Global burden and trends of tracheal, bronchus, and lung cancer in adolescents and young adults: a secondary analysis of the Global Burden of Disease Study 2021.
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BACKGROUND: Tracheal, bronchus, and lung (TBL) cancer is a major global cause of cancer-related morbidity and mortality. Adolescents and young adults (AYAs, ages 15-39 years) represent a distinctive demographic with unique epidemiological characteristics-including sex-specific trends, differing risk factor profiles, and distinct biological features-yet they are often overlooked in global cancer assessments. Understanding the TBL cancer burden in this age group is critical as they may serve as a sentinel population for emerging risk exposures including changing smoking patterns, e-cigarette use, and air pollution. This study aimed to analyze the burden of TBL cancer among AYAs in 204 countries and regions from 1990 to 2021, providing a basis for clinicians and public health institutions to formulate prevention strategies and optimize clinical treatment plans. METHODS: Data on TBL cancer in AYAs were obtained from the Global Burden of Disease (GBD) Study 2021. We extracted incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for TBL cancer in AYAs from 1990 to 2021. Age-standardized rates were derived using GBD population denominators. Analysis was stratified by age, sex, Socio-Demographic Index (SDI), and nationality. Trends were evaluated through estimated annual percentage change (EAPC) and percentage variation, with 95% uncertainty intervals (UIs) presented. RESULTS: In 2021, the global burden included 28,004 new cases (age-standardized rate: 0.94 per 100,000, 95% UI: 0.85-1.03), 71,750 prevalent cases (rate: 2.41 per 100,000, 95% UI: 2.17-2.66), 22,622 deaths (rate: 0.76 per 100,000, 95% UI: 0.68-0.84), and 1,291,020 DALYs (rate: 43.4 per 100,000, 95% UI: 39.02-47.75). Since 1990, case counts increased by 5% for incidence and 19% for prevalence, while deaths and DALYs declined by 3% each. Females showed significant increases in cases and prevalence [percentage change (100%): 0.4], whereas changes in males were more modest. The 35-39 age group bore the highest burden (15,420 cases, rate: 2.75 per 100,000, 95% UI: 2.45-3.06). Middle SDI regions accounted for approximately 40% of the global burden, while the steepest increases occurred in low SDI regions. CONCLUSIONS: The global burden of TBL cancer in AYAs varies substantially by age, sex, and socioeconomic development. Prevention strategies should prioritize tobacco and nicotine control among young people, reduction of environmental and occupational exposures, strengthening of healthcare infrastructure in low-resource settings, and narrowing inequalities in early diagnosis and treatment access.