Background:  Tracheal, bronchus, and lung (TBL) cancer is a major global disease burden, particularly significant for Group of Twenty (G20) countries, with its burden closely linked to patterns of economic development. As the country bearing the world's heaviest TBL cancer burden, China's experience in prevention and control holds critical reference value for the G20. However, a systematic research gap persists in characterizing the similarities and differences in disease patterns between China and the G20 based on long-term data. This gap constrains the capacity to design effective public health interventions within the framework of global economic cooperation.
Objectives: 1) To analyze and project the burden of TBL cancer in China and G20 across the 50 years since G20's establishment (2000-2050). 2) To inform evidence-based, collaborative prevention strategies for member states.
Methods: This observational longitudinal study utilized the latest data from the Global Burden of Disease (GBD) 2023 study, employing metrics such as incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rates to assess trends in TBL cancer. A decomposition analysis was conducted to delineate the composition of the disease burden by key demographics, and an autoregressive integrated moving average model was used to project the burden of TBL cancer from 2024 to 2050 in China and G20 countries.
Results: In 2023, the age-standardized rates for TBL cancer in China were as follows: incidence (ASIR), mortality (ASMR), and DALYs (ASDR) showed a decrease compared to 2000. The specific values (95% Confidence interval) were: ASIR 37.28 (31.81-43.09), ASMR 32.86 (28.34-37.85), and ASDR 742.26 (633.12-868.43). The ASIR, ASMR, and ASDR for G20 countries in 2000 and 2023 were substantially lower than those of China during the same periods. Sex-stratified decomposition analysis revealed differences in the drivers of rising absolute burden. In China, the increase in TBL cancer deaths from 2000 to 2023 was predominantly observed in males, who accounted for approximately 80% of the rise. Epidemiological changes contributed modestly to offsetting demographic pressures among Chinese men. In G20 countries, the increase was distributed more evenly between sexes, and greater epidemiological improvements, particularly among males, substantially counterbalanced the effects of population aging and growth. Predictions indicate a downward trend in ASIR, ASMR, and ASDR for both China and G20 countries over the next 27 years.
Conclusions: Age-standardized rates are declining, yet demographic forces are increasing the absolute burden of TBL cancers. In China, aging drives growth concentrated among males, indicating a need for male-focused prevention. In G20 countries, aging and population growth contribute, though greater epidemiological improvements provide a partial offset. These patterns call for tailored strategies: China should prioritize male-focused primary prevention alongside integrated aging care; G20 countries can further accelerate prevention in high-risk male groups. Global sharing of gender-specific prevention experience is essential to translate evidence into action.