Temporal trends of tracheal, bronchus, and lung cancer between 2010 and 2019, in Asian countries by geographical region and sociodemographic index, comparison with global data

Abstract

Background

This study aimed to describe the trends in incidence, mortality, and burden of tracheal, bronchial and lung (TBL) cancer in Asia from 2010 through 2019 and compare with global and other continental data.

Methods

We collected TBL cancer data from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. For all locations, annual case data and age‐standardized rates (ASRs) were used to investigate the incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs) of TBL from 2010 to 2019. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied.

Results

In 2019, more than 55% of TBL cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of lung cancer was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of TBL cancer increased over 1.34‐, 1.31‐, 1.31‐, and 1.26‐fold, in Asia. During this period, the age‐standardized incidence rate (ASIR), the age‐standardized death rate (ASDR), the age‐standardized prevalence rate (ASPR), and the age‐standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster. In 2019, age‐specific incidence, death, prevalence, and DALY cases of TBL cancer were peaking at 65–74, 70–74, 65–69, and 65–69 years, respectively. In 2019, the highest ASIR, ASDR, and DALYs ASR of TBL cancer was observed in East Asia countries and the highest ASPR in high‐income Asia Pacific countries. Central Asia and high‐income Asia Pacific countries experienced a decreasing trend in ASIR and ASDR, and the South Asia countries experienced the highest increasing trend from 2010 to 2019. ASPR only decreased in Central Asia, and DALYs ASR only increased in South Asia. In 2019, among high sociodemographic index (SDI) Asian countries, Brunei Darussalam had the highest ASIR, ASDR, and DALYs ASR and the Republic of Korea had the highest ASPR. Among high‐middle SDIs, Turkey and Georgia; among middle SDIs, China and Armenia; among low‐middle SDIs, Mongolia and the Democratic People's Republic of Korea had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer.

Conclusion

Most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures in order to reduce the process of this cancer is considered urgent.

In 2019, more than 55% of tracheal, bronchus, and lung (TBL) cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of TBL cancer was imposed on Asian countries. From 2010 to 2019, the age‐standardized incidence rate (ASIR), age‐standardized death rate (ASDR), age‐standardized death rate (ASDR), and age‐standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster.

INTRODUCTION

One of the worldwide leading causes of death is cancer and its burden is not consistent. ¹ Particularly between developing and developed countries, the incidence, mortality, and disability‐adjusted life year (DALY) burden of cancer vary considerably across countries and regions. ² , ³ , ⁴ , ⁵

Globally, TBL cancers are among important public health issues and the burden of these cancers varies in different countries. ⁶ , ⁷ In the past few decades, lung cancer has been the most common malignancy and cause of cancer deaths. ⁸ Furthermore, lung cancer remains the leading cause of cancer‐related deaths in men and women ⁹ and an important public health issue due to a 5‐year survival rate of 17.8% ¹⁰ and a high fatality rate. ¹¹

According to the latest GLOBOCAN estimates of cancer incidence and mortality in 2020, a total of 2 206 771 new cases were estimated, accounting for 11.4% of all new cancer diagnoses. ¹² In addition, according to the Global Cancer Observatory: Cancer Today statistics by the International Agency for Research on Cancer (IARC), after breast and prostate cancer, lung cancer had the third highest incidence and mortality in Asia in 2020. ¹³ In 2020, the Global Burden of Disease (GBD) study reported that the worldwide healthcare burden and costs attributed to lung cancer are significant. ¹⁴ In males and females, the age‐standardized cumulative lifetime risk of lung cancer diagnosis is 3.8% and 1.77%, respectively. ⁷ , ¹³ In Asia, the highest age‐standardized rate has been shown in Turkey and the lowest age‐standardized rate in Saudi Arabia. ¹⁵ , ¹⁶

Lung cancer has several risk factors. Nonmodifiable risk factors include; age, gender, family history and race/ethnicity, and modifiable risk factors include; tobacco smoking, cannabis smoking, asbestos, radon, arsenic, air pollution, infection, and chronic obstructive pulmonary diseases. ¹⁷ Lung cancer is more prevalent among men, individuals >60 years old, African Americans, and people with a positive family history. ¹⁷ Tobacco smoking is the most important risk factor for lung cancer, and 81.7% of lung cancer cases and 81.3% of lung cancer deaths are closely related to cigarette smoking. ¹⁸ In smokers, the relative risk of lung cancer is about 20‐fold higher than in nonsmokers. ¹⁹ On the other hand, the worldwide incidence of lung cancer is on the rise with increased industrialization. ²⁰ In this study, the trends of incidence, mortality, and burden of TBL cancer in Asia from 2010 through 2019 based on the sociodemographic index (SDI) are described and these data compared with the trend in global and other continents.

METHODS

Source data

The annual data for 49 Asian countries and territories and six GBD regions, global and continents in the context of incidence, prevalence, death, and the burden imposed by TBL cancer were extracted from the GBD 2019. The GBD 2019 were accessed via the online data source Global Health Data Exchange (GHDx) query tool (http://ghdx.healthdata.org/gbd-results-tool) based on the International Classification of Diseases 10 (ICD‐10) (code [C56.9] for TBL cancer). GBD estimates all available epidemiological data (incidence, mortality, prevalence, year of life lost [YLL], years lived with disability [YLD], and disability‐adjusted life years [DALY]) by time, location, gender, and age group for the comparative assessment of health loss due to 364 diseases and injuries across 204 countries and territories from 1990 to 2019. ²¹ , ²²

In this study, data were extracted for various classifications of Asian countries on the basis of a sociodemographic index (SDI), and six GBD regions of Asia from 2010 to 2019 and compared with worldwide and other continental data. Specifically, we used data for North Africa and the Middle East, given that 15 out of 21 GBD countries in North Africa and the Middle East belong to West Asia. In Southeast Asian countries, two were also from Africa.

GBD has developed a standardized international form of quality‐adjusted life year (QALY), known as the DALY, and is defined as a wasted year of healthy living as a result of premature death and years with a disability of specific severity and duration. "Premature" death is a death that occurs at an age when a person's death is not expected. The expected age at death for a person is calculated based on the predicted death for a certain age in a population standardized to the population of Japan, which has the longest life expectancy at birth in the world. The total number of DALYs for a given condition within a population is equal to the sum of years of life lost (YLLs) and years of disability of known severity and duration (YLDs). ²³ , ²⁴

The SDI is the geometric average of three indicators: (1) lag‐distributed income per capita, (2) average educational attainment of people aged 15 years and older, and (3) the total fertility rate (in people aged <25 years). ²⁵ The SDI is the reflection of levels of social and economic conditions that can affect health outcomes in a given location. Countries and territories were categorized into five groups based on SDI values: low SDI (<0.45), low‐middle SDI (≥0.45 and <0.61), middle SDI (≥0.61 and <0.69), high‐middle SDI (≥0.69 and <0.80), and high SDI (≥0.80). ²⁶ , ²⁷

An age‐standardized rate (ASR) is a weighted average of the age‐specific rates per 100 000 persons, where the weights are the proportions of people within the corresponding age groups of the WHO standard population. Age‐standardized rates take into account differences in the age distribution of the population by applying the rates for each population to a standardized population. ²⁸

Ethical considerations

The study was approved by the Ethics Committee of the Jahrom University of Medical Sciences in Iran (IR.JUMS.REC.1401.094). Informed consent was not necessary due to the use of the anonymous online dataset.

Statistical analysis

To remove the influence of the composition of different age groups within populations, incidence, prevalence, deaths, DALY and age‐standardized rates are expressed per 100 000 population. The data are reported as values with 95% confidence intervals (CI). Selected epidemiological indicators are presented separately for each classification system. To show comparative changes in incidence, prevalence, mortality, and age‐standardized rates, the relative difference (%) between years was used. The relative difference was calculated by dividing the value of the absolute difference by the value of the year of origin, which was then multiplied by 100. ²⁹ The definition of what was used can be accessed via https://www.healthdata.org/terms-defined and https://www.healthdata.org/gbd/.

RESULTS

Morbidity of TBL cancer in Asia

Compared with global data and continents

In Asia, the number of TBL cancer incidences increased from 975 361 (95% CI: 909 679–1 037 802) in 2010 to 1 305 525 (95% CI: 1 150 171–1 455 350) in 2019, which is over a 1.34‐fold increase. In 2019 approximately 58% (1 305 525/2 259 998) of TBL cancer cases happened in Asian countries. During this period, the ASIR of TBL cancer with a 1% change, decreased from 28.08 (95% CI: 26.16–29.89) per 100 000 in 2010 to 27.82 (95% CI: 24.56–30.95) per 100 000 in 2019, while in the same time, this rate globally decreased by 5%, in America by 10%, and in Europe by 7% (Figure 1 and Table 1).

FIGURE 1.

Temporal trend of incidence, prevalence, death and DALYs age standard rates (per 100 000 population) of TBL cancer in ASIA comparison with global data and other continents from 1990 to 2019.

TABLE 1.

Comparison of the incidence, death, prevalence, and burden rates of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019 (both sexes).

Location	Incidence					Death
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Global	1 832 625	28.99	2 259 998	27.66	‐0.05	1 670 745	26.70	2 042 640	25.18	‐0.06
	(1 747 456–1 909 105)	(27.58–30.18)	(2 067 316–2 451 832)	(25.28–29.99)	(‐0.13–0.03)	(1 592 451–1 737 302)	(25.29–27.77)	(1 879 241–2 193 269)	(23.16–27.01)	(‐0.13–0.02)
Continents
Africa	47 663	10.39	63 899	10.46	0.01	49 125	11.07	65 621	11.15	0.01
	(42 695–54 096)	(9.34–11.73)	(57 033–71 562)	(9.4–11.63)	(‐0.08–0.11)	(44 347–55 559)	(10–12.43)	(58 557–74 115)	(9.99–12.4)	(‐0.08–0.1)
America	331 037	33.45	385 406	29.96	‐0.10	282 630	28.49	331 172	25.67	‐0.10
	(316 473–339 397)	(32.01–34.28)	(345 604–429 508)	(26.86–33.37)	(‐0.19–‐0.01)	(268 084–290 210)	(27.07–29.23)	(309 812–345 847)	(24.05–26.8)	(‐0.13–‐0.07)
Asia	975 361	28.08	1 305 525	27.82	‐0.01	906 650	26.66	1 190 516	25.76	‐0.03
	(909 679–1 037 802)	(26.16–29.89)	(1 150 171–1 455 350)	(24.56–30.95)	(‐0.13–0.12)	(846 561–964 850)	(24.77–28.33)	(1 052 836–1 330 529)	(22.79–28.72)	(‐0.15–0.09)
Europe	476 813	36.07	503 130	33.37	‐0.07	430 658	32.16	453 373	29.55	‐0.08
	(459 978–486 467)	(34.9–36.76)	(455 166–552 462)	(30.25–36.73)	(‐0.16–0.02)	(413 701–440 000)	(31.01–32.82)	(426 326–476 093)	(27.88–31.01)	(‐0.12–‐0.04)
Countries by geographical location
Central Asia	11 934	20.23	14 342	18.91	‐0.07	11 820	20.47	13 990	19.04	‐0.07
	(11 487–12 356)	(19.45–20.94)	(12 983–15 870)	(17.14–20.76)	(‐0.15–0.03)	(11 373–12 240)	(19.68–21.2)	(12 661–15 452)	(17.29–20.86)	(‐0.15–0.02)
East Asia	628 151	41.17	854 582	41.31	0.00	594 187	39.99	778 387	38.38	‐0.04
	(575 530–685 242)	(37.73–44.79)	(721 022–1 002 044)	(35.03–48.11)	(‐0.17–0.19)	(541 920–645 351)	(36.53–43.35)	(658 108–907 254)	(32.72–44.57)	(‐0.19–0.14)
High‐income Asia Pacific	131 569	34.89	150 900	31.57	‐0.10	95 867	24.78	110 970	22.17	‐0.11
	(119 593–138 366)	(32.07–36.51)	(126 657–173 088)	(26.96–36.26)	(‐0.2–0.02)	(85 867–101 050)	(22.5–25.98)	(96 055–119 283)	(19.73–23.56)	(‐0.13–‐0.08)
North Africa and Middle East	52 191	16.66	71 681	16.83	0.01	53 176	17.44	72 510	17.55	0.01
	(48 178–56 416)	(15.33–17.98)	(63 424–81 049)	(14.91–19.02)	(‐0.1–0.14)	(48 971–57 366)	(16.03–18.79)	(64 112–81 925)	(15.56–19.82)	(‐0.1–0.13)
South Asia	80 950	7.84	117 195	8.36	0.07	82 457	8.25	119 644	8.75	0.06
	(74 897–86 782)	(7.24–8.41)	(100 085–133 943)	(7.14–9.52)	(‐0.09–0.22)	(76 287–88 125)	(7.61–8.85)	(101 195–137 368)	(7.44–10.05)	(‐0.09–0.21)
Southeast Asia	96 767	21.48	132 529	21.99	0.02	98 814	22.62	134 566	23.00	0.02
	(87 575–106 118)	(19.42–23.5)	(110 981–153 557)	(18.43–25.41)	(‐0.1–0.16)	(90 026–107 961)	(20.57–24.72)	(112 781–155 885)	(19.25–26.63)	(‐0.1–0.14)

