Background

Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019.

Methods

Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010–19 period.

Findings

Globally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (−16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (−10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (−8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (−8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9–66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3–69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019.

Interpretation

The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations—namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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1990 年至 2019 年全球、区域和国家呼吸道癌症负担及相关风险因素：2019 年全球疾病负担研究的系统分析

背景

呼吸道癌症的预防、控制和治疗是实现联合国可持续发展目标 (SDG) 目标 3.4 的重要步骤——到 2030 年将非传染性疾病导致的过早死亡率降低三分之一。我们旨在提供全球、 1990 年至 2019 年对气管、支气管、肺癌和喉癌的负担及其归因风险的区域和国家估计。

方法

基于 2019 年全球疾病负担、伤害和风险因素研究 (GBD) 方法，我们评估了呼吸道的发病率、死亡率、残疾寿命年数、损失寿命年数和残疾调整生命年数 (DALYs)癌症（即气管癌、支气管癌、肺癌和喉癌）。根据风险暴露、相对风险和来自 204 个国家和地区的理论最低风险暴露水平输入，按性别和社会人口统计分层，估计可归因于每个风险因素的气管、支气管和肺癌和喉癌死亡人数指数（SDI）。对 1990 年至 2019 年的趋势进行了估计，重点是 2010-19 年。

发现

在全球范围内，有 2·26 万（95% 不确定区间 2·07 至 2·45）新发气管、支气管和肺癌病例，以及 2·04 万（1·88 至 2·19）例死亡和 45· 2019 年因气管、支气管和肺癌导致 900 万（42·3 至 49·3）DALY。新发喉癌病例 209 000（194 000 至 225 000），123 000（115 000 至 03 ) 死亡和 3·26 百万 (3·03 至 3·51) DALYs 在 2019 年全球因喉癌。从 2010 年到 2019 年，新的气管、支气管和肺癌病例数增加了 23·3% (12 ·9 到 33·6)，全球喉癌病例数增加了 24·7%（16·0 到 34·1）。全球年龄标准化气管、支气管、在过去十年中，男性肺癌下降了 7·4%（-16·8 到 1·6），喉癌的年龄标准化发病率下降了 3·0%（-10·5 到 5·0） ; 然而，在同一时期，女性气管癌、支气管癌和肺癌的年龄标准化发病率增加了 0·9%（-8·2 至 10·2），下降了 0·5%（-8·4到 8·1) 用于喉癌。此外，尽管从 2010 年到 2019 年，全球气管癌、支气管癌、肺癌和喉癌的年龄标准化发病率和死亡率在两性中均有所下降，但一些地区的发病率有所上升，尤其是处于 SDI 范围低端的地区。据估计，吸烟导致所有气管癌、支气管癌和肺癌死亡人数的 64·2% (61·9–66·4) 和喉癌所有死亡人数的 63·4% (56·3-69·3) 2019. 对于男性和男女合并，

解释

在过去十年中，全球范围内气管癌、支气管癌、肺癌和喉癌的病例数和死亡数均有所增加。更令人担忧的是，由于气管癌、支气管癌、肺癌和喉癌的年龄标准化发病率和死亡率在某些人群中有所增加，即在较低的 SDI 五分位数和女性中。在这些环境中，应优先采取预防措施，例如吸烟控制干预措施、针对主要空气污染源的空气质量管理计划以及广泛使用清洁能源。

资金

比尔和梅琳达盖茨基金会。