Lung Cancer Mortality in China: Spatial and Temporal Trends Among Subpopulations

Background: Little is known regarding spatial and temporal trends of lung cancer mortality (LCM) among subpopulations in China. The study identified the changing spatial and temporal patterns of LCM across China as a whole and in different subpopulations (ie., region, age, and sex).Methods: The data on LCM for the period of 2006 to 2015 by region, age, and sex were extracted from the Chinese National Death Surveillance. Joinpoint regression and seasonal decomposition were used to assess the temporal trends of LCM. Geographic information system and spatial kriging interpolation were used to examine the spatial distributions of LCM.Findings: LCM was highest in men aged 70+ (annual average mortality rate 397·2 (95%CI (394·6-399·8)) per 100,000 person-years). LCM rate in men aged 30 to 49 significantly declined from 2009 to 2015 (annual percentage change: -2·7%, P<0·05). However, LCM continued to rise in men aged 70+ and women aged 50+ in the east, men and women aged 50 to 69 in the south, and most groups in the southwest. Among provincial capital cities, Shenyang, Changsha, and Hohhot had the highest ten-year average LCM rates for men aged 30 to 49, 50 to 69, and 70+, respectively, while among all ages of women, Harbin had the highest ten-year average LCM rates. When dividing the period by 5 years, the odds of the increases in LCM in men and women aged 30 to 49 and 50 to 69 decreased by 3% to 7% with the longitudes increasing by 1° (OR ranged from 0·93 (95%CI 0·90-0·95) to 0·97 (95%CI 0·95-0·99)), and decreased by 5% to 6% with the latitudes increasing by 1° (OR ranged from 0·94 (95%CI 0·91-0·97) to 0·95 (95%CI 0·92-0·98)).Interpretation: Disparities in the spatial and temporal patterns of LCM among different subpopulations support the need for long-term LC surveillance covering larger geographical areas in China and the need for exploration of possible socio-environmental drivers in a spatiotemporal context. Further investigation into the potential risk factors for rising LCM are urgently required in the east, south, and southwest of China.Funding Statement: For continuous support and assistance, we thank Peng Yin, Jiangmei Liu, and Yunning Liu (National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention). We thank all research staff from local Center for Disease Control and Prevention for collection of data. N Wang was supported by the Queensland University of Technology Postgraduate Research Award and Queensland University of Technology Higher Degree Research International Tuition Fee Sponsorship. K Mengersen is supported by the ARC Center of Excellence in Mathematics and Statistical Frontiers. M Kimlin is supported through a Cancer Council Queensland Professorial Chair. W Hu is supported by ARC future fellowship (FT140101216).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The study has been approved by the Human Research Ethics Committee of Queensland University of Technology (Reference No. 1700001107).