Burden of tracheal, bronchus, and lung cancer in high-income North America: Trends from 1990 to 2021 and death projections to 2050.

e22519 Background: Tracheal, bronchus, and lung cancer (TBL) cancer remain significant public health challenges, particularly in high-income regions of North America (HINA), where changing risk factors and advancements in healthcare have shaped disease trends over the decades. Methods: This study is the first to estimate the incidence, prevalence, deaths, disability-adjusted life years (DALYs), and years lived with disability (YLDs) due to tracheal, bronchus, and lung (TBL) cancer across high-income North America (HINA) by age, sex, year, and location from 1990 to 2021, utilizing the standardized Global Burden of Disease Study 2021 framework. Non-fatal health outcomes were modeled using DISMOD-MR 2.1, while fatal health outcomes were assessed using the Cause of Death Ensemble Model (CODEm). Results: The total percentage change (TPC) in prevalence of TBL cancer increased by 43% (95% UI: 37-48%), while deaths rose by 14% (95% UI: 8-18%) from 1990 to 2021. The highest TPC in incidence was observed in Canada (59%), followed by Greenland (31%) and the USA (19%). For deaths, Canada saw a 42% increase, Greenland 27%, and the USA 11%. The age-standardized incidence rate (ASIR) declined from 59.1 (56.5-60.8) per 100,000 in 1990 to 37.2 (34.5-38.9) per 100,000 in 2021, with a 42% reduction in the age-standardized mortality rate (ASMR) and a 50% decrease in the age-standardized DALY rate (ASDALR) over the same period. By age, individuals aged 55+ accounted for 238,470 (218,678-250,416) new cases in 2021, compared to 13,038 (12,610-13,487) in the 20-54 age group. Similarly, deaths in 2021 were predominantly in the 55+ age group, with 188,320 (172,394-198,521) deaths, compared to 8,983 (8,684-9,283) in the 20-54 group. Gender analysis revealed a higher burden increase among females compared to males. Incidence increased by 58% in females versus 1% in males, while deaths rose by 47% in females but decreased by 5% in males. YLDs also increased more significantly in females (61%) compared to males (3%). Conclusions: Deaths due to TBL cancer accounted for 24.56% of all cancer related casualties in HINA in 2021. From a public health perspective, the rising prevalence and mortality of TBL cancer in HINA, particularly among females and older adults, highlights the urgent need for targeted prevention strategies, including tobacco control and early detection programs. The decline in ASIR, ASMR, ASDALR suggests progress in cancer control measures, but disparities in outcomes by gender and location emphasize the need for equitable healthcare access and tailored interventions. For clinicians, the findings underscore the importance of vigilant screening, particularly in high-risk populations, and the integration of advanced therapeutic approaches to address the shifting epidemiology and improve patient outcomes.