Global Lung Cancer Mortality Trends and Lifestyle Modifications: Preliminary Analysis
Introduction
Non-communicable diseases (NCDs) are a significant global health burden, responsible for 71% of the 57 million deaths worldwide. Among NCDs, cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the most prevalent. These diseases are largely preventable through public policies targeting common risk factors such as tobacco use, harmful alcohol consumption, unhealthy diets, physical inactivity, and air pollution. The World Health Organization (WHO) has developed the Global NCD Action Plan 2013–2020 and the 13th General Programme of Work 2019–2023 to address this burden. These plans align with the United Nations Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from NCDs by one-third by 2030.
Lung cancer is the most common lethal neoplasm globally, accounting for 19.4% of all cancer-related deaths. Despite advancements in treatment, the prognosis for lung cancer remains poor, especially when diagnosed at advanced stages. This study aims to analyze the impact of lifestyle modifications promoted by WHO on global lung cancer mortality trends.
Methods
The study utilized WHO statistics based on unified mortality and causes-of-death reports from Member-State countries. Data from 2000 to 2018 were analyzed to evaluate global lung cancer mortality trends. The analysis included age-standardized death rates per 100,000 population by cause, sex, and age. Only countries with high-quality and complete death registration data were included.
Lifestyle modifications and risk factors were assessed based on WHO’s “best buy” interventions, which are cost-effective, affordable, feasible, and scalable measures. These interventions include tobacco control, reduction of harmful alcohol use, promotion of healthy diets, and increased physical activity. The study quantified the level of achievement of these interventions in different countries.
Results
Baseline age-standardized mortality rate for lung cancer in 2000 was 25.4 per 100,000 population. By 2016, total lung cancer mortality declined by 10% in 49 countries, with a 13% decline in high-income countries (HIC) and a 3% decline in middle-income countries (MIC). Among the 49 countries analyzed, 42 showed a decline in lung cancer mortality, one remained stable, and six experienced an increase.
The decline in lung cancer mortality was strongly associated with anti-tobacco campaigns initiated by WHO over the past 15 to 20 years. Comprehensive tobacco control was identified as the most successful lifestyle modification measure. In countries with declining lung cancer mortality, 91% had decreasing tobacco prevalence in males and 82% in females. Country-wide measures to increase physical activity were better implemented in countries with declining lung cancer mortality, although the difference was not statistically significant (t = 1.79, P > 0.05). Other WHO “best buy” interventions, such as diet and alcohol reduction campaigns, had weaker associations with lung cancer mortality.
Countries with the highest decline in lung cancer mortality included Guatemala (46%), Mexico (36%), Czechia (32%), and the United States (32%). These countries showed significant reductions in tobacco prevalence and fully achieved public education and awareness campaigns on physical activity. Conversely, countries with the highest increase in lung cancer mortality, such as Grenada, Brunei Darussalam, Mauritius, and the Republic of Moldova, had less visible declines or increases in tobacco prevalence and incomplete implementation of physical activity campaigns.
Discussion
The study highlights the critical role of tobacco control in reducing lung cancer mortality. The decline in lung cancer mortality observed in many countries is largely attributed to the reduction in tobacco use, which is the primary risk factor for lung cancer. Public health programs that reduce smoking are effective, but more efforts are needed, especially in countries where smoking prevalence is increasing.
Physical activity also showed a tendency to be associated with lower lung cancer mortality. WHO recommends at least 150 minutes of moderate-intensity aerobic physical activity per week for adults. Countries that implemented public education and awareness campaigns on physical activity had better outcomes in terms of lung cancer mortality. However, more research is needed to establish a definitive link between physical activity and lung cancer risk.
Diet and alcohol consumption showed weaker associations with lung cancer mortality in this study. While some evidence suggests that a diet rich in fruits and vegetables may protect against lung cancer, the study did not find a significant association between unhealthy diet reduction measures and lung cancer mortality. Similarly, the reduction of harmful alcohol use did not show a significant impact on lung cancer mortality.
Air pollution, both indoor and outdoor, is another risk factor for lung cancer. However, the study did not find a significant difference in ambient and household air pollution levels between countries with declining and increasing lung cancer mortality. This could be due to the complex interplay of various risk factors and the need for more detailed data on air pollution exposure.
Conclusion
Tobacco cessation remains the most effective strategy for reducing lung cancer mortality. The decline in tobacco use over the past 15 to 20 years has led to a corresponding decrease in lung cancer mortality in many countries. Public health programs should continue to focus on helping current smokers quit and preventing new smokers from starting.
Physical activity also plays a role in reducing lung cancer mortality, and WHO recommendations on physical activity should be adapted and implemented at the country level. While diet and alcohol consumption showed weaker associations with lung cancer mortality, they remain important components of a healthy lifestyle and should be addressed in public health policies.
Strengthening basic commitments to tobacco control, physical activity, healthy diet, and air quality will help nations move towards the SDG target 3.4 of reducing premature mortality from NCDs by one-third by 2030.
doi.org/10.1097/CM9.0000000000000918
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