The mortality of lung cancer attributable to smoking among adults in China and the United States during 1990-2017

Background Statistical data on the burden and relevant risk factors of lung cancer are valuable for policy-making. This study aimed to compare the mortality of lung cancer attributable to smoking stratified by sex and age among adults in China and the United States (US). Methods We extracted age-standardized mortality rates of lung cancer during 1990-2017 using the comparative risk assessment framework of the 2017 Global Burden of Disease study. We performed an age-period-cohort analysis to estimate time trend of lung cancer mortality attributable to smoking. Results During 1990-2017, the age-standardized mortality rate of lung cancer was increasing in China but decreasing in the US for both sexes. The mortality attributable to smoking in China showed a generally increasing trend, while a continuous decrease was observed in the US. The age-period-cohort analysis showed a similar trend of age effect among adults between China and the US: the mortality substantially increased from the 30-34 to 80-84 age group and subsequently decreased in the 90-94 age group. However, the period effect rapidly increased in Chinese adults during 1990-2017, while it tended to be stable in the US although it was still slightly increasing in women. The cohort effect generally peaked in the earlier cohort born in 1902-1906 in the two countries. Conclusions During 1990-2017, the lung cancer mortality attributable to smoking and the period effect are generally increasing in Chinese adults; the mortality attributable to smoking is decreasing in the US adults, but the period effect tends to be stable. The rapid aging and prevalence of smoking may intensify the increasing mortality of lung cancer in China.