Thirty-year changes and future tendencies in Asian burden of tracheal, bronchus, and lung cancer: insights from the Global Burden of Disease Study.

Background: Tracheal, bronchus, and lung (TBL) cancer remains the malignant tumor with the highest incidence and mortality worldwide, and Asia accounts for nearly 60% of the global disease burden. The Global Burden of Disease (GBD) database provides global disease burden estimates and supports epidemiological research on specific diseases. This study aimed to assess the burden and risk factors of TBL cancer in Asia between 1990 and 2021 to inform precise prevention and treatment strategies and rational resource allocation. Methods: Data were extracted from GBD database, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) and their age-standardized rates. Comprehensive analyses were performed using models including Joinpoint regression, age-period-cohort, decomposition, frontier and inequality analysis, attributable risk factor distribution estimation, and Bayesian age-period-cohort prediction. Results: From 1990 to 2021, the TBL cancer burden in Asia increased significantly, with the number of cases of incidence, prevalence, mortality and DALYs rising dramatically, approximately 2-fold in incidence and 2.7-fold in deaths. Age-standardized incidence rate (ASIR) rose by 22%, age-standardized prevalence rate (ASPR) by 49%, age-standardized mortality rate (ASMR) by 8%, age-standardized DALYs rate (ASDRs) by 2%, and indicators were higher in males than in females. East Asia, China, Japan and India led Asian subregions in terms of disease burden. Furthermore, the highest age group for each burden indicator was shifted back by 5 years. Joinpoint regression showed a significant increase in ASIR and ASPR, a slight increase in ASMR, and a large fluctuation in ASDRs, yet the burden indicators decreased for males and showed a significant increase for females. Population growth contributed the most to TBL cancer burden, followed by aging, and epidemiologic changes mitigated mortality and DALYs in males. Frontier analysis suggested that most countries or regions have much space for improvement in the ASDRs. Inequality analysis indicated that the cross-country absolute imbalance of TBL cancer burden in Asia has declined and the relative imbalance has increased over the past three decades. Risk factor analysis showed that smoking remained the primary factor and declined in most countries, following by particulate matter pollution, occupational carcinogens, which was about 10% and increasing, and low fruit intake with a large impact in South Asia. Conclusions: The TBL cancer burden continues to increase in Asia, notably among females. Despite recent progress, significant cross-national inequalities persist, particularly in low socio-demographic index countries. Future efforts should optimize healthcare resource allocation, improve health infrastructure, and strengthen health education to mitigate the burden. International collaboration and data sharing are vital to advance research and treatment.