Risk factors behind the global lung cancer burden: a pan-database exploration

Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide. Understanding its multifactorial risk factors is crucial for effective prevention strategies. While tobacco smoking remains the primary risk factor, the roles of other factors are less well understood across different global settings. This study aimed to provide a comprehensive analysis of global lung cancer trends from 1990 to 2021, examining associations between lung cancer outcomes and diverse environmental, socioeconomic, lifestyle, and dietary factors across 201 countries. We conducted a comprehensive analysis of lung cancer prevalence and mortality from 1990 to 2021 across 201 countries, utilizing data from multiple international databases, including the Global Burden of Disease Study and the World Health Organization. We assessed associations between lung cancer outcomes and various environmental, socioeconomic, lifestyle, and dietary factors using correlation analysis, generalized linear models, and canonical correlation analysis. Globally, lung cancer cases increased from 1.40 million in 1990 to 3.25 million in 2021, while age-standardized prevalence remained relatively stable. Smoking showed the strongest correlation with lung cancer prevalence (r=0.753, P<0.001), with urbanization also showing a significant positive association (r=0.481, P<0.001). Ambient temperature was negatively correlated with lung cancer prevalence (r=-0.296, P<0.001). Cooking methods influenced risk: gas cooking was associated with lower lung cancer prevalence compared to biomass cooking. These findings highlight the complex interplay of factors influencing lung cancer risk globally. While smoking remains the predominant risk factor for lung cancer, other factors such as urbanization, ambient temperature, and cooking methods significantly influence global prevalence patterns. Our study underscores the need for comprehensive public health strategies that address environmental and lifestyle factors alongside traditional risk factors. These insights are critical for informing targeted interventions aimed at reducing the global burden of lung cancer, especially in the context of rapid urbanization and climate change.