Trends in lung cancer burden, risk factors, and disease projections in China and the United States, 1990-2023

Our plain-English summary of Trends in lung cancer burden, risk factors, and disease projections in China and the United States, 1990-2023, by L. Guo, Y. Li, L. Cai, et al (Chinese Medical Journal Pulmonary and Critical Care Medicine, 2026).

The study

• Authors: L. Guo, Y. Li, L. Cai, H. Luan, J. Yuan, C. Zhu, H. Chen
• Journal: Chinese Medical Journal Pulmonary and Critical Care Medicine
• Published: 2026;4(3):267-277
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Lung cancer is among the most burdensome malignancies worldwide, with marked disparities between China and the United States in terms of its epidemiological characteristics, risk factors, and prevention outcomes. In this study, the long-term trends in lung cancer burden and risk factors in China and the United States from 1990 to 2023 were systematically analyzed using Global Burden of Disease (GBD) Study 2023 data, and disease burden was projected through 2050, aiming to provide evidence for optimizing lung cancer prevention and control strategies in both countries.

Methods: Data, including incident cases, deaths, prevalence cases, disability-adjusted life years (DALYs), age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), age-standardized prevalence rates (ASPRs), and age-standardized DALY rates (ASDRs) for lung cancer in China and the United States, along with data on smoking, air pollution, occupational exposure, and metabolic and dietary risk factors, were extracted from the GBD 2023 database. Joinpoint regression was used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs). The three-factor Das-Gupta decomposition analysis was used to quantify independent contributions of population size, population aging, and epidemiological change to variations in the absolute case burden of lung cancer in China and the United States, and Bayesian age-period-cohort models were used to project disease burden trends from 2024 to 2050.

Results: From 1990 to 2023, the numbers of lung cancer incident cases, deaths, prevalent cases and DALYs in China increased substantially and were far greater than those in the United States by 2023; the ASIR remained relatively stable (36.91 vs. 37.28 per 100,000), while ASMR decreased from 36.95 to 32.86 per 100,000, the ASPR increased from 40.04 to 53.03 per 100,000, and ASDR decreased from 935.08 to 742.26 per 100,000. In the United States, the ASIR, ASMR, and ASDR declined continuously and substantially, with a significant reduction in disease burden. With respect to risk factors, China experienced a continuous increase in the burden attributable to smoking (DALYs increased by 109.97%), ambient particulate matter pollution (DALYs increased by 414.84%), secondhand smoke (DALYs increased by 79.99%), high fasting plasma glucose (DALYs increased by 102.05%), and occupational exposure (including asbestos, diesel engine exhaust, and silica, with attributable DALY increasing by 219.97%, 164.39% and 110.59%, respectively), with only household air pollution from solid fuels declining (DALYs decreased by 85.58%). In the United States, the DALY burden attributable to all major risk factors decreased significantly. Sex-specific analyses revealed that the DALY burden was consistently higher in males than in females in both countries; the sex disparity remained stable in China but narrowed substantially in the United States. Projections through 2050 indicate that the absolute case burden of lung cancer in China will continue to increase, whereas that in the United States will continue to decrease, further widening the disparity between the two countries.

Conclusions: From 1990 to 2023, China and the United States exhibited diametrically opposite lung cancer burden trajectories. China remains in a phase of increasing risk factors and rising absolute case burden, whereas the United States has entered a phase of comprehensive risk factor control and sustained burden reduction. China should implement long-term stringent tobacco control, strengthen ambient PM2.5 management, target middle-aged and elderly populations for focused interventions, and promote universal low-dose computed tomography (LDCT) screening. The United States should consolidate tobacco control achievements and enhance screening among high-risk persons. The experiences of both countries provide stratified references for countries at different stages of development.

© 2026 Published by Elsevier B.V. on behalf of Chinese Medical Association.