Location	Prevalence					DALY
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Global	2 557 647	39.76	3 212 307	38.84	‐0.02	38 816 797	595.08	45 857 963	551.58	‐0.07
	(2 451 258–2 653 706)	(38.02–41.26)	(2 937 037–3 488 346)	(35.49–42.16)	(‐0.1–0.05)	(37 161 595–40 409 438)	(569.46–619.44)	(42 297 425–49 339 876)	(508.97–593.12)	(‐0.15–0)
Continents
Africa	48 619	9.97	66 194	10.14	0.02	1 297 006	258.89	1 724 110	257.28	‐0.01
	(43 488–55 370)	(8.93–11.32)	(58 602–74 477)	(9.06–11.34)	(‐0.07–0.12)	(1 157 918–1 478 946)	(232.57–293.8)	(1 518 047–1 970 898)	(228.41–292.12)	(‐0.1–0.1)
America	532 344	53.91	609 633	47.55	‐0.12	6 111 998	616.56	6 982 073	548.34	‐0.11
	(512 813–546 055)	(51.96–55.3)	(542 652–684 277)	(42.33–53.36)	(‐0.22–‐0.01)	(5 919 808–6 223 069)	(597.39–627.78)	(6 655 043–7 266 920)	(522.67–570.79)	(‐0.14–‐0.08)
Asia	1 308 776	36.35	1 820 539	37.81	0.04	21 516 974	579.16	27 120 537	553.68	‐0.04
	(1 225 459–1 392 332)	(34.01–38.67)	(1 605 530–2 034 496)	(33.46–42.14)	(‐0.09–0.17)	(20 162 682–22 913 727)	(543.52–616.66)	(23 951 875–30 414 194)	(488.57–619.78)	(‐0.16–0.09)
Europe	665 767	51.86	713 441	49.08	‐0.05	9 853 259	776.31	9 988 808	698.29	‐0.10
	(644 824–680 187)	(50.39–52.93)	(642 607–790 401)	(44.21–54.34)	(‐0.15–0.05)	(9 590 547–10 021 168)	(758.05–789.01)	(9 442 180–10 489 803)	(660.78–732.91)	(‐0.14–‐0.06)
Countries by geographical location
Central Asia	13 055	21.17	16 240	20.13	‐0.05	327 135	520.66	387 448	473.70	‐0.09
	(12 554–13 538)	(20.33–21.93)	(14 651–18 053)	(18.23–22.19)	(‐0.14–0.05)	(315 044–338 748)	(500.81–539.35)	(349 153–429 746)	(428.64–523.63)	(‐0.18–0.01)
East Asia	783 584	49.06	1 163 481	54.46	0.11	14 113 044	872.01	17 614 063	825.81	‐0.05
	(715 846–857 024)	(44.9–53.51)	(976 059–1 369 145)	(45.82–63.97)	(‐0.09–0.33)	(12 887 293–15 406 968)	(797.95–948.78)	(14 810 292–20 721 521)	(696.85–969.46)	(‐0.21–0.14)
High‐income Asia Pacific	288 182	80.42	326 643	74.32	‐0.08	1 745 570	494.73	1 830 128	427.39	‐0.14
	(267 010–304 566)	(75.25–84.6)	(276 230–376 769)	(63.96–85.75)	(‐0.19–0.06)	(1 622 311–1 810 575)	(464.58–510.51)	(1 654 973–1 933 641)	(395.68–448.33)	(‐0.16–‐0.11)
North Africa and Middle East	55 161	16.74	77 317	17.17	0.03	1 389 718	412.53	1 870 025	406.65	‐0.01
	(50 926–59 688)	(15.46–18.13)	(68 022–87 610)	(15.15–19.45)	(‐0.09–0.16)	(1 283 476–1 507 225)	(380.92–447.32)	(1 648 815–2 118 436)	(359.1–459.46)	(‐0.13–0.11)
South Asia	84 029	7.72	121 387	8.31	0.08	2 207 925	198.52	3 089 930	208.53	0.05
	(77 729–90 153)	(7.13–8.27)	(103 595–139 072)	(7.1–9.5)	(‐0.08–0.24)	(2 042 685–2 363 198)	(183.68–212.2)	(2 617 375–3 550 873)	(176.65–239.62)	(‐0.11–0.21)
Southeast Asia	102 121	21.45	141 713	22.31	0.04	2 580 293	530.60	3 429 720	532.93	0.00
	(92 437–112 157)	(19.46–23.5)	(118 238–165 160)	(18.65–25.86)	(‐0.09–0.18)	(2 343 315–2 826 856)	(483.12–580.93)	(2 859 905–3 965 337)	(445.89–615.84)	(‐0.12–0.13)

Abbreviations: CI, confidence interval; TBL, tracheal, bronchial and lung.

In Asian men, the number of TBL cancer incidences increased from 695 259 (95% CI: 643 022–750 702) in 2010 to 906 593 (95% CI: 771 042–1 049 246) in 2019, which is over a 1.3‐fold increase. In 2019 approximately 69.4% of Asia TBL cancer new cases, occurred in Asian men which included 59.5% (906 593/1 522 773) of global male TBL cancer incidence cases. During this period, the ASIR of TBL cancer with a 3% change, decreased from 42.54 (95% CI: 39.28–45.84) per 100 000 in 2010 to 41.16 (95% CI: 35.32–47.32) per 100 000 in 2019, while in the same time, this rate globally decreased by 7%, in America and Europe by 12% (Table 2).

TABLE 2.

Comparison of the incidence, death, prevalence and burden rates of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019 (males).

Location	Incidence					Death
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Global	1 266 190	43.69	1 522 773	40.44	‐0.07	1 164 258	40.94	1 386 094	37.38	‐0.09
	(1 202 565–1 326 841)	(41.45–45.77)	(1 373 842–1 676 681)	(36.55–44.42)	(‐0.17–0.02)	(1 108 350–1 215 596)	(38.85–42.68)	(1 260 237–1 513 800)	(34.09–40.74)	(‐0.17–0)
Continents
Africa	36 549	16.38	47 159	16.09	‐0.02	37 728	17.53	48 544	17.21	‐0.02
	(32 136–42 571)	(14.45–18.97)	(41 687–53 671)	(14.27–18.13)	(‐0.12–0.1)	(33 410–43 751)	(15.57–20.2)	(42 915–55 500)	(15.31–19.47)	(‐0.11–0.09)
America	186 025	41.78	214 269	36.70	‐0.12	162 602	36.77	188 270	32.43	‐0.12
	(179 186–189 993)	(40.16–42.72)	(186 646–245 610)	(31.99–42.07)	(‐0.23–0)	(156 145–166 234)	(35.23–37.65)	(178 831–195 807)	(30.74–33.75)	(‐0.14–‐0.09)
Asia	695 259	42.54	906 593	41.16	‐0.03	646 099	40.66	825 738	38.30	‐0.06
	(643 022–750 702)	(39.28–45.84)	(771 042–1 049 246)	(35.32–47.32)	(‐0.18–0.12)	(599 147–694 710)	(37.75–43.57)	(706 207–949 796)	(33–43.79)	(‐0.19–0.09)
Europe	347 179	60.89	353 424	53.32	‐0.12	316 705	55.64	322 275	48.46	‐0.13
	(337 249–353 973)	(59.11–62.1)	(320 472–389 686)	(48.36–58.75)	(‐0.21–‐0.03)	(306 915–322 902)	(53.81–56.78)	(303 139–339 418)	(45.56–51.06)	(‐0.17–‐0.09)
Countries by geographical location
Central Asia	9537	37.59	11 253	34.44	‐0.08	9420	38.30	10 955	34.98	‐0.09
	(9122–9950)	(35.97–39.22)	(9979–12 553)	(30.72–38.1)	(‐0.17–0.02)	(9018–9823)	(36.71–39.94)	(9718–12 201)	(31.18–38.66)	(‐0.18–0.01)
East Asia	442 614	61.68	590 047	61.06	‐0.01	418 526	60.80	536 789	57.50	‐0.05
	(394 667–493 908)	(55.3–68.47)	(467 100–722 744)	(48.89–73.86)	(‐0.22–0.24)	(376 929–464 328)	(55.06–66.96)	(427 357–661 038)	(46.25–69.74)	(‐0.25–0.17)
High‐income Asia Pacific	95 187	58.88	105 806	50.61	‐0.14	68 875	42.74	76 809	36.15	‐0.15
	(88 757–99 228)	(54.81–61.39)	(89 324–125 121)	(42.87–59.61)	(‐0.26–0.01)	(63 689–71 709)	(39.41–44.55)	(69 027–81 528)	(32.76–38.31)	(‐0.18–‐0.13)
North Africa and Middle East	42 203	26.63	55 843	25.77	‐0.03	43 261	28.02	57 114	27.16	‐0.03
	(38 782–45 960)	(24.42–28.91)	(49 149–63 493)	(22.74–29.16)	(‐0.15–0.1)	(39 698–46 972)	(25.64–30.39)	(50 323–64 674)	(24.02–30.62)	(‐0.14–0.1)
South Asia	63 332	12.38	85 412	12.42	0.00	64 539	13.05	87 160	13.03	0.00
	(57 745–69 047)	(11.25–13.47)	(69 746–101 658)	(10.19–14.74)	(‐0.18–0.2)	(58 846–70 169)	(11.88–14.19)	(71 240–102 821)	(10.68–15.32)	(‐0.18–0.18)
Southeast Asia	67 604	32.97	91 221	33.20	0.01	68 978	34.96	92 416	34.97	0.00
	(62 062–73 776)	(30.32–35.86)	(76 900–106 089)	(28.16–38.38)	(‐0.13–0.16)	(63 777–74 766)	(32.35–37.91)	(78 453–106 933)	(29.78–40.37)	(‐0.13–0.14)

Location	Prevalence					DALY
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Global	1 716 379	57.22	2 109 409	54.52	‐0.05	27 443 591	891.68	31 582 258	802.86	‐0.10
	(1 639 042–1 795 082)	(54.61–59.84)	(1 895 836–2 337 805)	(49.05–60.18)	(‐0.14–0.05)	(26 238 635–28 695 342)	(851.85–931.53)	(28 622 120–34 681 701)	(727.6–879.76)	(‐0.19–0)
Continents
Africa	37 211	15.64	48 599	15.49	‐0.01	996 182	407.65	1 273 661	395.57	‐0.03
	(32 606–43 427)	(13.77–18.18)	(42 835–55 456)	(13.7–17.58)	(‐0.11–0.11)	(874 751–1 168 008)	(360.63–474.74)	(1 115 235–1 475 387)	(348.98–453.39)	(‐0.13–0.09)
America	280 546	62.13	318 385	53.95	‐0.13	3 578 682	782.87	4 019 140	681.21	‐0.13
	(271 942–287 853)	(60.11–63.8)	(274 446–370 922)	(46.52–62.82)	(‐0.25–0.01)	(3 486 125–3 640 976)	(761.01–796.82)	(3 866 967–4 175 479)	(654.95–707.55)	(‐0.16–‐0.1)
Asia	928 147	54.01	1 257 715	54.94	0.02	15 471 795	862.61	19 032 930	806.43	‐0.07
	(861 104–1 000 537)	(50.08–58.12)	(1 069 513–1 462 350)	(46.96–63.32)	(‐0.13–0.18)	(14 340 748–16 696 371)	(800.85–929.03)	(16 188 395–21 991 610)	(688.15–928.33)	(‐0.21–0.1)
Europe	469 031	82.35	483 071	73.66	‐0.11	7 371 434	1296.88	7 228 445	1112.90	‐0.14
	(456 266–479 691)	(80.06–84.24)	(434 425–538 524)	(66.24–82.02)	(‐0.2–‐0.01)	(7 210 498–7 495 109)	(1268.24–1318.81)	(6 786 085–7 659 648)	(1044.81–1178.58)	(‐0.19–‐0.09)
Countries by geographical location
Central Asia	10 445	38.69	12 747	35.93	‐0.07	262 480	950.54	305 280	845.18	‐0.11
	(9966–10 916)	(36.98–40.34)	(11 269–14 251)	(31.94–39.9)	(‐0.17–0.03)	(250 744–274 008)	(909.87–992.11)	(269 545–342 706)	(750.29–941.04)	(‐0.2–‐0.01)
East Asia	549 320	71.26	798 517	78.03	0.09	10 022 616	1276.56	12 285 616	1195.54	‐0.06
	(489 021–614 703)	(63.72–79.36)	(623 900–988 417)	(61.43–95.66)	(‐0.14–0.39)	(8 962 494–11 190 274)	(1148.68–1419.36)	(970 2712–15 269 024)	(949.99–1478.03)	(‐0.27–0.18)
High‐income Asia Pacific	207 771	129.02	229 777	114.22	‐0.11	1 293 998	813.32	1 318 234	670.81	‐0.18
	(194 401–219 959)	(121.06–136.58)	(191 569–273 165)	(95.69–135.71)	(‐0.26–0.06)	(1 225 352–1 335 843)	(770.31–839.29)	(1 219 937–1 388 347)	(624.48–704.7)	(‐0.21–‐0.15)
North Africa and Middle East	43 906	26.37	58 612	25.59	‐0.03	1 129 551	663.37	1 471 977	629.27	‐0.05
	(40 334–47 853)	(24.21–28.71)	(51 424–66 749)	(22.48–29.12)	(‐0.15–0.11)	(1 037 014–1 231 394)	(609.93–724.26)	(1 292 740–1 675 771)	(554.11–713.7)	(‐0.17–0.09)
South Asia	65 683	12.12	88 383	12.28	0.01	1 720 712	310.76	2 242 983	306.69	‐0.01
	(59 942–71 764)	(11.06–13.21)	(72 063–105 442)	(10.04–14.62)	(‐0.17–0.22)	(1 574 121–1 878 619)	(283.66–338.27)	(1 835 005–2 652 810)	(251.04–361.99)	(‐0.2–0.18)
Southeast Asia	71 517	32.53	97 906	33.25	0.02	1 810 079	804.60	2 378 099	795.16	‐0.01
	(65 595–78 128)	(29.89–35.41)	(81 821–114 685)	(27.99–38.75)	(‐0.13–0.19)	(1 666 282–1 968 106)	(742.9–872.82)	(1 995 969–2 766 343)	(672.65–921.59)	(‐0.15–0.14)

Abbreviations: CI, confidence interval; TBL, tracheal, bronchial and lung.

In Asian women, the number of TBL cancer incidences increased from 280 101 (95% CI: 256 006–302 969) in 2010 to 398 932 (95% CI: 339 662–464 457) in 2019, which is over a 1.42‐fold increase. In 2019 approximately 30.6% of Asia TBL cancer new cases, occurred in Asian women which included 54.1% (398 932/737 225) of global female TBL cancer incidence cases. During this period, the ASIR of TBL cancer with a 5% change, increased from 15.48 (95% CI: 14.07–16.76) per 100 000 in 2010 to 16.21 (95% CI: 13.74–18.85) per 100 000 in 2019, while in the same time, this rate globally increased by 1%, in Africa by 12%, and in Europe by 3%, and in American countries decreased by 8% (Table 3).

TABLE 3.

Comparison of the incidence, death, prevalence and burden rates of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019 (females).

