Trends, inequalities, and 2030 projections of women's tracheal, bronchial, and lung cancer attributable to air pollution, radon, and tobacco exposure.

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.