Association between low fruit consumption and elevated lung cancer mortality: epidemiological evidence from the Global Burden of Disease Study 2021.

purposeLarge-scale, standardized epidemiological evidence on the relationship between low fruit consumption and lung cancer mortality remains limited. Based on the Global Burden of Disease (GBD) Study 2021, we aimed to systematically describe the association between low fruit consumption and global lung cancer mortality, and its spatiotemporal distribution patterns.

methodsAge-standardized exposure value (ASEV) was used to assess low fruit consumption levels, and age-standardized mortality rate (ASMR) was used to evaluate lung cancer mortality burden. Through multi-source data integration and standardized processing, we assessed low fruit intake exposure and attributable lung cancer mortality across different regions, socioeconomic development levels, and demographic characteristics from 2000 to 2021, analyzing temporal trends using estimated annual percentage change (EAPC).

resultsThe global ASEV for low fruit consumption was 40.90% (95% UI: 34.85%, 42.89%) in 2021, showing a decrease from 2000 (EAPC = − 0.35%, 95% CI − 0.39%, − 0.31%). The attributable lung cancer ASMR decreased from 1.13 (95% UI: 0.59, 1.63) to 0.77 (95% UI: 0.40, 1.13) per 100,000 during 2000–2021, while absolute deaths increased to 66.05 (95% UI: 34.01, 97.03) thousand. Regional analysis revealed South Asia as the only region with an increasing ASMR trend (EAPC = + 0.39%, 95% CI 0.24%, 0.53%), while Southeast Asia, East Asia, and Oceania showed the most significant improvement (EAPC = − 3.20%, 95% CI − 3.42%, − 2.98%). A clear socioeconomic gradient existed, with High-middle SDI regions showing the fastest ASMR improvement (EAPC = − 3.26%, 95% CI − 3.53%, − 2.99%) and Low SDI regions showing minimal improvement (EAPC = − 0.10%, 95% CI − 0.13%, − 0.08%); Middle SDI regions bore the highest mortality burden with 20.85 (95% UI: 10.80, 30.84) thousand deaths in 2021. Demographically, male ASMR of 1.12 (95% UI: 0.58, 1.63) per 100,000 was approximately 2.4 times higher than female ASMR of 0.47 (95% UI: 0.24, 0.70) per 100,000, with more pronounced improvement (male EAPC = − 2.22%, 95% CI − 2.33%, − 2.11%; female EAPC = − 1.26%, 95% CI − 1.45%, − 1.08%). Age-stratified analysis showed higher ASMR in the ≥ 55 years age group (3.81 per 100,000, 95% UI: 1.97, 5.60) but faster decline in the 25–55 years age group (EAPC = − 2.27%, 95% CI − 2.51%, − 2.03%), particularly among younger populations in High-middle SDI regions.

conclusionThis study provides the first systematic, large-scale epidemiological analysis of the estimated association between low fruit consumption and global lung cancer mortality. While acknowledging the observational nature of these findings and the primary role of smoking in lung cancer etiology, it contributes to the understanding of how dietary factors may relate to global lung cancer mortality burden.