Location	Incidence					Death
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Global	566 435	16.68	737 225	16.84	0.01	506 487	14.97	656 546	14.99	0.00
	(531 214–594 093)	(15.62–17.5)	(658 040–813 972)	(15.03–18.59)	(‐0.08–0.1)	(472 370–533 707)	(13.92–15.76)	(590 247–718 975)	(13.48–16.41)	(‐0.08–0.09)
Continents
Africa	11 114	4.73	16 740	5.29	0.12	11 397	5.04	17 076	5.62	0.12
	(10 146–12 213)	(4.32–5.18)	(14 748–18 781)	(4.68–5.89)	(0–0.22)	(10 387–12 508)	(4.58–5.52)	(14 976–19 279)	(4.97–6.28)	(0–0.23)
America	145 012	26.71	171 137	24.45	‐0.08	120 028	21.83	142 902	20.17	‐0.08
	(136 453–149 964)	(25.31–27.57)	(146 572–197 699)	(20.96–28.29)	(‐0.21–0.05)	(111 881–124 413)	(20.5–22.58)	(130 834–152 666)	(18.57–21.51)	(‐0.12–‐0.03)
Asia	280 101	15.48	398 932	16.21	0.05	260 550	14.67	364 778	14.98	0.02
	(256 006–302 969)	(14.07–16.76)	(339 662–464 457)	(13.74–18.85)	(‐0.1–0.22)	(238 233–282 526)	(13.35–15.92)	(312 089–421 085)	(12.81–17.27)	(‐0.12–0.17)
Europe	129 633	17.28	149 706	17.72	0.03	113 953	14.74	131 099	14.98	0.02
	(122 363–133 692)	(16.47–17.75)	(133 119–167 334)	(15.85–19.87)	(‐0.07–0.14)	(106 426–117 617)	(13.94–15.15)	(120 753–138 421)	(13.94–15.79)	(‐0.02–0.06)
Countries by geographical location
Central Asia	2397	7.22	3089	7.45	0.03	2400	7.38	3035	7.54	0.02
	(2310–2491)	(6.94–7.52)	(2767–3451)	(6.7–8.27)	(‐0.07–0.14)	(2307–2496)	(7.08–7.67)	(2724–3375)	(6.81–8.35)	(‐0.08–0.13)
East Asia	185 537	23.56	264 535	24.55	0.04	175 661	22.78	241 598	22.70	0.00
	(165 513–205 184)	(21.05–26.05)	(213 472–322 034)	(19.85–29.85)	(‐0.16–0.3)	(156 904–194 255)	(20.41–25.12)	(196 028–289 422)	(18.46–27.15)	(‐0.2–0.22)
High‐income Asia Pacific	36 382	16.86	45 094	16.45	‐0.02	26 992	11.76	34 161	11.37	‐0.03
	(30 613–39 687)	(14.74–18.09)	(35 652–53 403)	(13.64–19.2)	(‐0.15–0.12)	(22 018–29 634)	(10.03–12.69)	(27 113–38 231)	(9.6–12.41)	(‐0.07–0)
North Africa and Middle East	9987	6.46	15 838	7.62	0.18	9915	6.65	15 396	7.68	0.15
	(9196–10 762)	(5.93–6.97)	(13 642–18 196)	(6.56–8.74)	(0.03–0.32)	(9104–10 671)	(6.08–7.16)	(13 258–17 676)	(6.59–8.77)	(0.01–0.29)
South Asia	17 618	3.40	31 783	4.47	0.32	17 918	3.58	32 485	4.69	0.31
	(15 685–19 518)	(3.01–3.8)	(25 999–38 175)	(3.67–5.37)	(0.06–0.61)	(15 757–19 848)	(3.12–4)	(26 638–39 104)	(3.86–5.64)	(0.05–0.6)
Southeast Asia	29 163	11.99	41 308	12.78	0.07	29 836	12.61	42 151	13.36	0.06
	(24 280–34 189)	(10.03–14)	(316 31–51 823)	(9.8–15.93)	(‐0.08–0.22)	(24 900–34 975)	(10.55–14.7)	(32 050–52 566)	(10.19–16.57)	(‐0.09–0.21)

Location	Prevalence					DALY
	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Global	841 268	24.67	1 102 899	25.22	0.02	11 373 206	331.74	14 275 706	327.57	‐0.01
	(796 537–877 004)	(23.35–25.72)	(989 626–1 214 657)	(22.65–27.78)	(‐0.07–0.12)	(10 770 628–11 958 278)	(314.19–348.96)	(13 000 079–15 704 795)	(298.53–360.45)	(‐0.1–0.08)
Continents
Africa	11 408	4.54	17 596	5.17	0.14	300 825	116.06	450 450	128.37	0.11
	(10 366–12 602)	(4.15–4.99)	(15 351–19 862)	(4.58–5.79)	(0.01–0.25)	(271 961–331 332)	(105.52–127.2)	(390 478–514 074)	(111.98–145.41)	(‐0.02–0.23)
America	251 798	47.23	291 248	42.31	‐0.10	2 533 317	474.98	2 962 933	434.89	‐0.08
	(240 507–260 562)	(45.24–48.84)	(246 138–341 703)	(35.74–49.7)	(‐0.24–0.05)	(2 428 813–2 599 251)	(456.25–486.94)	(2 776 613–3 144 654)	(408.17–460.97)	(‐0.13–‐0.03)
Europe	380 630	20.43	562 824	22.49	0.10	6 045 179	316.95	8 087 606	321.18	0.01
	(349 763–411 327)	(18.67–22.08)	(480 164–653 889)	(19.21–26.12)	(‐0.06–0.28)	(5 551 988–6 575 776)	(290.95–344.55)	(6 962 536–9 358 865)	(276.65–371.34)	(‐0.14–0.18)
Asia	196 736	27.82	230 370	29.17	0.05	2 481 824	355.87	2 760 363	354.87	0.00
	(187 564–203 168)	(26.7–28.66)	(205 639–257 874)	(25.99–32.68)	(‐0.06–0.18)	(2 377 313–2 540 942)	(343.94–363.58)	(2 583 575–2 917 832)	(334.93–374.7)	(‐0.05–0.05)
Countries by geographical location
Central Asia	2611	7.54	3492	7.98	0.06	64 655	183.44	82 168	185.27	0.01
	(2518–2720)	(7.28–7.86)	(3111–3917)	(7.15–8.91)	(‐0.05–0.18)	(62 448–67 272)	(176.8–191.03)	(73 024–92 405)	(165.25–207.53)	(‐0.1–0.13)
East Asia	234 264	28.75	364 964	33.32	0.16	4 090 428	497.71	5 328 447	489.73	‐0.02
	(208 597–260 494)	(25.64–31.99)	(293 511–447 082)	(26.81–40.82)	(‐0.08–0.45)	(3 645 348–4 549 759)	(442.89–552.1)	(4 314 330–6 510 671)	(396.14–597.18)	(‐0.23–0.22)
High‐income Asia Pacific	80 411	41.17	96 866	40.86	‐0.01	451 572	235.42	511 894	219.77	‐0.07
	(70 235–87 650)	(37.37–44.11)	(79 104–114 755)	(34.13–48.03)	(‐0.15–0.16)	(395 398–481 572)	(213.57–247.32)	(437 678–555 713)	(197.35–234.68)	(‐0.1–‐0.03)
North Africa and Middle East	11 255	6.83	18 705	8.43	0.23	260 168	153.63	398 048	174.91	0.14
	(10 374–12 083)	(6.29–7.34)	(16 152–21 456)	(7.27–9.65)	(0.07–0.39)	(240 453–279 924)	(141.58–165.39)	(343 405–459 210)	(151.1–201.59)	(‐0.01–0.28)
South Asia	18 346	3.35	33 004	4.46	0.33	487 213	86.82	846 947	112.79	0.30
	(16 385–20 206)	(2.98–3.71)	(26 751–39 840)	(3.64–5.38)	(0.07–0.64)	(435 355–537 136)	(77.13–95.86)	(692 032–1 029 549)	(92.18–136.92)	(0.04–0.6)
Southeast Asia	30 604	12.01	43 807	13.01	0.08	770 214	295.65	1 051 621	308.47	0.04
	(25 450–35 989)	(10.04–14.06)	(33 416–55 120)	(9.98–16.28)	(‐0.07–0.25)	(633 511–914 063)	(243.82–348.23)	(796 523–1 324 390)	(233.06–387.26)	(‐0.11–0.2)

Abbreviations: CI, confidence interval; TBL, tracheal, bronchial and lung.

Age distribution

In 2019, age‐specific incidence cases of TBL cancer were generally peaking at 65–74 years, 65–69 years in males, and 70–74 years in females. In all age groups, the incidence cases of TBL cancer in males was higher, except in ages above 90 years which in females was higher (Figure 2).

FIGURE 2.

Age specific incidence cases of TBL cancer among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest ASIR of TBL was observed in East Asian countries (41.31 [95% CI: 35.03–48.11]); without any changes compared with 2010. While the Central Asia and high‐income Asia Pacific countries experienced a decreasing trend of 10% and 7%, respectively; the South Asian countries experienced the highest increasing trend from 2010 to 2019 (by 7%) (Figure 3).

FIGURE 3.

Temporal trend of incidence, prevalence, death and DALYs age standard rates (per 100 000 population) of TBL cancer in Asian regions from 1990 to 2019.

In men, the highest ASIR of TBL was observed in East Asian countries (61.06 [95% CI: 48.89–73.86]); with a 1% decrease compared with 2010. While the Central Asia and high‐income Asia Pacific countries experienced a decreasing trend of 8% and 14%, respectively; the Southeast Asia countries experienced an increasing trend from 2010 to 2019 by 1%.

In women, the highest ASIR of TBL was observed in East Asian countries (24.55 [95% CI: 19.85–29.85]) in 2019, these countries and other countries experienced an increasing trend from 2010 to 2019 except high‐income Asia Pacific countries that experienced a decreasing trend by 2%. South Asia countries experienced the highest increasing trend from 2010 to 2019 (by 32%).

Among high SDI Asian countries, Brunei Darussalam (46.15) and the Republic of Korea (35.61) had the highest ASIR of TBL, and Saudi Arabia (8.77) had the lowest rate.

Based on SDI

Among high SDI Asian countries, Brunei Darussalam (45.16) and the Republic of Korea (35.61) had the highest ASIR of TBL, and Saudi Arabia (8.77) had the lowest rate. Among high‐middle SDI Asian countries, Turkey (33.08) and Georgia (31.14) had the highest ASIR of TBL, and Sri Lanka (9.71) had the lowest rate. Among middle SDI Asian countries, China (41.71) and Armenia (33.81) had the highest ASIR of TBL, and Turkmenistan (9.90) had the lowest rate. Among low‐middle SDI Asian countries, Mongolia (31.19) and the Democratic People's Republic of Korea (27.87) had the highest ASIR of TBL, and Bangladesh (7.43) had the lowest rate. Among low SDI Asian countries, Pakistan (16.43) had the highest ASIR of TBL, and Nepal (8.03) had the lowest rate. Further details are presented in Table 4.

TABLE 4.

