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Background <p>Tobacco exposure remains the leading preventable cause of lung cancer. However, long-term trends in tobacco-related lung cancer premature mortality have been insufficiently studied in rural China. This study aimed to determine premature mortality burden due to lung cancer attributable to smoking and secondhand smoke (SHS) exposure in rural southwest China from 2013 to 2025.</p> Methods <p>Years of life lost (YLL) per 1,000 and mortality rate per 100,000 due to lung cancer were calculated from medical death certificates, while smoking and SHS exposure data were collected from three waves of cross-sectional interviews conducted in 2013, 2019, and 2025 among individuals aged ≥ 35 years in rural China. The population attributable fraction (PAF) was used to derive mortality and YLL due to lung cancer attributable to tobacco exposure.</p> Results <p>From 2013 to 2025, prevalence of smoking increased in men (75.56% vs. 81.12%, <i>P</i> &lt; 0.01) but declined in women (2.34% vs. 1.40%, <i>P</i> &lt; 0.01), while prevalence of exposure to SHS decreased significantly both in men (34.66% vs. 20.57%, <i>P</i> &lt; 0.01) and women (44.12% vs. 28.24%, <i>P</i> &lt; 0.01). The mortality and YLL rate of lung cancer rose significantly from 11.67 to 38.34 per 100,000 population and from 1.77 to 4.92 per 1,000 population, respectively. These increasing rates were also observed in both sexes, with the largest relative increase occurring among men. The age-standardized mortality and YLL rate of lung cancer attributable to both smoking and exposure to SHS increased consistently in men and women over the study period. Further, smoking contributed much more to mortality and YLL due to lung cancer than exposure to SHS in men, while the difference in contributions among women was less pronounced.</p> Conclusions <p>The premature mortality burden due to lung cancer attributable to smoking and SHS exposure has increased substantially in rural southwest China over the twelve-year study period. Future lung cancer prevention and management efforts should prioritize reducing smoking in men as well as strengthening protections against SHS exposure in women and other non-smoking populations.</p>

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Changes in premature mortality burden due to lung cancer attributable to tobacco exposure in rural southwest China: three repeated cross-sectional studies from 2013 to 2025

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月4日

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  • Guo-hui Li,
  • Qing-rou Bao,
  • Rui-min Shi,
  • Fan Gu,
  • Guo-yu Ma,
  • Allison Rabkin Golden,
  • Le Cai

摘要

Background

Tobacco exposure remains the leading preventable cause of lung cancer. However, long-term trends in tobacco-related lung cancer premature mortality have been insufficiently studied in rural China. This study aimed to determine premature mortality burden due to lung cancer attributable to smoking and secondhand smoke (SHS) exposure in rural southwest China from 2013 to 2025.

Methods

Years of life lost (YLL) per 1,000 and mortality rate per 100,000 due to lung cancer were calculated from medical death certificates, while smoking and SHS exposure data were collected from three waves of cross-sectional interviews conducted in 2013, 2019, and 2025 among individuals aged ≥ 35 years in rural China. The population attributable fraction (PAF) was used to derive mortality and YLL due to lung cancer attributable to tobacco exposure.

Results

From 2013 to 2025, prevalence of smoking increased in men (75.56% vs. 81.12%, P < 0.01) but declined in women (2.34% vs. 1.40%, P < 0.01), while prevalence of exposure to SHS decreased significantly both in men (34.66% vs. 20.57%, P < 0.01) and women (44.12% vs. 28.24%, P < 0.01). The mortality and YLL rate of lung cancer rose significantly from 11.67 to 38.34 per 100,000 population and from 1.77 to 4.92 per 1,000 population, respectively. These increasing rates were also observed in both sexes, with the largest relative increase occurring among men. The age-standardized mortality and YLL rate of lung cancer attributable to both smoking and exposure to SHS increased consistently in men and women over the study period. Further, smoking contributed much more to mortality and YLL due to lung cancer than exposure to SHS in men, while the difference in contributions among women was less pronounced.

Conclusions

The premature mortality burden due to lung cancer attributable to smoking and SHS exposure has increased substantially in rural southwest China over the twelve-year study period. Future lung cancer prevention and management efforts should prioritize reducing smoking in men as well as strengthening protections against SHS exposure in women and other non-smoking populations.