Baseline Characteristics of Underlying Death from Lung Cancer
From 1973 to 2019, all registered permanent residents in PNA, with a total of 80,543,137 person-years, were enrolled in this study. There were 42,229 deaths in permanent residents from lung cancer. Of them, 30,638 (72.55%) were men. The median age at death from lung cancer was 72.10 years old, and the average age at death was 70.96 ± 11.21 years old. The CMR and ASMRW of lung cancer were 52.43/105 person-years and 27.79/105 person-years, respectively. The CMR and ASMRW were 77.04/105 person-years and 44.27/105 person-years in males, while the corresponding rates were 28.43/105 person-years and 13.77/105 person-years in females (Table 1).
Age-specific Mortality of Lung Cancer
The crude mortality rates in the age groups of 0-4 years, 5-14 year, 15-29 years, 30-44 years, 45-59 years, 60-69 years, 70-79 years, and ≥80 years were 0.09, 0.02, 0.36, 4.26, 35.97, 132.70, 302.76, and 372.98/105 person-years, respectively (Table 2).
Burden of Premature Death from Lung Cancer
During 1973-2019, the YLL due to premature death from lung cancer was 481779.14 years, and the rate of YLL was 598.16/105 person-years. YLL and rates of YLL in males (343728.73 years, 864.30/105) were higher than those in females (138050.40 years, 338.58/105) (Table 1). In term of age, the top three in YLL were in the age groups of 60-69 years, 70-79 years, and 45-59 years, which were 159523.69, 134731.32, and 119690.09 years, respectively. The top three age groups in the rates of YLL were 70-79 years, 80+ years, and 60-69 years, which were 2785.91/105, 1975.87/105, and 1837.34/105, respectively (Table 2).
Trends of Mortality and YLL of Lung Cancer
The temporal trends in CMR, ASMRW, and rate of YLL were expressed based on the modeled CMR, ASMRW, and rate of YLL and shown in Figure 1. The CMR, and rate of YLL for deaths from lung cancer showed significantly increasing trends in males, females, and the total population during 1973-2019 (all P<0.001). The ASMRW for deaths was decreased in males by 0.72% (95% CI=-1.05% to -0.40%, P < 0.001) per year, while ASMRW in females and the total population during 1973-2019 were not statistically significant (P=0.23 and 0.18 respectively). The CMR of lung cancer in the total population increased by 2.86% (95% CI=2.66%-3.07%, P < 0.001) per year during the study period. The YLL rate increased with an APCC of 2.21% (95% CI = 1.92% to 2.51%, P < 0.001) per year from 1973 to 2019 (Figure 1A, 1B).
In terms of age-specific mortality and YLL, CMR and ASMRW of the total population had showed from 1973 to 2019 (Figure 1C, 1D). The increasing trends of CMR were also seen in the age groups of 70-79 years (P=0.007), and 80+ years (P < 0.001). The age groups of 30-44 years, 45-59 years, and 60-69 years had the statistically decreasing trends in CMR of lung cancer (P < 0.001). The rate of YLL increased by 8.24% (95% CI =2.83%-13.94%, P =0.005) per year in the age group of 80+ years, 0.03% (95% CI =-0.44%-0.50%, P =0.09) per year in the age group of 70-79 years. However, the rate of YLL decreased by 1.51% (95% CI = -2.51%- -0.05%, P =0.001) per year in the age group of 30-44 years, 1.27% (95% CI = -1.72%- -0.83%, P < 0.001) per year in the age group of 45-59years, and 1.46% (95% CI = -1.84%- -1.09%, P < 0.001) per year in the age group of 60-69 years, respectively (Figure 1C, 1D) .
Quantitatively Impacts of Demographic and Non-demographic Factors on Increased Rates in CMR
The trends of increased rates in CMR caused by non-demographic and demographic factors are shown in Figure 2. Based on the CMR of lung cancer in 1973-1979, no statistically significant trend was found caused by non-demographic factors in the total population, with an APC of 0.17% (95% CI =-11.34%-13.16%, P =0.97) from 1980 to 2019，but a significant upward trend was also observed in the increased rate caused by demographic factors [APC (95% CI) = 51.70% (35.48%- 69.88%), P < 0.001]. In males, the increased rate caused by non-demographic factors decreased by 32.96% (95% CI = -51.68%- -6.99%, P = 0.02) during 1980-2019, and the rate caused by demographic factors increased by 46.42% (95% CI = 32.23%-62.03%, P < 0.001). In females, the increased rate caused by non-demographic factors showed an upward trend with an APC of 24.24% (95% CI = 2.60%-50.44%, P = 0.03), and the rate caused by demographic factors also increased [APC (95% CI) = 55.63% (38.54%-74.83%), P < 0.001] (Table 3). Figure 2B-D shown the proportion of increased values of CMR caused by non-demographic and demographic factors. From 1985 to 2019, demographic factors played a decisive role in the contribution rate of CMR compared to 1973-1979.