Aug 2026· Frontiers in Global Women's Health· Vol 7· 0 citations· 43 references
Medicine
TL;DR
The findings underscore the need to prioritize surveillance of inhalation-related hazards for female TBL cancer, especially in resource-limited and rapidly developing regions beyond traditionally industrialized settings.
Abstract
Background Tracheal, bronchial, and lung (TBL) cancer attributable to environmental and behavioral exposures remains a major global health concern. However, evidence on long-term trends, inequalities, and future burden among women remains limited. This study used Global Burden of Disease (GBD) 2023 data to address these gaps. Methods We analyzed female TBL cancer data from the GBD 2023 (1990–2023) to assess mortality and disability-adjusted life year (DALY) patterns associated with five rountine inhalation-related risk factors. We further evaluated associations with the socio-demographic index (SDI) using smoothing and deviation analyses, quantified SDI-related inequalities through concentration indices, decomposed burden changes by demographic and epidemiological factors, and projected the burden to 2030. Results In 2023, smoking remained the leading contributor to female TBL cancer mortality, followed by ambient particulate matter and secondhand smoke. Between 1990 and 2023, mortality attributable to household solid fuel declined most markedly, whereas mortality related to particulate matter increased slightly. Comparable trends were observed for DALYs. Marked cross-country and regional heterogeneity was observed by risk factors, with China standing out for particulate matter-related burden. Along socio-demographic gradients, burdens from radon and tobacco-related hazards rose with SDI alongside elevated concentration indices, whereas solid fuel burdens declined with increasingly negative concentration indices, and particulate matter displayed a rising burden but diminishing inequality. Population growth and aging drove increases in burdens from particulate matter, radon, and tobacco, whereas epidemiological change reduced solid fuel-related burden. By 2030, burdens attributable to particulate matter, radon, and secondhand smoke are projected to continue increasing, whereas the burden related to solid fuel is expected to decline. Although the number of smoking-related cases is projected to increase, the corresponding rate is expected to decrease. Conclusions Our findings underscore the need to prioritize surveillance of inhalation-related hazards for female TBL cancer, especially in resource-limited and rapidly developing regions beyond traditionally industrialized settings.
Focused interventions in low- and middle-SDI countries and rapidly industrializing regions are needed, including strengthened occupational exposure regulations, improved workplace arsenic monitoring, engineering controls, personal protective equipment, and regular health surveillance for workers in high-risk industries, to reduce inequalities and mitigate public health threats.
Di Wu, Xinxiao Li, Minghan Luo et al.· Medicine· 0 citations
INTRODUCTION
Tobacco smoking is a major modifiable risk factor for bladder and kidney cancer. In Latin America and the Caribbean (LAC), comprehensive longitudinal evidence on the smoking-attributable burden of these cancers remains limited. This study assessed the burden, temporal trends, socioeconomic inequalities, and future projections of smoking-attributable bladder and kidney cancer in LAC.
METHODS
Data were obtained from the Global Burden of Disease (GBD) 2023 study to estimate deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) for smoking-attributable bladder and kidney cancer across 33 countries and territories in Latin America and the Caribbean from 1990 to 2023. Temporal trends were evaluated using joinpoint regression and average annual percent change (AAPC). Socioeconomic inequalities were assessed in relation to the sociodemographic index (SDI) using the slope index of inequality (SII) and concentration index (CIX). Future burden to 2050 was projected using a Bayesian age-period-cohort model.
RESULTS
In 2023, smoking-attributable bladder cancer caused an estimated 1742 deaths and 35903 DALYs in LAC, while kidney cancer caused 637 deaths and 14947 DALYs. From 1990 to 2023, ASMR and ASDR for both cancers showed overall declining trends, although substantial regional heterogeneity was observed, with the Caribbean showing increasing burden. At the national level, the burden of both cancers was positively associated with SDI in 2023. Projections to 2050 indicate that age-standardized rates will continue to decline, whereas the absolute numbers of deaths and DALYs will increase.
CONCLUSIONS
Age-standardized rates declined overall, whereas the absolute numbers of deaths and DALYs are projected to increase in Latin America and the Caribbean. Stronger tobacco control and better-prepared health systems are needed to address the growing cancer burden in aging populations.
BACKGROUND
Smoking-related respiratory cancers, including lung, laryngeal and nasopharyngeal cancers, remain a major global public health challenge. The WHO MPOWER framework has guided international tobacco control, but most evaluations have focused on smoking prevalence and cessation rather than disease-specific burden. The present study introduces an ecological, lag-aligned inequality regression framework, linking MPOWER policy scores with age-standardised disability-adjusted life-years (DALYs) of smoking-related respiratory diseases derived from the Global Burden of Disease (GBD) study.
MATERIALS AND METHODS
We quantified the global burden of smoking-attributable respiratory cancers from 1990 to 2021 using GBD 2021 estimates, the WHO MPOWER policy database and World Bank ageing statistics. We analysed age-standardised mortality rates (ASMRs) and age-standardised DALY rates (ASDRs) by sex and region and projected trends to 2050 with a BAPC model. For the policy analysis, we ran associational, ecological, lag-aligned global inequality regressions, regressing the annual cross-country 90-10 ASDR gap (Δq_t) on the global-mean MPOWER score and global-mean ageing aligned by lags.