Incidence distribution of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

		Both					Male						Female
		2010		2019		% change 2010‐2010	2010		2019		% change 2010‐2019	2010		2019		% change 2010‐2019
Location	SDI 2019 lower	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
		(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
High SDI
Brunei Darussalam	0.823	75	46.27	116	46.15	0.00	42	60.33	63	61.02	0.01	33	36.25	53	37.94	0.05
		(69–82)	(42.48–50.29)	(102–130)	(40.91–51.83)	(‐0.13–0.13)	(38–47)	(53.39–67.93)	(52–75)	(51.36–71.21)	(‐0.16–0.21)	(29–37)	(32.03–40.41)	(44–63)	(32.3–44.03)	(‐0.13–0.25)
Cyprus	0.841	402	28.10	514	26.03	‐0.07	314	48.19	398	42.31	‐0.12	88	11.61	116	11.39	‐0.02
		(374–430)	(26.17–30)	(444–592)	(22.56–30.01)	(‐0.21–0.08)	(289–339)	(44.52–51.86)	(330–469)	(35.14–49.85)	(‐0.28–0.05)	(79–98)	(10.48–12.77)	(95–138)	(9.37–13.59)	(‐0.2–0.17)
Israel	0.803	2177	25.06	2670	23.37	‐0.07	1454	37.13	1752	33.44	‐0.10	722	14.94	918	14.64	‐0.02
		(2059–2270)	(23.75–26.11)	(2088–3391)	(18.1–29.71)	(‐0.27–0.18)	(1379–1533)	(35.22–39.1)	(1347–2241)	(25.75–42.7)	(‐0.31–0.15)	(664–771)	(13.82–15.89)	(724–1168)	(11.54–18.64)	(‐0.22–0.24)
Japan	0.87	107 228	34.48	116 798	30.66	‐0.11	77 692	57.88	81 717	49.05	‐0.15	29 535	16.57	35 081	15.94	‐0.04
		(96 325–113 274)	(31.52–36.12)	(95 776–136 541)	(25.55–36)	(‐0.24–0.04)	(71 790–81 155)	(53.74–60.37)	(66 731–99 572)	(40–59.9)	(‐0.3–0.03)	(24 210–32 466)	(14.34–17.85)	(26 628–42 644)	(12.55–19.49)	(‐0.2–0.16)
Kuwait	0.851	129	10.02	225	10.10	‐0.18	98	12.48	173	13.28	0.06	31	5.92	53	5.18	‐0.12
		(119–137)	(9.15–10.72)	(185–272)	(8.19–12.19)	(‐0.3–‐0.04)	(90–105)	(11.35–13.45)	(133–216)	(10.29–16.6)	(‐0.17–0.34)	(28–34)	(5.24–6.53)	(41–66)	(4.08–6.47)	(‐0.3–0.09)
Qatar	0.83	69	21.90	125	18.78	0.02	58	26.31	103	21.19	‐0.19	11	12.28	21	11.80	‐0.04
		(55–85)	(18.02–26.44)	(89–174)	(14.38–23.88)	(‐0.19–0.27)	(45–73)	(20.85–32.57)	(71–149)	(15.97–27.58)	(‐0.41–0.09)	(9–13)	(9.85–14.95)	(16–27)	(9.21–14.72)	(‐0.23–0.17)
Republic of Korea	0.878	22 698	36.90	31 825	35.61	‐0.14	16 431	65.28	22 655	59.14	‐0.09	6266	17.78	9170	18.25	0.03
		(21 256–24 229)	(34.36–39.47)	(26 456–37 538)	(29.58–41.94)	(‐0.35–0.11)	(15 413–17 712)	(60.97–70.45)	(18 637–27 109)	(48.64–70.35)	(‐0.25–0.08)	(5647–6772)	(15.98–19.21)	(7492–10 916)	(14.97–21.76)	(‐0.14–0.21)
Saudi Arabia	0.805	1032	9.13	1545	8.77	‐0.04	771	12.14	1115	10.94	‐0.10	261	5.08	429	5.46	0.07
		(909–1197)	(8.21–10.31)	(1187–1900)	(6.98–10.62)	(‐0.19–0.14)	(680–897)	(10.9–14.02)	(841–1392)	(8.54–13.69)	(‐0.29–0.11)	(225–299)	(4.44–5.78)	(321–551)	(4.16–6.88)	(‐0.17–0.35)
Singapore	0.861	1568	33.19	2162	28.39	‐0.04	1021	48.41	1371	38.69	‐0.20	547	21.28	790	19.73	‐0.07
		(1463–1657)	(30.81–35.1)	(1724–2713)	(22.71–35.43)	(‐0.22–0.16)	(951–1085)	(44.94–51.53)	(1081–1724)	(30.75–48.3)	(‐0.37–0)	(498–592)	(19.27–23.06)	(627–991)	(15.65–24.76)	(‐0.25–0.15)
Taiwan (Province of China)	0.868	10 295	34.33	12 618	31.88	‐0.07	6690	46.05	7802	42.62	‐0.07	3605	23.35	4815	22.78	‐0.02
		(9689–10 735)	(32.27–35.75)	(9963–16 206)	(25.21–40.93)	(‐0.27–0.18)	(6311–6979)	(43.42–48.07)	(6140–9885)	(33.46–54.21)	(‐0.27–0.19)	(3337–3813)	(21.55–24.72)	(3751–6185)	(17.78–29.35)	(‐0.23–0.25)
United Arab Emirates	0.88	227	22.85	542	18.62	‐0.18	176	25.31	434	21.52	‐0.15	51	18.43	108	12.79	‐0.31
		(181–274)	(18.93–26.98)	(393–721)	(13.54–25.75)	(‐0.37–0.06)	(138–216)	(20.35–30.9)	(310–593)	(15.82–29.85)	(‐0.33–0.09)	(40–63)	(14.8–22.63)	(72–145)	(7.5–19.26)	(‐0.58–0.1)
High‐middle SDI
Bahrain	0.751	85	24.23	141	19.84	‐0.18	62	34.52	104	26.50	‐0.23	23	13.99	37	12.46	‐0.11
		(75–95)	(21.4–27.15)	(107–186)	(15.2–25.09)	(‐0.36–0.02)	(53–71)	(29.94–39.4)	(75–142)	(19.94–34.33)	(‐0.42–0)	(20–26)	(12.09–16.15)	(29–45)	(9.96–15.05)	(‐0.28–0.07)
Georgia	0.702	1662	29.30	1784	31.14	0.06	1400	58.14	1515	62.13	0.07	261	7.81	269	8.03	0.03
		(1515–1810)	(26.6–31.96)	(1487–2108)	(25.89–36.87)	(‐0.13–0.29)	(1252–1545)	(52.05–64.25)	(1251–1796)	(51.46–73.5)	(‐0.13–0.3)	(235–290)	(7.01–8.66)	(224–322)	(6.65–9.7)	(‐0.18–0.26)
Jordan	0.731	485	15.10	914	14.34	‐0.05	383	23.14	697	20.90	‐0.10	102	6.42	218	7.19	0.12
		(431–543)	(13.47–16.94)	(748–1110)	(11.86–17.36)	(‐0.23–0.14)	(336–437)	(20.32–26.46)	(537–882)	(16.3–26.2)	(‐0.3–0.14)	(87–117)	(5.51–7.41)	(171–277)	(5.69–9.03)	(‐0.11–0.4)
Kazakhstan	0.723	3740	25.91	3829	21.36	‐0.14	3062	52.86	3047	41.77	‐0.21	678	8.02	782	7.67	‐0.04
		(3558–3945)	(24.65–27.24)	(3259–4406)	(18.36–24.44)	(‐0.31–0.06)	(2885–3267)	(49.82–56.14)	(2577–3559)	(35.53–48.48)	(‐0.33–‐0.08)	(641–718)	(7.58–8.48)	(656–915)	(6.46–8.97)	(‐0.21–0.13)
Lebanon	0.708	1183	27.80	1421	27.29	‐0.07	841	41.03	914	38.92	‐0.05	342	15.58	507	17.75	0.14
		(1016–1518)	(23.82–35.74)	(1168–1868)	(22.42–35.83)	(‐0.18–0.06)	(699–1095)	(34.1–53.77)	(729–1203)	(30.94–51.44)	(‐0.2–0.13)	(284–441)	(12.95–20.1)	(375–703)	(13.08–24.52)	(‐0.14–0.39)
Malaysia	0.737	3915	21.33	5165	19.78	0.03	2743	30.05	3642	28.00	‐0.07	1173	12.86	1523	11.70	‐0.09
		(3573–4318)	(19.34–23.57)	(3997–6561)	(15.37–25.12)	(‐0.16–0.25)	(2494–3026)	(27.12–33.41)	(2793–4631)	(21.62–35.55)	(‐0.28–0.18)	(1058–1301)	(11.53–14.41)	(1163–1934)	(8.98–14.81)	(‐0.29–0.14)
Oman	0.783	119	11.97	147	9.86	0.14	88	16.17	102	12.86	‐0.21	31	6.96	45	6.72	‐0.03
		(109–131)	(10.89–13.07)	(117–192)	(8.16–11.94)	(‐0.1–0.41)	(79–98)	(14.56–17.97)	(76–145)	(10.25–16.55)	(‐0.37–0.04)	(27–36)	(6.02–7.98)	(33–54)	(5.08–8.06)	(‐0.26–0.17)
Sri Lanka	0.69	1963	10.10	2507	9.71	‐0.04	1446	16.37	1731	15.00	‐0.08	517	4.97	775	5.51	0.11
		(1848–2087)	(9.5–10.73)	(1822–3414)	(7.08–13.11)	(‐0.29–0.3)	(1338–1549)	(15.11–17.54)	(1203–2446)	(10.53–20.91)	(‐0.34–0.29)	(472–567)	(4.56–5.46)	(571–1026)	(4.06–7.27)	(‐0.19–0.44)
Turkey	0.748	23 266	34.31	29 511	33.08	‐0.04	19 710	61.72	24 326	57.70	‐0.07	3556	9.96	5185	11.13	0.12
		(20 540–26 279)	(30.29–38.64)	(23 370–36 799)	(26.25–41.11)	(‐0.25–0.25)	(17 304–22 401)	(54.28–70.08)	(19 210–30 440)	(45.57–72.04)	(‐0.28–0.22)	(3128–4031)	(8.77–11.28)	(4127–6459)	(8.87–13.83)	(‐0.13–0.43)
Middle SDI
Armenia	0.689	1316	35.13	1346	31.80	‐0.09	1085	67.75	1105	60.67	‐0.10	231	10.73	241	10.22	‐0.05
		(1260–1376)	(33.69–36.69)	(1130–1596)	(26.74–37.68)	(‐0.24–0.07)	(1035–1141)	(64.76–71.21)	(925–1317)	(50.99–72.07)	(‐0.25–0.06)	(216–246)	(10.07–11.45)	(201–285)	(8.49–12.07)	(‐0.22–0.14)
Azerbaijan	0.683	1748	23.41	2375	23.47	0.00	1404	41.30	1922	41.36	0.00	344	8.69	454	8.92	0.03
		(1484–1986)	(19.89–26.53)	(1746–3042)	(17.37–29.48)	(‐0.19–0.23)	(1145–1636)	(33.91–48.1)	(1298–2561)	(28.35–54.1)	(‐0.23–0.28)	(298–401)	(7.43–10.1)	(350–577)	(6.97–11.37)	(‐0.18–0.29)
China	0.686	610 140	41.51	832 922	41.71	0.00	430 691	62.27	576 186	61.74	‐0.01	179 449	23.73	256 736	24.76	0.04
		(557 957–666 933)	(38–45.26)	(700 293–981 632)	(35.22–48.8)	(‐0.17–0.2)	(383 493–481 118)	(55.7–69.25)	(451 396–709 265)	(48.93–75.2)	(‐0.22–0.25)	(159 280–199 243)	(21.12–26.3)	(205 684–314 159)	(19.89–30.26)	(‐0.17–0.3)
Indonesia	0.66	34 906	21.37	48 199	22.87	0.07	24 046	31.51	32 897	33.24	0.05	10 860	12.55	15 302	13.85	0.10
		(27 783–40 662)	(17.15–24.9)	(35 266–59 309)	(16.78–28.04)	(‐0.12–0.28)	(19 581–29 530)	(26.13–37.98)	(24 544–43 307)	(25.13–42.84)	(‐0.18–0.33)	(6739–15 321)	(7.83–17.48)	(8548–22 850)	(7.74–20.59)	(‐0.14–0.39)
Iran (Islamic Republic of)	0.67	5621	10.72	8705	12.24	0.14	4043	15.36	5878	16.58	0.08	1578	5.98	2827	7.94	0.33
		(5345–5896)	(10.12–11.25)	(8040–9366)	(11.26–13.16)	(0.07–0.22)	(3833–4244)	(14.51–16.12)	(5357–6411)	(15.1–18.09)	(0–0.17)	(1486–1666)	(5.59–6.33)	(2548–3081)	(7.13–8.68)	(0.19–0.45)
Iraq	0.671	2395	15.50	4154	18.69	0.21	1808	24.40	2997	28.37	0.16	587	7.15	1157	9.79	0.37
		(1875–2958)	(12.28–18.91)	(3200–5129)	(14.53–22.68)	(0–0.46)	(1380–2283)	(18.91–30.38)	(2290–3678)	(21.98–34.02)	(‐0.05–0.45)	(447–756)	(5.5–9.09)	(880–1475)	(7.53–12.32)	(0.08–0.76)
Philippines	0.623	9978	17.35	13 827	17.71	0.17	7244	27.40	9522	26.62	‐0.03	2734	8.93	4305	10.38	0.16
		(9081–11 179)	(15.83–19.4)	(11 026–17 100)	(14.24–21.75)	(‐0.03–0.38)	(6420–8373)	(24.42–31.58)	(7205–12 395)	(20.36–34.23)	(‐0.29–0.27)	(2428–3108)	(7.96–10.1)	(3199–5617)	(7.79–13.4)	(‐0.15–0.56)
Syrian Arab Republic	0.619	1167	11.71	1372	11.09	‐0.05	873	16.49	991	15.37	‐0.07	294	6.40	382	6.61	0.03
		(954–1400)	(9.68–13.97)	(1007–1814)	(8.24–14.52)	(‐0.28–0.22)	(702–1070)	(13.34–20.1)	(720–1313)	(11.3–20.13)	(‐0.31–0.23)	(239–354)	(5.28–7.58)	(262–519)	(4.56–8.78)	(‐0.26–0.36)
Thailand	0.687	17 710	24.56	22 545	22.24	‐0.09	11 686	35.60	14 701	31.98	‐0.10	6023	15.44	7845	14.17	‐0.08
		(15 447–19 944)	(21.44–27.57)	(17 018–29 560)	(16.78–29.04)	(‐0.33–0.2)	(9968–13 420)	(30.55–40.69)	(10 810–19 418)	(23.67–42.06)	(‐0.34–0.23)	(5229–6868)	(13.37–17.66)	(5967–10 297)	(10.77–18.62)	(‐0.33–0.22)
Turkmenistan	0.67	262	8.51	413	9.90	0.16	197	14.51	311	16.65	0.15	66	3.86	102	4.57	0.19
		(248–276)	(8.04–8.97)	(326–521)	(7.84–12.37)	(‐0.08–0.46)	(184–209)	(13.58–15.43)	(242–395)	(13.16–20.87)	(‐0.1–0.44)	(59–72)	(3.49–4.27)	(79–130)	(3.56–5.83)	(‐0.06–0.48)
Uzbekistan	0.631	1825	11.77	2771	12.67	0.08	1333	19.63	1992	20.46	0.04	493	5.81	779	6.73	0.16
		(1741–1915)	(11.25–12.31)	(2282–3324)	(10.65–14.92)	(‐0.1–0.27)	(1253–1414)	(18.57–20.78)	(1620–2421)	(17.03–24.28)	(‐0.14–0.24)	(464–523)	(5.47–6.2)	(638–942)	(5.58–7.99)	(‐0.04–0.39)
Vietnam	0.617	17 235	24.83	25 550	26.72	0.08	12 590	42.65	18 528	44.80	0.05	4645	11.81	7022	13.29	0.13
		(15 159–19 723)	(22.04–28.24)	(19 741–32 387)	(20.83–33.51)	(‐0.13–0.3)	(11 087–14 260)	(38.09–47.93)	(14 064–23 736)	(34.83–56.18)	(‐0.15–0.28)	(3843–5618)	(9.79–14.37)	(5269–9137)	(9.98–17.24)	(‐0.12–0.41)
Low‐middle SDI
Bangladesh	0.483	6566	7.64	9652	7.43	‐0.03	5397	11.69	7502	11.08	‐0.05	1169	2.90	2150	3.43	0.18
		(4863–8976)	(5.7–10.28)	(6331–15 120)	(4.91–11.56)	(‐0.28–0.27)	(3987–7425)	(8.74–15.83)	(4817–12 048)	(7.15–17.71)	(‐0.33–0.26)	(801–1657)	(1.97–4.14)	(1422–3061)	(2.26–4.91)	(‐0.09–0.49)
Bhutan	0.455	32	7.24	43	7.73	0.07	24	10.64	31	11.08	0.04	8	3.61	12	4.25	0.18
		(24–41)	(5.44–9.48)	(31–58)	(5.57–10.59)	(‐0.11–0.28)	(16–32)	(7.04–14.45)	(20–44)	(7.06–15.83)	(‐0.14–0.25)	(5–13)	(2.36–6.02)	(8–18)	(2.88–6.69)	(‐0.04–0.47)
Cambodia	0.469	1943	23.27	2888	24.71	0.06	1444	42.72	2091	44.38	0.04	499	10.00	796	11.58	0.16
		(1615–2410)	(19.41–29.44)	(2267–3576)	(19.4–30.59)	(‐0.12–0.26)	(1172–1852)	(34.7–55.69)	(1607–2668)	(34.42–57.78)	(‐0.14–0.24)	(408–613)	(8.27–12.25)	(609–1018)	(8.95–14.76)	(‐0.06–0.41)
Democratic People's Republic of Korea	0.558	7716	28.48	9042	27.88	‐0.02	5232	49.12	6058	45.66	‐0.07	2484	15.64	2984	15.88	0.02
		(5937–9904)	(22.28–36.22)	(7008–11 461)	(21.77–35.2)	(‐0.17–0.14)	(3767–7144)	(36.39–65.33)	(4408–8117)	(33.78–59.94)	(‐0.21–0.1)	(1904–3102)	(12.08–19.45)	(2144–3880)	(11.37–20.73)	(‐0.19–0.24)
India	0.566	58 555	6.95	87 339	7.70	0.11	44 441	10.80	61 253	11.16	0.03	14 113	3.30	26 086	4.49	0.36
		(53 880–63 454)	(6.38–7.52)	(71 865–103 504)	(6.36–9.1)	(‐0.09–0.31)	(40 224–48 717)	(9.74–11.84)	(48 085–75 929)	(8.8–13.74)	(‐0.19–0.27)	(12 387–15 766)	(2.88–3.7)	(20 315–32 542)	(3.51–5.59)	(0.06–0.71)
Kyrgyzstan	0.596	464	13.08	569	12.20	0.01	358	23.41	430	21.29	‐0.09	106	5.22	139	5.37	0.03
		(444–483)	(12.5–13.63)	(493–647)	(10.62–13.86)	(‐0.19–0.27)	(340–374)	(22.28–24.5)	(371–492)	(18.45–24.33)	(‐0.21–0.04)	(99–113)	(4.85–5.59)	(115–164)	(4.47–6.31)	(‐0.14–0.21)
Lao People's Democratic Republic	0.49	714	22.07	973	22.78	0.01	539	35.53	713	35.30	‐0.01	174	10.05	260	11.45	0.14
		(549–920)	(17.04–28.22)	(718–1264)	(17.04–29.01)	(‐0.17–0.22)	(402–723)	(26.79–47.27)	(519–923)	(26.3–44.79)	(‐0.2–0.22)	(134–247)	(7.83–14.21)	(186–372)	(8.37–16.54)	(‐0.09–0.41)
Maldives	0.562	18	9.88	26	9.58	‐0.02	14	14.24	20	13.74	‐0.04	4	4.54	6	4.83	0.06
		(16–20)	(8.82–11.02)	(22–32)	(7.88–11.42)	(‐0.17–0.14)	(12–16)	(12.47–16.19)	(17–24)	(11.12–16.56)	(‐0.22–0.18)	(3–4)	(3.88–5.24)	(5–8)	(3.86–5.91)	(‐0.14–0.31)
Mongolia	0.606	436	30.80	662	31.19	‐0.07	342	56.92	521	58.13	0.02	94	12.49	141	12.53	0.00
		(360–520)	(25.83–36.06)	(512–863)	(24.67–39.68)	(‐0.27–0.16)	(280–412)	(47.51–67.06)	(391–686)	(44.99–74.31)	(‐0.21–0.29)	(77–115)	(10.34–15.05)	(109–182)	(9.93–15.84)	(‐0.22–0.28)
Myanmar	0.521	7977	22.49	10 291	22.43	‐0.03	5560	35.70	6983	35.42	‐0.01	2417	12.20	3308	12.78	0.05
		(5874–11 118)	(16.61–31.11)	(7608–14 071)	(16.85–30.17)	(‐0.2–0.17)	(3740–8705)	(24.28–55.37)	(4957–10 306)	(25.24–51.86)	(‐0.2–0.23)	(1893–3145)	(9.51–16.02)	(2559–4360)	(9.87–16.75)	(‐0.13–0.27)
Palestine	0.588	318	19.25	523	22.53	‐0.05	252	34.39	410	38.02	0.11	66	7.17	113	9.15	0.27
		(288–348)	(17.43–21.05)	(444–613)	(19.09–26.1)	(‐0.28–0.27)	(226–280)	(30.8–38.2)	(349–478)	(32.52–43.98)	(‐0.09–0.32)	(59–76)	(6.29–8.2)	(92–137)	(7.46–10.99)	(0.01–0.59)
Tajikistan	0.539	481	12.86	593	11.98	‐0.07	355	19.54	411	17.78	‐0.09	125	6.50	182	6.80	0.05
		(415–555)	(11.02–14.91)	(479–740)	(9.76–14.83)	(‐0.27–0.17)	(300–416)	(16.35–22.98)	(323–527)	(14.3–22.37)	(‐0.29–0.16)	(108–145)	(5.59–7.55)	(146–229)	(5.48–8.49)	(‐0.18–0.32)
Timor‐Leste	0.514	108	17.36	158	19.48	0.12	79	25.16	113	28.08	0.12	30	9.47	46	11.12	0.17
		(77–142)	(12.32–22.53)	(113–207)	(13.86–25.27)	(‐0.12–0.39)	(52–105)	(16.6–33.1)	(75–148)	(18.7–36.55)	(‐0.13–0.41)	(22–47)	(7.2–15.05)	(32–66)	(7.93–15.99)	(‐0.11–0.49)
Low SDI
Afghanistan	0.343	1102	11.67	1476	11.74	0.01	873	19.77	1111	19.22	‐0.03	229	4.29	365	5.10	0.19
		(622–1880)	(6.83–19.97)	(871–2335)	(7.33–18.53)	(‐0.17–0.27)	(458–1626)	(10.56–36.59)	(618–1928)	(11.28–33.01)	(‐0.2–0.24)	(158–330)	(3.13–6.1)	(237–524)	(3.62–7.06)	(‐0.08–0.53)
Nepal	0.422	1176	7.04	1759	8.03	0.00	839	10.15	1202	11.51	0.13	337	3.97	557	4.84	0.22
		(862–1552)	(5.13–9.3)	(1263–2275)	(5.86–10.37)	(‐0.18–0.22)	(619–1110)	(7.53–13.39)	(873–1535)	(8.4–14.59)	(‐0.12–0.39)	(212–508)	(2.46–6.09)	(371–803)	(3.22–7.03)	(‐0.04–0.57)
Pakistan	0.449	14 621	17.38	18 401	16.43	‐0.18	12 630	28.75	15 424	26.67	‐0.07	1991	4.94	2978	5.50	0.11
		(11 540–18 092)	(13.79–21.4)	(13 970–24 265)	(12.47–21.49)	(‐0.32–0.02)	(9607–16 079)	(22.1–36.25)	(11 224–21 011)	(19.52–36.05)	(‐0.34–0.29)	(1564–2433)	(3.86–6)	(2160–3927)	(4.05–7.16)	(‐0.17–0.5)
Yemen	0.412	952	10.13	1302	9.95	‐0.02	766	16.44	1014	15.94	‐0.03	186	3.83	289	4.15	0.09
		(684–1373)	(7.29–14.61)	(885–1930)	(6.8–14.67)	(‐0.21–0.21)	(532–1136)	(11.48–24.16)	(658–1601)	(10.39–24.91)	(‐0.24–0.21)	(141–250)	(2.9–5.03)	(212–391)	(3.11–5.57)	(‐0.21–0.36)

