The shifting burden of tracheal, bronchus and lung cancer in ageing Asia: structural drivers and projections to 2050

BACKGROUND: Tracheal, bronchus, and lung (TBL) cancer remains a major cause of cancer morbidity and mortality. We quantified historical trends, structural drivers, inequality, and future burden of TBL cancer among Asian adults aged ≥60 years. METHODS: Using Global Burden of Disease 2023 data, we assessed incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2023. Age-standardised rates (ASRs), estimated annual percentage changes, sex- and age-specific patterns, socioeconomic inequality, and demographic decomposition were evaluated. Bayesian age-period-cohort modelling projected burden to 2050. RESULTS: From 1990 to 2023, incident cases increased from 334,563 to 1,102,794 and DALYs from 7.3 million to 19.4 million. ASR point estimates changed modestly, with Asia-wide EAPCs not statistically distinguishable from zero. Burden increased sharply with age and remained consistently higher in males. Socioeconomic inequality attenuated, particularly for mortality and DALYs. Population growth accounted for much of the absolute increase, while negative age-specific-rate components partly offset demographic effects in several Central Asian countries. From 2024 to 2050, ASIR and ASDR were projected to decline by 44.2% and 45.6%, respectively, with only modest reductions in absolute numbers. CONCLUSIONS: TBL cancer burden in older Asian adults is increasingly shaped by demographic expansion and heterogeneous epidemiological change. Despite projected declines in ASRs, population ageing will sustain substantial burden, underscoring the need for targeted prevention and age-responsive health-system planning.