Disease burden of lung cancer attributable to metabolic and behavioral risks in China and globally from 1990 to 2021

Background: There are differences between China and globally in the burden of lung cancer attributed to behavioral and metabolic risks. Methods: This research utilized the GBD 2021 database to extract the deaths and disability-adjusted life-years (DALYs) of lung cancer attributed to metabolic and behavioral risks in China and globally, along with their age-standardized rates (ASR). The age-period-cohort model was used to identify age effects, period effects, cohort effects, as well as local and net drift. Decomposition analysis was used to quantify the relative contributions of aging, epidemiological change, and population to the lung cancer burden. Bayesian age-period-cohort model was used for predictive analysis. Results: From 1990 to 2021, the ASMR of lung cancer attributed to smoking, secondhand smoke, and diet low in fruits decreased at globally, while the ASMR attributed to high fasting plasma glucose had a slow rise, with a percentage change of 19.45% (6.29%-31.97%). In China, the ASMR of lung cancer attributed to behavioral and metabolic risks all increased slightly, excepting the rate for low fruit intake declined by 57.12% (-69%-41.25%). The net drift for smoking, secondhand smoke, diet low in fruits and high fasting plasma glucose was -1.28%, -1.19%, -2.06% and 0.29% respectively at globally, while it was -0.02%, -0.30%, -3.61% and 0.90% in China. In the next 15 years, the burden of lung cancer attributed to behavioral and metabolic risks was expected to decrease in China and globally, but the burden among Chinese women attributed to smoking and secondhand smoke showed a slow upward trend. Conclusions: Over the past thirty years, the global burden of lung cancer attributed to behavioral factors has decreased, while it increased slow in attribution to metabolic factors. In China, only the lung cancer burden attributed to diet low in fruits has decrease, others have exhibited a fluctuating trend. In the next 15 years, the burden of lung cancer attributed to these risks was expected to decrease in both China and globally, but there will still be an upward trend in Chinese women.