In plain English

This study analyzed Global Burden of Disease (GBD) 2023 modeled estimates of tracheal, bronchial and lung cancer in China and the United States, 1990 to 2023. In China, estimated new cases rose from 318,666.71 (95% uncertainty interval 270,891.32 to 407,364.30) in 1990 to 872,463.45 (739,142.24 to 1,009,478.00) in 2023, while the age-standardized incidence rate rose slightly, from 36.91 (31.44 to 47.38) to 37.28 (31.81 to 43.09) per 100,000. In the United States, the age-standardized rate of disability-adjusted life years (DALYs) fell from 1,259.93 (1,203.43 to 1,314.35) per 100,000 in 1990 to 555.88 (521.34 to 596.51) in 2023. In China, DALYs attributed to occupational asbestos exposure rose by 219.97%; in the United States, the burden from occupational asbestos exposure declined by 21.47%. The authors projected that new cases in China would rise from 933,721 in 2024 to 7,870,519 in 2050. The authors concluded that China remained in a phase of increasing risk factors and rising absolute case burden, while the United States had entered a phase of comprehensive risk factor control and sustained burden reduction.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Secondary analysis of modeled Global Burden of Disease (GBD) 2023 estimates. The authors used joinpoint trend analysis, a three-factor decomposition (population size, aging, and changes in rates) and Bayesian age-period-cohort projections to 2050.
• Who was studied: Estimated lung cancer burden (tracheal, bronchial, and lung cancer) in the populations of China and the United States, 1990 to 2023, by sex and age group.
• Exposure: GBD estimates of lung cancer DALYs attributed to risk factors. These included smoking, household air pollution from solid fuels, secondhand smoke, ambient particulate matter pollution, a diet low in fruits, high fasting plasma glucose and residential radon. They also included 9 occupational exposures: silica, asbestos, diesel engine exhaust, arsenic, nickel, polycyclic aromatic hydrocarbons, chromium, cadmium and beryllium.
• Main results:
  • In China, the estimated numbers of lung cancer incident cases, deaths, prevalent cases and DALYs increased from 1990 to 2023. Incident cases in 1990 were 318,666.71 (95% UI: 270,891.32 to 407,364.30).
  • In China, estimated lung cancer incident cases in 2023 were 872,463.45 (95% UI: 739,142.24 to 1,009,478.00).
  • In China, the age-standardized incidence rate increased slightly, from 36.91 (95% UI 31.44 to 47.38) to 37.28 (95% UI 31.81 to 43.09) per 100,000. The age-standardized mortality rate decreased from 36.95 to 32.86 per 100,000.
  • In the United States, the age-standardized DALY rate decreased from 1,259.93 per 100,000 (95% UI 1,203.43 to 1,314.35) in 1990 to 555.88 per 100,000 (95% UI 521.34 to 596.51) in 2023.
  • In the United States, the male-to-female ratios of the age-standardized incidence, mortality, prevalence and DALY rates fell from 2.23, 2.36, 1.94 and 2.21 in 1990 to 1.22, 1.31, 1.06 and 1.28 in 2023.
  • In China, for incident cases between 1990 and 2007, population aging contributed 72.17% of the increase, population size 20.80% and epidemiological changes 7.02%.
  • In China, smoking-attributable DALYs in 2023 were 109.97% higher than in 1990.
  • In China, DALYs attributed to occupational asbestos increased by 219.97%, those attributed to diesel engine exhaust by 164.39%, and those attributed to silica by 110.59%, from 1990 to 2023.
  • In China, DALYs attributed to household air pollution from solid fuels decreased by 85.58%.
  • In the United States, smoking-attributable DALYs decreased by 24.93% and the smoking-attributable age-standardized DALY rate decreased by 61.83%.
  • In the United States, the burden from occupational asbestos exposure declined by 21.47% and the burden from residential radon by 13.92%.
  • Projection for China: incident cases rising from 933,721 in 2024 to 7,870,519 in 2050.
  • Projection for the United States: incident cases falling from 198,651 in 2024 to 145,129 in 2050.
• The authors' conclusion: The authors concluded that China remains in a phase of increasing risk factors and rising absolute case burden. In their view, the United States has entered a phase of comprehensive risk factor control and sustained burden reduction.
• Limitations the authors state:
  • The GBD figures are modeled estimates affected by the quality of registration data, underreporting and model assumptions.
  • The study did not include quantitative analysis of social factors such as regional economic levels, distribution of healthcare resources, and screening coverage.
  • The projections are based on historical trends. They do not account for uncertainty from future policy interventions, advances in medical technology, or changes in environmental improvement.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Incidence, Occupational Exposure, Low-Dose CT Screening.

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