Abbreviations: CI, confidence interval; SDI, sociodemographic index; TBL, tracheal, bronchial and lung.

National comparison

Among Asian countries, 20 countries experienced an increasing trend in the TBL cancer morbidity rate between 2010 and 2019; the greatest increase was detected in Iraq (increase in ASIR = 0.21 [95% CI: 0–0.46]) and the greatest decrease was detected in the United Arab Emirates (decrease in ASIR = −0.18 [95% CI: −0.37–0.06]) (Figure 4).

FIGURE 4.

The relative change (%) in age‐standardized incidence rate (ASIR), age‐standardized death rate (ASMR), age‐standardized DALYs rate (DALYs ASR), and age‐standardized prevalence rate (ASPR) of TBL cancer in Asian countries from 1990 to 2019.

In 2019, the highest ASIR (per 100 000) of TBL cancer was reported in Brunei Darussalam (46.15), China (41.71), the Republic of Korea (35.61), Turkey (33.08), and Taiwan (Province of China) (31.88). The lowest ASIR of TBL cancer was reported in Bangladesh (7.43), India (7.7), Bhutan (7.73), Nepal (8.03), and Saudi Arabia (8.77). The national distribution of TBL cancer among men and women was the same as the overall distribution; however, men in Georgia had the highest ASIR rate (62.13). Detailed results are presented in Table 4.

Mortality of TBL cancer in Asia

Compared with global data and continents

In Asia, the number of TBL cancer deaths increased from 906 650 (95% CI: 846 561–964 850) in 2010 to 1 190 516 (95% CI: 1 052 836–1 330 529) in 2019, which is over a 1.31‐fold increase. In 2019 more than 58% (1 190 516/2 042 640) of TBL cancer deaths happened in Asian countries. During this period, the ASDR of TBL cancer with a 3% change, decreased from 26.66 (95% CI: 24.77–28.33) per 100 000 in 2010 to 25.76 (95% CI: 22.79–28.72) per 100 000 in 2019, while in the same time, this rate globally decreased by 6%, in America by 10%, and in Europe by 8% (Figure 1 and Table 1).

In Asian men, the number of TBL cancer deaths increased from 646 099 (95% CI: 599 147–694 710) in 2010 to 825 738 (95% CI: 706 207–949 796) in 2019, which is over a 1.28‐fold increase. In 2019 approximately 69.4% of Asian TBL cancer deaths occurred in Asian men which included 60% (825 738/1 386 094) of global male TBL cancer death cases. During this period, the ASDR of TBL cancer with a 6% change, decreased from 40.66 (95% CI: 37.75–43.57) per 100 000 in 2010 to 38.3 (95% CI: 33–43.79) per 100 000 in 2019, while in the same time, this rate globally decreased by 9%, in America by 12% and in Europe by 13% (Table 2).

In Asian women, the number of TBL cancer deaths increased from 260 550 (95% CI: 238 233–282 526) in 2010 to 364 778 (95% CI: 312 089–421 085) in 2019, which is over a 1.4‐fold increase. In 2019 approximately 30.6% of Asian TBL cancer deaths occurred in Asian women which included 55.6% (364 778 /656 546) of global female TBL cancer incidence cases. During this period, the age‐standardized incidence rate (ASIR) of TBL cancer with a 2% change, increased from 14.67 (95% CI: 13.35–15.92) per 100 000 in 2010 to 14.98 (95% CI: 12.81–17.27) per 100 000 in 2019, while in the same time, this rate globally experienced no changes, in Africa increased by 12%, and in Europe by 2%; while in American countries decreased by 8% (Table 3).

Age distribution

In 2019, age‐specific death cases of TBL cancer were peaking at 70–74 years generally, in males, and females. In all age groups, death cases of TBL cancer in males were higher than in females, except in ages above 90 years which in females was higher (Figure 5).

FIGURE 5.

Age specific death cases of TBL cancer among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest ASDR of TBL was observed in East Asian countries (38.38 [95% CI: 32.72–44.57]); with a 4% decrease compared with 2010. While the Central Asia and high‐income Asia Pacific countries experienced a decreasing trend of 7% and 11%, respectively; the South Asian countries experienced the highest increasing trend from 2010 to 2019 (by 6%) (Figure 3 and Table 1).

In men, the highest ASDR of TBL was observed in East Asia countries (57.5 [95% CI: 46.25–69.74]); with a 5% decrease compared with 2010. While Central Asia, High‐income Asia Pacific, North Africa and Middle East countries experienced a decreasing trend of 9, 15, and 3%, respectively; the South Asian and Southeast Asian countries experienced a stable trend from 2010 to 2019 (Table 2).

In women, the highest ASDR of TBL was observed in Southeast Asian countries (13.36 [95% CI: 10.19–16.57]) in 2019; other countries experienced an increasing trend from 2010 to 2019, except high‐income Asia Pacific countries who experienced a decreasing trend by 3% from 2010 to 2019 and East Asia experienced a stable trend. Other countries experienced an increasing trend from 2% to 31%. South Asian countries experienced the highest increasing trend from 2010 to 2019 (by 31%) (Table 3).

Based on SDI

Among high SDI Asian countries, Brunei Darussalam (44.83) and Taiwan (Province of China) (30.35) had the highest ASDR of TBL, and Saudi Arabia (9.14) had the lowest rate. Among high‐middle SDI Asian countries, Turkey (33.77) and Georgia (30.57) had the highest ASDR of TBL, and Sri Lanka (9.78) had the lowest rate. Among middle SDI Asian countries, China (38.70) and Armenia (31.62) had the highest ASIR of TBL, and Turkmenistan (9.86) had the lowest rate. Among low‐middle SDI Asian countries, Mongolia (33.35) and the Democratic People's Republic of Korea (28.54) had the highest ASDR of TBL, and Bangladesh (7.81) had the lowest rate. Among low SDI Asian countries, Pakistan (17.16) had the highest ASDR of TBL, and Nepal (8.62) had the lowest rate. Further details are presented in Table 5.

TABLE 5.

