): 2920.
34. Zhao Q, Zhang B, Chen X, et al. Global, regional, and national burden of motor neuron disease in adults aged 65 years and older from 1990 to 2021 and forecast to 2040. Front Neurol, 2025, 16: 1641887.

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Latest ArticlesComparative trends in disease burden of tracheal, bronchial, and lung cancer in china and across socio-demographic index (low, middle and high SDI) countries, 1990–2021

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