Table_1_The incidence and mortality of lung cancer in China: a trend analysis and comparison with G20 based on the Global Burden of Disease Study 2019.docx

BackgroundLung cancer is a significant health concern in China. There is limited available data of its burden and trends. This study aims to evaluate the trends of lung cancer across different age groups and genders in China and the Group of Twenty (G20) countries, explore the risk factors, and predict the future trends over a 20-year period.
MethodsThe data were obtained from the GBD study 2019. The number of cases, age standardized rate (ASR), and average annual percentage changes (AAPC) were used to estimate the trend in lung cancer by age, gender, region and risk factor. The trend of lung cancer was predicted by autoregressive integrated moving average (ARIMA) model by the “xtarimau” command. The joinpoint regression analysis was conducted to identify periods with the highest changes in incidence and mortality. Additionally, the relationship between AAPCs and socio-demographic index (SDI) was explored.
ResultsFrom 1990 to 2019, both the incidence and mortality of lung cancer in China and G20 significantly increased, with China experiencing a higher rate of increase. The years with the highest increase in incidence of lung cancer in China were 1998-2004 and 2007-2010. Among the G20 countries, the AAPC in incidence and mortality of lung cancer in the Republic of Korea was the highest, followed closely by China. Although India exhibited similarities, its AAPC in lung cancer incidence and mortality rates was lower than that of China. The prediction showed that the incidence in China will continue to increase. In terms of risk factors, smoking was the leading attributable cause of mortality in all countries, followed by occupational risk and ambient particulate matter pollution. Notably, smoking in China exhibited the largest increase among the G20 countries, with ambient particulate matter pollution ranking second.
ConclusionLung cancer is a serious public health concern in China, with smoking and environmental particulate pollution identified as the most important risk factors. The incidence and mortality rates are expected to continue to increase, which places higher demands on China’s lung cancer prevention and control strategies. It is urgent to tailor intervention measures targeting smoking and environmental pollution to contain the burden of lung cancer.

背景 肺癌在中国是一项重大公共卫生健康问题。目前关于其疾病负担与流行趋势的公开数据较为有限。本研究旨在评估中国及二十国集团（Group of Twenty, G20）成员国不同年龄组与性别的肺癌流行趋势，探究其危险因素，并对未来20年的肺癌发病趋势进行预测。
方法 数据来源于2019年全球疾病负担（Global Burden of Disease, GBD）研究。以病例数、年龄标化率（age standardized rate, ASR）及年度平均变化百分比（average annual percentage changes, AAPC）为评估指标，按年龄、性别、地区及危险因素分层，分析肺癌的流行趋势。采用"xtarimau"命令构建自回归整合移动平均（autoregressive integrated moving average, ARIMA）模型，预测肺癌发病趋势；通过连接点回归分析识别肺癌发病率与死亡率变化幅度最大的时间段。此外，本研究还探讨了AAPC与社会人口学指数（socio-demographic index, SDI）之间的关联。
结果 1990年至2019年，中国及二十国集团成员国的肺癌发病率与死亡率均显著上升，且中国的增幅更高。中国肺癌发病率增幅最显著的时间段为1998-2004年与2007-2010年。在二十国集团成员国中，大韩民国的肺癌发病率与死亡率年度平均变化百分比最高，紧随其后的为中国。尽管印度的变化趋势相似，但其肺癌发病率与死亡率的AAPC低于中国。预测结果显示，中国肺癌发病率将持续上升。在危险因素方面，吸烟是所有国家肺癌死亡的首要可归因危险因素，其次为职业暴露风险与环境颗粒物污染。值得注意的是，中国的吸烟相关肺癌死亡增幅在二十国集团成员国中居首，环境颗粒物污染次之。
结论 肺癌是中国亟待解决的重大公共卫生问题，吸烟与环境颗粒物污染为其最主要的危险因素。中国肺癌发病率与死亡率预计将持续上升，这对中国的肺癌防控策略提出了更高要求。亟需制定针对吸烟与环境污染的个性化干预措施，以遏制肺癌的疾病负担。