The death distribution of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

		Both					Male					Female
Location	SDI 2019	2010		2019		% change 2010–2010	2010		2019		% change 2010–2019	2010		2019		% change 2010–2019
		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	number	ASR per 100 000
		(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
High SDI
Brunei Darussalam	0.823	69	45.89	103	44.83	‐0.02	39	60.935874	57	61.11	0.00	30	35.25	47	5.76	0.02
		(63–76)	(41.83–49.96)	(92–116)	(39.66–50.19)	(‐0.14–0.11)	(35–44)	(53.69–68.48)	(47–67)	(51.96–71.14)	(‐0.16–0.18)	(27–33)	(31.44–39.05)	(40–54)	(4.23–7.59)	(‐0.13–0.2)
Cyprus	0.841	362	25.56	462	23.42	‐0.08	283	44.832451	358	38.37	‐0.14	79	10.36	104	11.76	‐0.01
		(340–385)	(24–27.22)	(404–525)	(20.52–26.63)	(‐0.21–0.05)	(264–305)	(41.76–48.26)	(309–412)	(33.08–44.39)	(‐0.27–0)	(71–87)	(9.4–11.38)	(88–121)	(8.38–16.83)	(‐0.17–0.13)
Israel	0.803	2084	23.74	2518	21.69	‐0.09	1391	35.486246	1651	31.35	‐0.12	692	14.02	867	13.53	‐0.04
		(1963–2166)	(22.44–24.64)	(2314–2684)	(20.04–23.1)	(‐0.14–‐0.03)	(1320–1451)	(33.69–37)	(1526–1769)	(29.01–33.63)	(‐0.17–‐0.05)	(633–735)	(12.95–14.82)	(769–953)	(10.5–17.71)	(‐0.12–0.04)
Japan	0.87	77 446	23.94	86 001	21.21	‐0.11	55 542	41.086896	59 128	34.43	‐0.16	21 904	11.34	26 873	13.46	‐0.04
		(68 445–82 060)	(21.57–25.15)	(73 379–92 677)	(18.86–22.52)	(‐0.14–‐0.09)	(50 829–57 902)	(37.63–42.84)	(52 951–62 882)	(31.29–36.42)	(‐0.19–‐0.14)	(17 457–24 307)	(9.57–12.3)	(20 579–30 319)	(10.15–17.38)	(‐0.07–0)
Kuwait	0.851	133	10.71	228	10.75	0.00	104	13.622346	181	14.51	0.07	29	5.86	47	7.64	‐0.15
		(123–142)	(9.82–11.46)	(185–275)	(8.72–12.98)	(‐0.18–0.21)	(95–112)	(12.47–14.67)	(140–225)	(11.28–18.13)	(‐0.16–0.34)	(26–32)	(5.19–6.45)	(37–59)	(6.43–8.89)	(‐0.32–0.04)
Qatar	0.83	66	23.82	119	20.74	‐0.13	56	28.944687	101	23.78	‐0.18	10	12.55	18	6.89	‐0.06
		(53–81)	(19.57–28.75)	(85–165)	(16–26.07)	(‐0.32–0.11)	(44–71)	(23.08–35.69)	(70–144)	(18.07–30.42)	(‐0.39–0.1)	(8–12)	(10.07–15.24)	(14–23)	(5.75–8.14)	(‐0.24–0.16)
Republic of Korea	0.878	17 173	28.48	23 300	26.30	‐0.08	12 516	51.709606	16 614	44.73	‐0.13	4658	13.36	6686	5.07	‐0.02
		(16 151–18 288)	(26.55–30.46)	(20 864–25 565)	(23.51–28.95)	(‐0.15–0)	(11 907–13 376)	(48.53–55.26)	(14 800–18 406)	(39.53–49.69)	(‐0.22–‐0.04)	(4138–5002)	(11.84–14.43)	(5681–7580)	(4.04–6.2)	(‐0.12–0.09)
Saudi Arabia	0.805	1026	9.67	1492	9.14	‐0.05	779	13.087167	1110	11.67	‐0.11	247	5.16	382	16.51	0.03
		(911–1186)	(8.74–10.97)	(1146–1830)	(7.33–11.06)	(‐0.23–0.13)	(692–914)	(11.82–15.09)	(842–1380)	(9.15–14.5)	(‐0.29–0.1)	(215–283)	(4.51–5.86)	(286–493)	(12.14–22.82)	(‐0.21–0.29)
Singapore	0.861	1180	25.62	1566	20.89	‐0.18	779	38.33246	1010	29.36	‐0.23	401	15.82	556	12.13	‐0.12
		(1106–1228)	(23.72–26.8)	(1414–1682)	(18.7–22.48)	(‐0.24–‐0.13)	(736–812)	(35.88–40.11)	(915–1087)	(26.4–31.74)	(‐0.3–‐0.18)	(363–430)	(14.22–16.98)	(476–621)	(9.35–15.37)	(‐0.21–‐0.03)
Taiwan (Province of China)	0.868	9477	31.76	12 053	30.35	‐0.04	6275	43.334223	7526	41.31	‐0.05	3201	20.89	4527	5.15	0.01
		(8860–9886)	(29.66–33.13)	(9527–15 345)	(24.07–38.58)	(‐0.24–0.21)	(5890–6556)	(40.7–45.28)	(5915–9577)	(32.49–52.51)	(‐0.25–0.21)	(2911–3386)	(18.96–22.13)	(3521–5766)	(3.38–7.58)	(‐0.2–0.29)
United Arab Emirates	0.88	221	25.27	523	20.35	‐0.19	172	28.051538	423	23.74	‐0.15	49	20.31	100	13.55	‐0.33
		(177–267)	(20.93–29.73)	(380–697)	(14.71–28.22)	(‐0.38–0.06)	(136–211)	(22.57–34.14)	(303–580)	(17.44–32.88)	(‐0.33–0.09)	(38–60)	(16.3–24.84)	(66–135)	(7.93–20.63)	(‐0.6–0.08)
High‐middle SDI
Bahrain	0.751	86	27.19	142	22.08	‐0.19	64	39.55	106	30.42	‐0.23	22	15.08	35	10.91	‐0.14
		(76–97)	(24–30.54)	(107–187)	(17.07–27.74)	(‐0.36–0.01)	(55–74)	(34.23–45.28)	(78–144)	(22.96–39.13)	(‐0.41–0)	(19–26)	(13.06–17.35)	(28–43)	(9.02–12)	(‐0.3–0.04)
Georgia	0.702	1659	28.83	1770	30.57	0.06	1392	57.63	1496	61.47	0.07	267	7.74	274	12.19	0.03
		(1512–1806)	(26.19–31.44)	(1485–2080)	(25.58–36.05)	(‐0.13–0.28)	(1248–1533)	(51.79–63.61)	(1241–1764)	(51.26–72.48)	(‐0.13–0.29)	(242–293)	(7.01–8.52)	(230–329)	(9.55–15.44)	(‐0.17–0.25)
Jordan	0.731	492	16.12	917	15.11	‐0.06	394	24.90	711	22.35	‐0.10	98	6.54	206	7.21	0.10
		(437–554)	(14.4–18.16)	(749–1110)	(12.47–18.25)	(‐0.24–0.14)	(347–451)	(21.91–28.36)	(551–897)	(17.53–27.92)	(‐0.3–0.13)	(84–113)	(5.61–7.63)	(163–261)	(5.7–9.09)	(‐0.12–0.4)
Kazakhstan	0.723	3707	26.06	3717	21.14	‐0.19	3023	53.60	2949	41.77	‐0.22	684	8.18	768	9.16	‐0.07
		(3528–3903)	(24.81–27.42)	(3184–4261)	(18.19–24.13)	(‐0.31–‐0.06)	(2849–3222)	(50.5–56.9)	(2501–3441)	(35.55–48.3)	(‐0.34–‐0.09)	(644–724)	(7.72–8.65)	(646–894)	(7.1–11.7)	(‐0.22–0.1)
Lebanon	0.708	1233	28.99	1433	27.51	‐0.05	901	43.86	961	40.95	‐0.07	332	15.21	472	13.69	0.09
		(1055–1587)	(24.77–37.45)	(1184–1898)	(22.67–36.43)	(‐0.19–0.1)	(750–1179)	(36.6–57.8)	(768–1281)	(32.73–54.66)	(‐0.21–0.11)	(278–431)	(12.73–19.7)	(347–656)	(10.94–17.28)	(‐0.17–0.3)
Malaysia	0.737	3987	22.70	5221	20.60	‐0.09	2788	32.03	3689	29.23	‐0.09	1199	13.73	1532	12.07	‐0.12
		(3634–4394)	(20.65–25.05)	(4060–6639)	(16.01–25.95)	(‐0.29–0.13)	(2532–3082)	(28.86–35.47)	(2834–4679)	(22.62–37.18)	(‐0.29–0.15)	(1085–1335)	(12.35–15.43)	(1177–1946)	(8.92–17.44)	(‐0.31–0.1)
Oman	0.783	120	12.61	144	10.45	‐0.17	90	17.49	103	14.17	‐0.19	30	6.91	42	13.13	‐0.04
		(109–131)	(11.49–13.75)	(115–187)	(8.67–12.59)	(‐0.31–0.02)	(81–100)	(15.76–19.37)	(77–143)	(11.41–18.04)	(‐0.36–0.04)	(26–34)	(5.96–7.91)	(30–50)	(11.21–14.86)	(‐0.26–0.15)
Sri Lanka	0.69	1958	10.37	2478	9.78	‐0.06	1438	16.86	1704	15.17	‐0.10	520	5.14	774	11.80	0.08
		(1845–2082)	(9.75–11.02)	(1804–3369)	(7.17–13.16)	(‐0.3–0.26)	(1329–1540)	(15.56–18.17)	(1181–2405)	(10.71–20.97)	(‐0.36–0.25)	(475–570)	(4.7–5.64)	(570–1018)	(9.31–14.65)	(‐0.2–0.4)
Turkey	0.748	23 677	35.27	29 832	33.77	‐0.04	20 121	64.00	24 781	59.69	‐0.07	3556	10.04	5051	6.60	0.09
		(20 919–26 663)	(31.17–39.67)	(23 752–37 028)	(26.89–41.8)	(‐0.25–0.23)	(17 682–22 813)	(56.28–72.42)	(19 591–30 951)	(47.29–74.06)	(‐0.28–0.21)	(3109–4051)	(8.77–11.45)	(4027–6271)	(4.98–7.96)	(‐0.15–0.39)
Middle SDI
Armenia	0.689	1318	35.17	1334	31.62	‐0.10	1084	68.17	1091	60.65	‐0.11	234	10.84	243	13.41	‐0.06
		(1259–1380)	(33.7–36.83)	(1122–1578)	(26.67–37.28)	(‐0.24–0.06)	(1035–1140)	(65.21–71.66)	(916–1296)	(51.04–71.69)	(‐0.25–0.05)	(219–249)	(10.16–11.57)	(202–285)	(11.96–14.7)	(‐0.22–0.12)
Azerbaijan	0.683	1718	23.64	2296	23.58	0.00	1376	41.67	1852	41.55	0.00	342	8.96	444	5.58	0.02
		(1462–1949)	(20.17–26.79)	(1687–2921)	(17.54–29.65)	(‐0.19–0.22)	(1123–1599)	(34.32–48.26)	(1253–2449)	(28.54–53.95)	(‐0.23–0.27)	(295–398)	(7.6–10.43)	(346–567)	(4.12–7.34)	(‐0.18–0.27)
China	0.686	576 914	40.32	757 171	38.70	‐0.04	407 013	61.44	523 192	58.10	‐0.05	169 901	22.95	233 980	13.86	0.00
		(525 378–627 888)	(36.72–43.74)	(638 741–887 752)	(32.8–45.03)	(‐0.2–0.14)	(364 221–453 597)	(55.4–67.89)	(413 189–647 410)	(46.53–70.89)	(‐0.25–0.18)	(151 510–187 913)	(20.52–25.38)	(189 176–282 754)	(11.9–15.47)	(‐0.21–0.23)
Indonesia	0.66	35 895	22.85	49 437	24.43	0.07	24 808	34.01	33 792	35.81	0.05	11 086	13.29	15 645	3.62	0.11
		(29 166–41 844)	(18.64–26.48)	(36 066–61 105)	(17.87–30.22)	(‐0.12–0.25)	(20 169–30 290)	(28.07–40.5)	(24 844–44 220)	(27.13–45.72)	(‐0.18–0.34)	(6893–15 503)	(8.37–18.31)	(8696–23 612)	(2.36–5.2)	(‐0.13–0.37)
Iran (Islamic Republic of)	0.67	5820	11.43	8923	12.88	0.13	4251	16.54	6155	17.78	0.07	1569	6.19	2768	10.93	0.30
		(5524–6094)	(10.75–11.99)	(8247–9595)	(11.86–13.89)	(0.06–0.21)	(4013–4451)	(15.54–17.35)	(5636–6725)	(16.23–19.41)	(0–0.16)	(1478–1653)	(5.77–6.54)	(2488–3018)	(8.44–13.91)	(0.16–0.42)
Iraq	0.671	2439	16.40	4232	19.86	0.21	1862	26.22	3106	30.87	0.18	577	7.29	1125	16.34	0.36
		(1919–2991)	(13.04–19.86)	(3275–5190)	(15.62–23.82)	(0.01–0.46)	(1430–2338)	(20.5–32.43)	(2375–3782)	(24.16–36.78)	(‐0.03–0.46)	(441–738)	(5.65–9.2)	(861–1428)	(11.79–21.14)	(0.08–0.74)
Philippines	0.623	10 071	18.10	13 964	18.47	0.02	7292	28.64	9574	27.81	‐0.03	2779	9.40	4391	36.09	0.16
		(9171–11 304)	(16.52–20.33)	(11 342–17 103)	(15.13–22.39)	(‐0.18–0.24)	(6473–8370)	(25.5–32.82)	(7259–12 342)	(21.32–35.44)	(‐0.26–0.25)	(2482–3134)	(8.41–10.6)	(3359–5627)	(30.48–41.95)	(‐0.13–0.53)
Syrian Arab Republic	0.619	1163	12.34	1374	11.62	‐0.06	883	17.36	1007	16.16	‐0.07	280	6.69	368	5.33	0.02
		(951–1394)	(10.22–14.66)	(1011–1813)	(8.7–15.09)	(‐0.28–0.2)	(713–1080)	(14.13–21.12)	(735–1330)	(11.92–21.03)	(‐0.31–0.22)	(229–337)	(5.52–7.91)	(251–496)	(3.89–7.3)	(‐0.26–0.33)
Thailand	0.687	18 077	25.63	23 109	22.96	‐0.10	11 877	37.26	14 984	33.14	‐0.11	6200	16.16	8125	4.70	‐0.09
		(15 773–20 299)	(22.28–28.73)	(17 523–30 148)	(17.39–29.79)	(‐0.33–0.18)	(10 169–13 616)	(31.81–42.52)	(11 049–19 714)	(24.72–43.49)	(‐0.35–0.21)	(5362–7096)	(13.93–18.5)	(6109–10 606)	(3.69–5.87)	(‐0.33–0.2)
Turkmenistan	0.67	255	8.52	399	9.86	0.16	191	14.68	300	16.74	0.14	64	3.88	99	9.30	0.17
		(242–268)	(8.04–8.99)	(316–504)	(7.82–12.24)	(‐0.08–0.45)	(179–203)	(13.73–15.6)	(234–380)	(13.32–20.9)	(‐0.1–0.43)	(58–71)	(3.5–4.29)	(77–126)	(7.6–11.15)	(‐0.07–0.47)
Uzbekistan	0.631	1777	12.10	2656	12.93	0.07	1299	20.34	1912	20.99	0.03	479	6.03	744	4.34	0.14
		(1697–1861)	(11.6–12.67)	(2189–3179)	(10.95–15.15)	(‐0.1–0.26)	(1220–1375)	(19.23–21.51)	(1564–2316)	(17.52–24.9)	(‐0.15–0.23)	(451–508)	(5.67–6.43)	(612–898)	(3.25–5.81)	(‐0.05–0.37)
Vietnam	0.617	17 351	25.40	25 161	26.98	0.06	12 611	44.08	18 151	45.80	0.04	4741	12.13	7010	5.31	0.11
		(15 352–19 780)	(22.5–28.76)	(19 494–31 704)	(21.12–33.59)	(‐0.14–0.28)	(11 157–14 257)	(39.47–49.43)	(13 927–23 007)	(35.79–57.02)	(‐0.16–0.25)	(3943–5695)	(10.14–14.62)	(5288–9118)	(4.06–6.69)	(‐0.13–0.38)
Low‐middle SDI
Bangladesh	0.483	6743	8.11	9970	7.81	‐0.04	5553	12.39	7765	11.63	‐0.06	1190	3.09	2206	10.23	0.17
		(5015–9167)	(6.03–10.91)	(6569–15 550)	(5.19–12.13)	(‐0.29–0.26)	(4139–7591)	(9.3–16.69)	(5023–12 476)	(7.59–18.55)	(‐0.34–0.26)	(810–1679)	(2.07–4.43)	(1454–3162)	(8.52–12.03)	(‐0.09–0.46)
Bhutan	0.455	33	7.75	44	8.26	0.07	25	11.44	33	11.87	0.04	8	3.84	12	8.03	0.17
		(25–43)	(5.8–10.14)	(32–61)	(5.99–11.35)	(‐0.11–0.27)	(17–34)	(7.51–15.45)	(21–46)	(7.58–16.84)	(‐0.14–0.25)	(5–13)	(2.53–6.37)	(8–19)	(7.19–8.8)	(‐0.04–0.46)
Cambodia	0.469	2022	25.00	2985	26.38	0.05	1511	46.42	2169	47.99	0.03	510	10.54	816	9.90	0.16
		(1683–2527)	(20.87–31.72)	(2340–3699)	(20.84–32.64)	(‐0.12–0.25)	(1224–1953)	(37.87–61.36)	(1672–2792)	(37.23–62.64)	(‐0.14–0.24)	(420–626)	(8.75–12.92)	(629–1048)	(7.7–12.23)	(‐0.06–0.41)
Democratic People's Republic of Korea	0.558	7796	29.26	9163	28.54	‐0.02	5238	51.31	6072	47.49	‐0.07	2558	16.21	3091	7.96	0.01
		(6038–9952)	(23.13–36.87)	(7158–11 540)	(22.5–35.77)	(‐0.16–0.14)	(3795–7105)	(38.38–67.9)	(4439–8075)	(35.33–61.49)	(‐0.21–0.09)	(1988–3187)	(12.68–20.03)	(2235–3985)	(6.61–9.56)	(‐0.19–0.22)
India	0.566	59 637	7.31	89 242	8.07	0.10	45 272	11.38	62 544	11.73	0.03	14 365	3.47	26 698	22.86	0.35
		(55 118–64 928)	(6.72–7.96)	(73 675–105 403)	(6.65–9.49)	(‐0.09–0.3)	(40 946–50 024)	(10.27–12.56)	(49 134–76 427)	(9.25–14.32)	(‐0.19–0.27)	(12 383–16 094)	(2.97–3.93)	(20 990–33 532)	(18.52–27.52)	(0.04–0.7)
Kyrgyzstan	0.596	463	13.28	560	12.35	‐0.07	354	23.76	422	21.60	‐0.09	108	5.40	139	10.21	0.02
		(443–481)	(12.7–13.83)	(486–636)	(10.8–14.02)	(‐0.19–0.05)	(337–370)	(22.63–24.86)	(364–483)	(18.79–24.65)	(‐0.21–0.04)	(101–116)	(5.03–5.78)	(115–163)	(8.66–11.83)	(‐0.15–0.2)
Lao People's Democratic Republic	0.49	735	23.51	1000	24.28	0.03	558	38.21	736	37.99	‐0.01	177	10.56	264	4.55	0.14
		(567–944)	(18.32–29.96)	(742–1290)	(18.33–30.73)	(‐0.15–0.25)	(418–746)	(29.15–50.58)	(538–944)	(28.33–48.32)	(‐0.19–0.21)	(137–251)	(8.33–14.96)	(191–380)	(3.59–5.73)	(‐0.08–0.41)
Maldives	0.562	19	10.71	27	10.19	‐0.05	15	15.42	21	14.67	‐0.05	4	4.86	6	14.71	0.04
		(17–21)	(9.55–11.95)	(22–32)	(8.37–12.12)	(‐0.22–0.14)	(13–17)	(13.54–17.52)	(17–25)	(11.9–17.69)	(‐0.23–0.16)	(3–5)	(4.14–5.62)	(5–8)	(8.21–21.61)	(‐0.16–0.3)
Mongolia	0.606	444	32.91	672	33.35	0.01	346	61.58	525	62.75	0.02	98	13.68	146	14.65	0.00
		(368–528)	(27.71–38.32)	(523–869)	(26.47–41.97)	(‐0.19–0.25)	(284–415)	(51.74–72.13)	(397–686)	(49.16–79.39)	(‐0.2–0.28)	(81–120)	(11.37–16.36)	(114–188)	(11.02–19.14)	(‐0.21–0.26)
Myanmar	0.521	8280	23.93	10 614	23.80	‐0.01	5780	38.31	7195	37.84	‐0.01	2500	12.90	3419	7.07	0.05
		(6111–11 662)	(17.77–33.42)	(7896–14 368)	(17.76–31.88)	(‐0.17–0.22)	(3900–9101)	(25.96–59.89)	(5113–10 591)	(27.01–55.32)	(‐0.19–0.22)	(1957–3185)	(10.04–16.86)	(2644–4499)	(5.71–8.81)	(‐0.13–0.29)
Palestine	0.588	327	20.51	530	23.83	0.16	261	37.39	420	41.19	0.10	66	7.40	110	5.50	0.26
		(296–357)	(18.54–22.39)	(448–618)	(20.24–27.6)	(‐0.04–0.38)	(234–289)	(33.48–41.42)	(358–487)	(35.31–47.72)	(‐0.09–0.31)	(58–75)	(6.48–8.45)	(90–133)	(4.59–6.45)	(‐0.01–0.57)
Tajikistan	0.539	480	13.31	586	12.57	‐0.06	355	20.32	408	18.83	‐0.07	124	6.72	178	4.96	0.05
		(414–554)	(11.39–15.41)	(476–732)	(10.27–15.51)	(‐0.25–0.19)	(300–416)	(16.96–23.89)	(322–522)	(15.17–23.47)	(‐0.28–0.18)	(108–145)	(5.76–7.81)	(143–224)	(3.95–6.14)	(‐0.17–0.32)
Timor‐Leste	0.514	113	18.81	165	20.90	0.11	82	27.40	118	30.31	0.11	31	10.08	47	6.82	0.17
		(80–148)	(13.31–24.46)	(116–216)	(14.99–27.09)	(‐0.12–0.37)	(54–110)	(18.17–35.66)	(78–154)	(20.01–39.3)	(‐0.14–0.39)	(23–49)	(7.75–16.04)	(33–67)	(4.76–8.95)	(‐0.11–0.47)
Low SDI
Afghanistan	0.343	1136	12.46	1492	12.53	0.01	908	21.10	1133	20.59	‐0.02	228	4.48	359	13.04	0.19
		(652–1939)	(7.48–21.27)	(892–2356)	(7.99–19.7)	(‐0.17–0.27)	(482–1679)	(11.52–38.64)	(641–1954)	(12.25–34.99)	(‐0.19–0.24)	(160–326)	(3.3–6.35)	(238–512)	(10.45–15.76)	(‐0.08–0.53)
Nepal	0.422	1225	7.55	1837	8.62	0.14	878	10.95	1263	12.43	0.13	347	4.22	574	4.50	0.22
		(897–1614)	(5.5–9.99)	(1334–2371)	(6.31–11.18)	(‐0.1–0.4)	(647–1161)	(8.12–14.42)	(917–1608)	(9.07–15.75)	(‐0.12–0.39)	(217–528)	(2.6–6.55)	(382–830)	(3.1–7.16)	(‐0.05–0.58)
Pakistan	0.449	14 819	18.22	18 550	17.16	‐0.06	12 810	30.17	15 555	27.89	‐0.08	2009	5.18	2995	21.16	0.11
		(11 510–18 507)	(14.31–22.58)	(14 209–23 969)	(13.14–22.05)	(‐0.28–0.25)	(9608–16 488)	(22.98–38.53)	(11 375–20 942)	(20.64–37.13)	(‐0.33–0.27)	(1606–2463)	(4.14–6.31)	(2197–3983)	(16.49–27.08)	(‐0.16–0.49)
Yemen	0.412	979	10.80	1336	10.61	‐0.02	792	17.69	1047	17.12	‐0.03	187	4.01	289	10.90	0.08
		(703–1412)	(7.75–15.53)	(912–1972)	(7.26–15.61)	(‐0.21–0.21)	(552–1167)	(12.37–26.05)	(681–1639)	(11.19–26.67)	(‐0.24–0.21)	(142–251)	(3.03–5.36)	(214–390)	(8.71–13.53)	(‐0.21–0.35)

