Burden of adolescent and young adult lung cancer in South Asia: 1990−2023.

Abstract

e22596 Background: Lung cancer is the leading cause of cancer mortality worldwide. South Asia, the world’s most populous region, bears a significant yet understudied burden of adolescent and young adult (AYA) lung cancer. Methods: Using the Global Burden of Disease 2023, we report incidence rate (IR) and mortality rate (MR) per 100,000 and deaths attributable to risk factors for AYA (ages 15–49) lung cancer in South Asia (Bangladesh, Bhutan, India, Nepal, and Pakistan) from 1990–2023, stratified by sex. Global and GBD super-region estimates were used as comparators. Results: Global IR and MR declined to 3.2 (−24%) and 2.5 (−27%) in 2023, respectively; however, South Asia, despite having the second-lowest IR (1.9) and third-lowest MR (1.6) in 2023, was the only GBD super-region with increasing IR (+68%) and MR (+65%) from 1990–2023, driven by rising female IR (+96%) and MR (+92%). In South Asia, IR and MR were double in males (IR 2.5; MR 2.1) compared with females (IR 1.3; MR 1.0). In 2023, IR and MR were highest in Bangladesh (IR 3.4; MR 2.8) and Bhutan (IR 2.6; MR 2.1), and lowest in Pakistan (IR 1.8; MR 1.5), India (IR 1.7; MR 1.5), and Nepal (IR 1.7; MR 1.4). Male rates were highest in Bangladesh (IR 4.8; MR 3.9), while female rates were highest in Bhutan (IR 2.4; MR 2.0). Pakistan was the only country where female rates exceeded male rates (IR 2.2 vs 1.5; MR 1.8 vs 1.3). All countries had increasing IR and MR, with the largest in Bhutan, where rates rose by over 200% in all populations. In 2023, 71% of male and 57% of female deaths in South Asia were attributable to modifiable risks. In males, behavioral risks predominated (50%), driven by tobacco (39%), while environmental and occupational risks contributed 42%, including particulate matter pollution (31%). Among females, environmental and occupational risk were dominant (39%), exceeding behavioral risks (28%), with particulate matter pollution contributing 33% and tobacco 15%. From 1990-2023, risk attributable deaths decreased (–5.8% males; –9.9% females). Tobacco risk decreased by 20% in males and 29% in females, driven by India and Nepal. Males had increases in occupational exposure to asbestos (+102%), diesel engine exhaust (+34%), and silica (+31%). Females had increases in all occupational exposures, with the highest increases in Bangladesh (131–203%) and Pakistan (199–281%). Ambient particulate matter attributable deaths increased by 93% in males and 121% in females, peaking in Bhutan (+186% males, +264% females). Conclusions: Despite low IR and MR, South Asia is the only GBD super-region with rising AYA lung cancer burden from 1990-2023, driven largely by rising female burden. Declines in tobacco-attributable mortality have been offset by rapid growth in ambient particulate matter pollution and occupational carcinogens, with marked country-level heterogeneity. Sex- and country-specific prevention strategies are needed that extend beyond tobacco control to address other exposures.