To conduct comparative analysis of lung cancer incidence and mortality, as well as long-term trends in incidence and mortality rates and risk factors in China and the United States from 1990 to 2019 based on data from the Global Burden of Disease Study 2019 (GBD 2019) .

The GBD 2019 database was used to extract new lung cancer cases, deaths, and age-standardized rate data for the analysis of lung cancer incidence and deaths in China and the United States based on different sex and age groups from 1990 to 2019. Joinpoint software was used to calculate and analyze annual percentage change (APC) and average annual percentage change (AAPC) of age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of lung cancer in China and the United States from 1990 to 2019, and to analyze the long-term trends. Risk factors associated with lung cancer mortality in China and the United States were analyzed using the disability-adjusted life years (DALYs) .

New cases of lung cancer in China increased from 257 000 cases in 1990 to 832 900 cases in 2019, and ASIR increased from 30.20/100 000 in 1990 to 41.71/100 000 in 2019; deaths increased from 256 300 cases in 1990 to 757 200 cases in 2019, and ASMR increased from 31.18/100 000 in 1990 to 38.70/100 000 in 2019. ASIR and ASMR for lung cancer in the United States showed a decreasing trend from 1990 to 2019, with ASIR decreasing from 58.87/100 000 in 1990 to 45.13/100 000 in 2019, and ASMR decreasing from 49.35/100 000 in 1990 to 36.11/100 000 in 2019. In terms of gender, the disease burden of lung cancer in Chinese males was higher than that of females in 1990 and 2019, with new cases of lung cancer in males rising from 179 000 in 1990 to 576 200 in 2019, and ASIR rising from 44.29/100 000 in 1990 to 61.74/100 000 in 2019, mortality rising from 177 900 in 1990 to 523 200 in 2019, and ASMR rising from 46.33/100 000 in 1990 to 58.10/100 000 in 2019. The number of new cases of lung cancer in Chinese females rose from 78 100 in 1990 to 256 700 in 2019, and ASIR rose from 18.01/100 000 in 1990 to 24.76/100 000 in 2019; the number of deaths rose from 78 400 in 1990 to 234 000 in 2019, and ASMR rose from 18.63/100 000 in 1990 to 22.86/100 000 in 2019. In 2019, lung cancer incidence rates for males and females in China and the United States showed an increasing and then decreasing trend with age, with incidence rates of lung cancer in Chinese males and females peaking in the age group of 85-89 years old; and in the United States, incidence rates of lung cancer in males peaked in the age group of 85-89 years old, and incidence rates of females peaked in the age group of 80-84 years old. In 2019, it was shown that mortality rate of lung cancer among males in China increased and then decreased with age, reaching a peak in the age group of 85-89 years old, and mortality rate of lung cancer among females increased with age, reaching a peak in the age group of ≥95 years old. In the United States, lung cancer mortality rate for males and females showed an increasing and then decreasing trend with age, peaking in the 85-89 and 80-84 age groups, respectively. Incidence and mortality rates were higher for males than females in all age groups in China and the United States in 1990 and 2019. The analysis results of Joinpoint software showed that ASIR and ASMR of lung cancer in China showed an overall increasing trend from 1990 to 2019, with an AAPC of 1.16% (95%CI: 0.93%-1.38%, P<0.001) for ASIR and 0.78% (95%CI: 0.56%-1.01%, P<0.001) for ASMR, with the most obviously increasing trend in ASIR and ASMR from 1997 to 2004, the APC were 2.84% and 2.58%, respectively. Lung cancer ASIR and ASMR in the United States population showed a decreasing trend, with an AAPC of -1.08% (95%CI: -1.20%-0.96%, P<0.001) for ASIR and -1.05% (95%CI: -1.24%--0.87%, P<0.001) for ASMR. In 1990 and 2019, the major mortality-related risk factor for lung cancer in China and the United States was smoking, and the major mortality-related risk factor for lung cancer in Chinese females was environmental particulate matter pollution.

ASIR and ASMR of lung cancer in China show an increasing trend from 1990 to 2019, and ASIR and ASMR of lung cancer in the United States show a decreasing trend. In 2019, incidence rate of lung cancer in males and females in China show an increasing and then decreasing trend with age, mortality rate of lung cancer for males show an increasing and then decreasing trend with age, and mortality rate of lung cancer for females show an increasing trend with age. Lung cancer incidence and mortality rates for males and females in the United States in 2019 show an increasing and then decreasing trend with age. In both 1990 and 2019, incidence rates and mortality rates are higher for males than for females in all age groups in both China and the United States. Smoking is the major mortality-related risk factor for lung cancer in China and the United States, and environmental particulate matter pollution is the major mortality-related risk factor for lung cancer in Chinese females.

Lung neoplasms; Incidence; Mortality; Global burden of disease