Global lung cancer burden shifting to middle-income countries

The number of smokers in Africa continues to grow despite a global decrease. Credit: Media Lens King/Alamy China — a country where more than 40% of men smoke — has become the epicentre of the global lung cancer epidemic. Historically, lung cancer has been predominantly a disease of rich industrialized nations. But the burden of disease in China is indicative of a global shift, with middle-income countries facing the greatest increase in cases as high rates of smoking combine with rapid population growth, urbanization and the associated air pollution. The trend is most dramatic in upper-middle-income countries, as defined by the World Bank, including China, Brazil and Iran. Between 2003 and 2023, yearly deaths from tracheal, bronchus and lung cancers (lower respiratory tract cancers for which data is typically combined by health-tracking organizations because the causes are so similar) grew by almost two-thirds while populations grew by only about 16% in upper-middle-income countries (see ‘An unequal burden’). A similar pattern is evident in lower-middle income countries in Asia and Africa — particularly India and Nigeria. There, the number of tracheal, bronchus and lung cancer deaths more than doubled while populations increased by just over one-third. Source: Institute of Health Metrics and Evaluation The main driver is tobacco smoking, which contributes to 85% of lung cancer cases. …