Abbreviations: CI, confidence interval; SDI, sociodemographic index; TBL, tracheal, bronchial and lung.

National comparison

Among Asian countries, 31 countries experienced a decreasing trend in the TBL cancer mortality rate between 2010 and 2019; the greatest increase was detected in Iraq (increase in ASDR = 0.21 [95% CI: 0.01–0.45]) and the greatest decrease was detected in the United Arab Emirates (decrease in ASDR = −0.18 [95% CI: −0.38–0.06]) (Figure 4).

In 2019, the highest ASDR (per 100 000) of TBL cancer was reported in Brunei Darussalam (44.83), China (38.7), Turkey (33.77), Mongolia (33.35), and Armenia (31.62). The lowest ASDR of TBL cancer was reported in Bangladesh (7.81), India (8.07), Bhutan (8.26), Nepal (8.62), and Saudi Arabia (9.14).

The national distribution of TBL cancer among men was the same as the overall distribution; however, men in Georgia had the second highest ASIR rate (61.47).

The national distribution of TBL cancer among women is different: the highest ASDR (per 100 000) of TBL cancer was reported in Brunei Darussalam (36.09), China (22.86), Taiwan (Province of China) (21.16), Lebanon (16.51), and Democratic People's Republic of Korea (16.34). The lowest ASDR (per 100 000) of TBL cancer was reported in Bangladesh (3.62), Yemen (4.34), Bhutan (4.5), Turkmenistan (4.55), and India (4.7). Detailed results are presented in Table 5.

Prevalence of TBL cancer in Asia

Compared with global data and continents

In Asia, the number of cases who lived with TBL cancer increased from 1 308 776 (95% CI: 1 225 459–1 392 332) in 2010 to 1 820 539 (95% CI: 1 605 530–2 034 496) in 2019, which is a 1.4‐fold increase. In 2019 approximately 57% (1 820 539/3 212 307) of TBL cancer prevalence happened in Asian countries. During this period, the ASPRof TBL cancer with a 4% change, increased from 36.35 (95% CI: 34.01–38.67) per 100 000 in 2010 to 37.81 (95% CI: 33.46–42.14) per 100 000 in 2019, while in the same time, this rate globally decreased by 2%, in America by 12%, and in Europe by 5% (Figure 1 and Table 1).

In Asian men, the number of TBL cancer prevalence increased from 928 147 (95% CI: 861 104–1 000 537) in 2010 to 1 257 715 (95% CI: 1 069 513–1 462 350) in 2019, which is over a 1.36‐fold increase. In 2019 approximately 69.1% of patients who lived with TBL cancer in Asia, were men which included 59.6% (1 257 715/2 109 409) of global male TBL cancer prevalence cases. During this period, the ASPR rate of TBL cancer with a 2% change, increased from 54.01 (95% CI: 50.08–58.12) per 100 000 in 2010 to 54.94 (95% CI: 46.96–63.32) per 100 000 in 2019, while in the same time, this rate globally decreased by 5%, in America by 11% and in Europe by 11% (Table 2).

In Asian women, the number of TBL cancer prevalence increased from 380 630 (95% CI: 349 763–411 327) in 2010 to 562 824 (95% CI: 480 164–653 889) in 2019, which is over a 1.48‐fold increase. In 2019 approximately 30.9% of patients who lived with TBL cancer in Asia, were women which included 51% (562 824/1 102 899) of global female TBL cancer prevalence cases. During this period, the ASPR of TBL cancer with a 10% change, increased from 20.43 (95% CI: 18.67–22.08) per 100 000 in 2010 to 22.49 (95% CI: 19.21–26.12) per 100 000 in 2019, while in the same time, this rate globally increased by 2%, in Africa by 14%, and in Europe by 5%; while in American countries decreased by 10% (Table 3).

Age distribution

In 2019, age‐specific prevalence cases of TBL cancer were peaking at 65–69 years generally, in males, and females. In all age groups, the prevalence cases of TBL cancer in males was higher than in females, except in ages above 95 years which in females was higher (Figure 6).

FIGURE 6.

Age specific prevalence cases of TBL cancer among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest ASPR of TBL was observed in high‐income Asia Pacific countries (74.32 [95% CI: 63.96–85.75]); with an 8% decrease compared with 2010. While these countries and Central Asia countries experienced a decreasing trend of 8% and 5%, respectively, other Asian countries experienced an increasing trend from 2010 to 2019 (by 3%–11%) (Figure 3).

In men, the highest ASPR of TBL was observed in High‐income Asia Pacific countries at (114.22 [95% CI: 95.69–135.71]); with an 11% decrease compared with 2010. While these countries, Central Asia, and North Africa and Middle East countries experienced a decreasing trend of 11, 7, and 3%, respectively, other Asian countries experienced an increasing trend from 2010 to 2019 (by 1%–9%) (Table 2).

In women, the highest ASPR of TBL was observed in high‐income Asia Pacific countries (40.86 [95% CI: 34.13–48.03]); with a 1% decrease compared with 2010. Other countries experienced an increasing trend from 2010 to 2019 (by 6%–33%). The highest increase was reported in South Asian countries (33%). (Table 3).

Based on SDI

Among high SDI Asian countries, the Republic of Korea (75.66) and Japan (74.49) had the highest ASPR of TBL, and Saudi Arabia (9.01) had the lowest rate. Among high‐middle SDI Asian countries, Turkey (34.95) and Georgia (34.83) had the highest ASPR of TBL, and Oman (9.74) had the lowest rate. Among middle SDI Asian countries, China (55.13) and Armenia (35.13) had the highest ASPR of TBL, and Turkmenistan (10.826) had the lowest rate. Among low‐middle SDI Asian countries, Mongolia (29.55) and the Democratic People's Republic of Korea (29.05) had the highest ASPR of TBL, and Bangladesh (7.40) had the lowest rate. Among low SDI Asian countries, Pakistan (16.44) had the highest ASPR of TBL, and Nepal (7.71) had the lowest rate. Further details are presented in Table 6.

TABLE 6.

