Global, regional, and national lung cancer burden attributable to low fruit intake: 2021 Global Burden of Disease Study Analysis

Abstract Background Dietary habits, notably inadequate fruit consumption, are increasingly implicated in elevating lung cancer risk across diverse populations. However, the lung cancer burden attributable to a low fruit intake has not yet been systematically evaluated. Methods Epidemiological data on lung cancer attributable to low fruit intake from 1990 to 2021 were extracted for 204 countries and territories using the Global Health Data Exchange (GHDx). Joinpoint regression was used to estimate the average annual percentage change (AAPC) to reflect the temporal trend of the lung cancer burden attributable to low fruit intake. Burden estimates, stratified by age, period, and birth cohort, were quantified using Bayesian age–period–cohort modeling. Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life-year rate (ASDR) were used as the primary outcome metrics. Results Low fruit intake was responsible for 66,045 deaths and 1611,267 disability-adjusted life years (DALYs) of lung cancer in 2021, with an ASMR of 0.77 (95% uncertainty intervals [UI], 0.4–1.13) and an ASDR of 18.46 (95% UI, 9.49–26.9) per 100,000 population. Mortality and DALY rates for different age groups increased with age, peaking in the group aged 70 years. Gender-specific analyses revealed persistently higher absolute burdens among males despite comparable downward trajectories in both sexes. The ASMR and ASDR of lung cancer attributable to low fruit intake globally showed a declining trend (AAPC, −1.72% and −2.04%, respectively) from 1990 to 2021. Significant regional disparities were observed, with low-middle sociodemographic index (SDI) regions bearing the heaviest burden (ASMR, 0.84; 95% UI, 0.44–1.18). The age–period cohort analysis revealed that the risk of lung cancer attributable to low fruit intake increased with age. Period-effect analysis revealed an overall decreasing trend across all age groups. Cohort analysis indicated a higher susceptibility in earlier birth cohorts, with individuals born before 1927–1931 exhibiting elevated risk characteristics that gradually declined over time. Conclusions The overall lung cancer burden attributed to low fruit intake showed a downward trend. However, the burden is disproportionately distributed to less developed regions and elderly populations. Therefore, prevention and health education efforts should prioritize regions and populations with low fruit intake.