RESULTS
Smoking-attributable ASDRs and ASMRs declined from 2008 to 2021, although disparities by sex and region persisted. BAPC projections suggest continued decline through 2050, particularly among women. Countries with higher MPOWER scores, especially for Monitor, Protect and Enforce measures, were associated with narrower ASDR gaps with slower progress among men.
CONCLUSION
Our findings suggest that robust MPOWER implementation is associated with reduced inequality in smoking-related cancer burden. Prioritising monitoring, protective measures and enforcement, while tailoring strategies by sex and age, may further accelerate the reductions. Future studies with unit-level data are needed to strengthen causal inference.
An-Qi Guan, Xian-Yao Wang, Xi Chen· Tobacco Control· 0 citations
BACKGROUND
Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes.
METHODS
Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs).
FINDINGS
In 2023, an estimated 2·71 billion (95% UI 2·44-3·02) people worldwide were exposed to SHS, including 767 million (687-858) children aged 0-14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0-53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6-32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0-144·4] increase) and North Africa and the Middle East (72·1% [47·8-101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33-2·07) deaths and 44·8 million (35·8-54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31-15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48-7·12]).
INTERPRETATION
We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments.
FUNDING
Bloomberg Philanthropies and the Gates Foundation.
Luisa S. Flor, Jason A Anderson, Brooks W. Morgan et al.· Lancet Public Health· 0 citations
The findings suggest that socioeconomic and environmental factors may be associated with regional disparities in lung cancer burden and could offer insights for targeted prevention policies, including smoking control and air quality management.
Jiawei Zhai, Hui-Juan Zheng, Lan-Gang Xue· Frontiers in Public Health· 0 citations
Summary Background Despite extraordinary progress in global tobacco control and prevention, smoking, secondhand smoke (SHS) and chewing tobacco continue to profoundly impact public health, affecting males and females differently. Existing studies have not systematically characterized sex disparities in disease burden attributable to these three tobacco risks within a unified framework, nor have they quantified the contributions of demographic and exposure-related drivers to these disparities or projected their future trajectories. We aimed to assess patterns of sex disparity in smoking-, SHS-, and chewing tobacco-attributable disease burden from 1990 to 2023, decompose the drivers of these disparities, and project sex-specific burden to 2050 under alternative scenarios. Methods We used data from the Global Burden of Disease Study (GBD) 2023, including sex-specific estimates of disability-adjusted life years (DALYs) and the age-standardized DALY rates (ASDR) attributable to smoking, SHS, and chewing tobacco. Sex disparities were examined across geographic, temporal, and age dimensions. Decomposition analysis was applied to quantify the contributions of population growth, population aging, change in risk exposure, and change in risk-deleted burden to sex-specific DALY changes between 1990 and 2023. Sex ratios were derived from ASDR and their 95% confidence intervals (CI) were estimated using the delta method. Future sex disparities were projected to 2050 under four counterfactual tobacco exposure scenarios. Findings Over the past three decades, the tobacco-attributable disease burden among males has consistently exceeded that among females. In 2023, the overall smoking-attributable ASDR remained substantially higher in males than in females (3146.9 [95% uncertainty interval 2591.8–3703.8] vs. 507.8 [361.0–677.1] per 100,000). The all-cause ASDR attributable to SHS was slightly higher in males than in females (540.7 [434.3–672.9] vs. 506.6 [402.8–612.5] per 100,000). For chewing tobacco, the attributable burden was also markedly greater in males (95.3 [61.3–144.1] vs. 47.8 [25.4–78.5] per 100,000). Decomposition analysis showed that population growth and aging were the predominant drivers of increasing absolute DALYs in both sexes, with consistently larger effects among males, while change in risk exposure contributed differently to sex-specific burden trajectories across the three tobacco risks. Among GBD regions, the sex ratio of smoking-attributable ASDR of all causes was notably lowest in Australasia and high-income North America. The sex ratio of SHS-attributable all-cause ASDR increased from below 1.0 in 1990 to above 1.0 in 2023 across several GBD regions like high-income Asia Pacific and Andean Latin America. Globally, the sex ratio of overall ASDR attributable to chewing tobacco has remained stable, from 1990 (ratio: 1.9 95% CI 1.0–4.0) to 2023 (ratio: 2.0 95% CI 1.0–4.0). Among age groups, smoking-attributable DALY rates increased with age, peaking in the 75+ group in 2023, and the burden among males always exceeded that among females in all age brackets. Compared to the sex ratios of DALY rates attributable to smoking risk in the same regions, the fluctuations in disease burden attributable to SHS and chewing tobacco between sexes across age groups were less pronounced in 2023. Projections suggested that sex disparities would persist to 2050, with alternative tobacco control scenarios yielding divergent patterns of future burden. Interpretation While smoking- and SHS-attributable ASDRs have declined and chewing tobacco-attributable ASDR has remained stable, sex disparities have varied by time, region, and life stage. These findings may inform the integration of sex-specific perspectives into tobacco control strategies, which could strengthen the implementation of the Framework Convention on Tobacco Control and help mitigate the future burden of tobacco use. Funding National Science and Technology Innovation 2030, Noncommunicable Chronic Diseases-National Science and Technology Major Project.
Sheng Li, Zhe Xu, Brooks Morgan et al.· EClinicalMedicine· 0 citations
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