ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Global burden of tracheal, bronchus, and lung cancer attributable to second-hand smoke exposure from 1992 to 2021: An Age-Period-Cohort analysis and 25-year mortality projections
Provisionally accepted
- 1Quanzhou First hospital, Quanzhou, China
- 2Fujian Medical University Union Hospital, Fujian, China
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Background: Tracheal, bronchus, and lung (TBL) cancer remains the leading cause of cancer-related mortality worldwide. While smoking is the primary risk factor, several non-smoking-related factors also significantly contribute to TBL cancer, notably second-hand smoke (SHS) exposure, which plays a substantial role in the disease's burden. This study assesses and forecasts the temporal trends in the disease burden of TBL cancer attributable to SHS exposure at global, regional, and national levels. Methods: We extracted data from the ≥ 25 years population in the Global Burden of Disease Study 2021 (GBD 2021) to assess deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) at both global and regional levels. We evaluated temporal trends using descriptive statistics, estimated annual percentage change (EAPC), and both the age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models. Results: From 1992 to 2021, absolute deaths and DALYs linked to TBL cancer due to SHS exposure increased, although ASMR and ASDR showed declining trends, with EAPC values of -0.92% and -1.30%, respectively. Regions with a high socio-demographic index (SDI) displayed the most significant improvements. In contrast, high-middle and middle SDI regions bore the greatest disease burden, and low SDI regions saw minimal progress. The highest ASMR in 2021 occurred mainly in Western Europe, North America, and East Asia, with ASMR correlating positively with SDI. The disease burden was consistently higher among males, particularly in the 65-74 age group, across both sexes. Future projections indicate a continuing decline in the disease burden from 2022 to 2046. Conclusions: SHS exposure continues to be a significant factor in the disease burden of TBL cancer. Although there has been an overall declining trend globally, it still caused the deaths of more than 97,000 people in 2021. There exists considerable heterogeneity among regions, with some areas still bearing a substantial disease burden. These findings highlight the need for specific prevention and control strategies to mitigate the health impacts of SHS exposure.
Keywords: Second-hand smoke (SHS), Tracheal, Bronchus, and Lung (TBL) Cancer, Global Burden of Disease(GBD), Age-standardized mortality rate (ASMR), age-standardized DALY rate (ASDR), estimated
Received: 09 May 2025; Accepted: 13 Nov 2025.
Copyright: © 2025 Lin, Lin, Liao, Hong, Cai and Zhuang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xibin Zhuang, zxbqz@163.com
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