Trends and projections of smoking-attributable lung cancer burden among the elderly in China, 1990-2021

This study retrospectively analyzed trends in smoking-attributable lung cancer burden among Chinese adults aged 65 years and above from 1990 to 2021 and projected future trends from 2021 to 2050. Data on deaths and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease Study (GBD 2021). Statistical analysis was performed using R software (4.1.3) to estimate estimated annual percentage changes (EAPC) in disease burden trends. A Bayesian age-period-cohort (BAPC) model was applied to forecast smoking-attributable lung cancer burden from 2021 to 2050. From 1990 to 2021, the burden of lung cancer attributable to smoking among older adults in China showed an upward trend, in contrast to the global decline. The DALY rate increased from 2,948.7 to 3,384.46 per 100,000 population (EAPC = 0.62%, 95% CI: 0.4%, 0.85%), while the mortality rate rose from 150.12 to 186.36 per 100,000 population (EAPC = 0.93%, 95% CI: 0.67%, 1.19%). Both DALY and mortality rates increased across all age groups (65-69, 70-74, 75-79, 80-84, and ≥85 years), with males exhibiting significantly higher burden levels and growth rates than females. Projections indicate that between 2021 and 2050, both the absolute number of DALYs and deaths from smoking-attributable lung cancer in this population will continue to rise, and their share of the total national burden will progressively increase. In conclusion, the smoking-attributable lung cancer burden among elderly Chinese adults has risen continuously since 1990 and is expected to grow further. Strengthened tobacco control policies, targeted public health interventions, and enhanced early screening among high-risk groups, including the elderly and women, are urgently needed to mitigate this growing burden.