The prevalence of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

		Both					Male					Female
		2010		2019		% change 2010‐2010	2010		2019		% change 2010‐2019	2010		2019		% change 2010‐2019
Location	SDI 2019	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
		(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
High SDI
Brunei Darussalam	0.823	99	52.20	159	54.57	0.05	53	64.12	82	66.37	0.04	46	43.65	355 552	47.91	0.10
		(91–109)	(47.58–57.25)	(139–180)	(48.21–61.68)	(‐0.1–0.2)	(47–60)	(56.81–72.81)	(67–100)	(54.72–78.31)	(‐0.15–0.25)	(41–52)	(38.22–49.32)	(283 761–437 708)	(40.23–56.75)	(‐0.1–0.33)
Cyprus	0.841	568	39.25	738	37.79	‐0.04	440	64.47	563	59.63	‐0.07	128	17.04	867	17.54	0.03
		(520–623)	(36.01–42.97)	(627–857)	(32.07–43.96)	(‐0.2–0.14)	(394–494)	(58.09–71.81)	(456–680)	(48.33–71.87)	(‐0.25–0.14)	(113–145)	(15.14–19.33)	(633–1147)	(14.41–21.44)	(‐0.17–0.26)
Israel	0.803	2759	32.41	3480	31.44	‐0.03	1838	46.97	2277	44.02	‐0.06	921	19.86	153	20.29	0.02
		(2606–2927)	(30.62–34.39)	(2683–4484)	(24.12–40.59)	(‐0.26–0.25)	(1713–1977)	(43.77–50.44)	(1720–2947)	(33.08–56.83)	(‐0.29–0.23)	(846–1000)	(18.28–21.62)	(127–182)	(15.57–26.04)	(‐0.21–0.31)
Japan	0.87	239 828	83.17	253 321	74.49	‐0.10	173 940	133.02	178 822	114.78	‐0.14	65 888	42.00	882	40.36	‐0.04
		(220 045–254 311)	(77.37–87.44)	(207 167–301 074)	(62.1–88.37)	(‐0.24–0.06)	(160 796–185 273)	(124.17–140.89)	(142 682–222 462)	(91.52–142.05)	(‐0.3–0.07)	(56 557–72 450)	(37.73–45.16)	(732–1039)	(32.04–49.65)	(‐0.21–0.17)
Kuwait	0.851	140	10.05	259	10.32	0.03	100	11.92	181	12.72	0.07	40	6.93	1882	6.63	‐0.04
		(130–149)	(9.28–10.72)	(216–310)	(8.46–12.42)	(‐0.15–0.23)	(92–107)	(10.92–12.79)	(139–227)	(9.79–15.96)	(‐0.17–0.34)	(36–44)	(6.21–7.7)	(1457–2409)	(5.22–8.49)	(‐0.25–0.21)
Qatar	0.83	83	20.42	153	17.54	‐0.14	68	23.84	120	18.97	‐0.20	15	13.06	74 499	13.47	0.03
		(67–102)	(16.78–24.68)	(107–213)	(13.23–22.69)	(‐0.36–0.14)	(52–86)	(18.86–29.61)	(81–174)	(14.08–25.29)	(‐0.43–0.09)	(12–19)	(10.4–16.04)	(56 948–92 097)	(10.35–16.86)	(‐0.19–0.28)
Republic of Korea	0.878	45 010	71.02	68 345	75.66	0.07	31 756	117.33	47 936	118.34	0.01	13 254	37.40	1203	41.95	0.12
		(40 638–50 489)	(64.09–79.28)	(55 468–83 426)	(61.36–92.07)	(‐0.14–0.31)	(27 724–36 550)	(102.56–134.48)	(37 412–60 031)	(92.79–148.38)	(‐0.21–0.29)	(11 604–15 012)	(32.83–42.09)	(927–1536)	(33.8–50.7)	(‐0.09–0.38)
Saudi Arabia	0.805	1156	8.97	1848	9.01	0.00	829	11.46	1239	10.62	‐0.07	327	5.54	609	6.53	0.18
		(1009–1359)	(8–10.18)	(1411–2305)	(7.13–10.91)	(‐0.2–0.21)	(725–981)	(10.24–13.39)	(928–1560)	(8.17–13.27)	(‐0.27–0.15)	(279–378)	(4.81–6.33)	(451–786)	(4.9–8.28)	(‐0.1–0.48)
Singapore	0.861	3245	65.18	4818	61.39	‐0.06	2022	88.58	2936	78.05	‐0.12	1223	46.20	2247	46.90	0.02
		(2924–3587)	(58.54–72.18)	(3741–6168)	(48.02–78.24)	(‐0.26–0.2)	(1770–2314)	(77.32–101.94)	(2193–3842)	(58.72–101.45)	(‐0.33–0.14)	(1077–1384)	(40.58–52.49)	(1497–3209)	(36.25–59.99)	(‐0.21–0.29)
Taiwan (Province of China)	0.868	14 224	46.92	16 026	40.73	‐0.13	8775	59.88	9654	52.09	‐0.13	5449	34.84	570	30.87	‐0.11
		(13 443–15 014)	(44.32–49.51)	(12 395–20 728)	(31.55–52.71)	(‐0.33–0.12)	(8230–9366)	(56.15–63.93)	(7375–12 486)	(39.87–66.95)	(‐0.34–0.13)	(4995–5896)	(31.93–37.68)	(382–817)	(24–40.24)	(‐0.31–0.15)
United Arab Emirates	0.88	260	20.24	627	16.87	‐0.17	199	22.15	492	19.03	‐0.14	61	16.86	283	12.51	‐0.26
		(207–314)	(16.69–24.01)	(454–835)	(12.24–23.29)	(‐0.36–0.08)	(155–246)	(17.66–26.99)	(349–669)	(13.97–26.33)	(‐0.32–0.1)	(47–75)	(13.48–20.84)	(233–340)	(7.54–18.28)	(‐0.54–0.13)
High‐middle SDI
Bahrain	0.751	90	21.50	155	18.01	‐0.16	64	29.29	109	22.56	‐0.23	26	13.50	1649	12.83	‐0.05
		(79–101)	(19.05–24.08)	(117–205)	(13.69–22.9)	(‐0.34–0.05)	(55–74)	(25.45–33.36)	(79–152)	(16.86–29.66)	(‐0.42–0.01)	(22–30)	(11.69–15.61)	(1254–2116)	(10.19–15.62)	(‐0.24–0.15)
Georgia	0.702	1802	32.75	1949	34.83	0.06	1527	63.97	1666	68.25	0.07	275	8.73	7808	8.96	0.03
		(1632–1969)	(29.65–35.86)	(1614–2329)	(28.85–41.54)	(‐0.14–0.3)	(1366–1689)	(57.15–70.75)	(1371–1996)	(56.18–81.57)	(‐0.14–0.31)	(248–306)	(7.86–9.71)	(5853–10 343)	(7.35–10.77)	(‐0.18–0.26)
Jordan	0.731	522	14.97	1015	14.58	‐0.03	400	22.53	743	20.51	‐0.09	121	6.87	210	8.08	0.17
		(464–584)	(13.37–16.75)	(836–1233)	(12.05–17.57)	(‐0.21–0.18)	(349–459)	(19.73–25.71)	(571–943)	(15.91–25.81)	(‐0.3–0.16)	(104–140)	(5.9–7.96)	(166–264)	(6.35–10.25)	(‐0.07–0.48)
Kazakhstan	0.723	4019	27.05	4337	23.34	‐0.14	3298	53.98	3455	44.44	‐0.18	721	8.37	406	8.47	0.01
		(3814–4251)	(25.66–28.49)	(3676–5019)	(19.84–26.85)	(‐0.27–0.01)	(3096–3536)	(50.82–57.63)	(2887–4068)	(37.5–51.78)	(‐0.31–‐0.04)	(681–768)	(7.92–8.91)	(252–594)	(7.05–9.98)	(‐0.17–0.2)
Lebanon	0.708	1221	28.93	1577	30.40	0.05	815	40.36	920	39.26	‐0.03	406	18.48	657	23.13	0.25
		(1045–1542)	(24.76–36.28)	(1266–2051)	(24.38–39.49)	(‐0.12–0.24)	(675–1052)	(33.56–52.1)	(725–1213)	(30.94–51.72)	(‐0.19–0.16)	(336–515)	(15.29–23.43)	(477–898)	(16.79–31.66)	(‐0.06–0.56)
Malaysia	0.737	4165	21.04	5544	20.20	‐0.04	2928	29.58	3896	28.42	‐0.04	1237	12.60	175	12.05	‐0.04
		(3815–4583)	(19.19–23.21)	(4258–7066)	(15.66–25.69)	(‐0.25–0.21)	(2660–3246)	(26.8–32.81)	(2979–4981)	(21.78–36.21)	(‐0.26–0.22)	(1118–1368)	(11.37–14.06)	(144–213)	(9.19–15.3)	(‐0.26–0.22)
Oman	0.783	130	11.80	169	9.74	‐0.17	92	15.11	109	11.68	‐0.23	38	7.78	315	7.77	0.00
		(118–143)	(10.72–12.89)	(132–224)	(7.92–12.01)	(‐0.33–0.04)	(83–102)	(13.61–16.82)	(80–160)	(9.06–15.5)	(‐0.4–0.04)	(34–44)	(6.74–8.9)	(226–432)	(5.74–9.33)	(‐0.25–0.24)
Sri Lanka	0.69	2170	10.63	2834	10.73	0.01	1604	17.10	1967	16.38	‐0.04	566	5.22	118	6.09	0.17
		(2037–2306)	(10–11.3)	(2039–3892)	(7.78–14.6)	(‐0.27–0.37)	(1481–1725)	(15.81–18.3)	(1359–2794)	(11.45–23.09)	(‐0.33–0.34)	(518–619)	(4.78–5.71)	(90–152)	(4.45–8.04)	(‐0.15–0.54)
Turkey	0.748	24 613	35.56	31 740	34.95	‐0.02	20 625	62.65	25 592	59.00	‐0.06	3988	11.01	76	13.07	0.19
		(21 619–27 940)	(31.23–40.27)	(25 031–39 550)	(27.58–43.51)	(‐0.24–0.29)	(18 045–23 490)	(54.81–71.26)	(20 163–32 173)	(46.56–73.95)	(‐0.27–0.24)	(3478–4545)	(9.61–12.58)	(62–92)	(10.33–16.36)	(‐0.08–0.53)
Middle SDI
Armenia	0.689	1420	38.05	1490	35.13	‐0.08	1174	72.41	1227	66.05	‐0.09	246	11.65	6372	11.36	‐0.03
		(1357–1486)	(36.45–39.78)	(1240–1771)	(29.38–41.81)	(‐0.23–0.1)	(1116–1233)	(68.91–76)	(1018–1473)	(55–79.09)	(‐0.24–0.09)	(230–263)	(10.91–12.43)	(4949–8313)	(9.34–13.51)	(‐0.21–0.17)
Azerbaijan	0.683	1956	24.88	2746	25.34	0.02	1577	43.69	2230	44.41	0.02	379	9.04	3039	9.42	0.04
		(1658–2237)	(21.13–28.3)	(2011–3522)	(18.71–32.12)	(‐0.18–0.26)	(1287–1849)	(35.73–51.1)	(1504–3000)	(30.16–58.78)	(‐0.22–0.31)	(329–441)	(7.78–10.43)	(2158–4033)	(7.32–12)	(‐0.18–0.32)
China	0.686	761 233	49.44	1 137 880	55.13	0.12	534 950	71.85	782 328	79.00	0.10	226 282	28.91	273	33.69	0.17
		(693 273–835 137)	(45.12–54.12)	(950 548–1 344 733)	(46.21–64.95)	(‐0.09–0.34)	(475 301–600 750)	(64.16–80.29)	(606 195–970 479)	(61.77–97.4)	(‐0.14–0.41)	(200 660–252 832)	(25.66–32.31)	(193–392)	(26.89–41.45)	(‐0.08–0.47)
Indonesia	0.66	36 236	20.76	50 234	22.23	0.07	24 946	30.21	34 308	31.89	0.06	11 290	12.27	8375	13.55	0.10
		(28 719–42 387)	(16.56–24.13)	(36 773–62 098)	(16.26–27.3)	(‐0.13–0.3)	(20 103–30 912)	(24.77–36.89)	(25 370–45 680)	(23.94–41.65)	(‐0.19–0.36)	(6970–16 045)	(7.6–17.29)	(6254–11 048)	(7.59–20.19)	(‐0.15–0.42)
Iran (Islamic Republic of)	0.67	5867	10.58	9366	12.53	0.18	4071	14.81	6029	16.26	0.10	1796	6.32	142	8.84	0.40
		(5631–6141)	(10.1–11.08)	(8689–10 053)	(11.58–13.47)	(0.1–0.27)	(3887–4277)	(14.06–15.55)	(5484–6596)	(14.83–17.72)	(0.01–0.19)	(1704–1898)	(5.94–6.68)	(110–186)	(7.96–9.68)	(0.25–0.53)
Iraq	0.671	2546	15.40	4484	18.76	0.22	1883	23.61	3125	27.36	0.16	664	7.54	20 410	10.70	0.42
		(1976–3165)	(12.07–18.97)	(3428–5629)	(14.44–23.11)	(0–0.48)	(1428–2390)	(18.02–29.65)	(2383–3910)	(20.93–33.27)	(‐0.06–0.46)	(501–862)	(5.76–9.73)	(16 337–24 713)	(8.13–13.75)	(0.11–0.84)
Philippines	0.623	10 548	17.23	14 616	17.65	0.02	7667	26.95	10 100	26.23	‐0.03	2881	8.85	3165	10.34	0.17
		(9593–11 828)	(15.69–19.3)	(11 581–18 202)	(14.07–21.88)	(‐0.19–0.28)	(6777–8908)	(23.87–31.2)	(7602–13 221)	(19.91–34.02)	(‐0.3–0.28)	(2560–3274)	(7.87–10.02)	(2280–4193)	(7.66–13.54)	(‐0.15–0.59)
Syrian Arab Republic	0.619	1303	11.86	1509	11.37	‐0.04	944	16.54	1052	15.43	‐0.07	360	6.73	6147	7.14	0.06
		(1064–1562)	(9.74–14.19)	(1100–2011)	(8.39–15.01)	(‐0.28–0.25)	(757–1162)	(13.27–20.34)	(759–1405)	(11.28–20.4)	(‐0.32–0.25)	(290–436)	(5.5–8.03)	(4867–7714)	(4.89–9.67)	(‐0.25–0.41)
Thailand	0.687	19 013	25.39	24 361	23.76	‐0.06	12 622	36.50	15 986	33.82	‐0.07	6391	15.94	12	15.19	‐0.05
		(16 557–21 431)	(22.19–28.6)	(18 211–32 138)	(17.79–31.24)	(‐0.31–0.26)	(10 739–14 550)	(31.19–42.01)	(11 712–21 314)	(24.81–44.92)	(‐0.33–0.27)	(5578–7259)	(13.9–18.15)	(8–19)	(11.31–20.08)	(‐0.31–0.29)
Turkmenistan	0.67	301	9.18	478	10.82	0.18	226	15.40	361	17.86	0.16	75	4.17	1359	5.06	0.21
		(285–316)	(8.68–9.69)	(376–606)	(8.57–13.61)	(‐0.07–0.49)	(211–240)	(14.45–16.38)	(279–461)	(13.98–22.45)	(‐0.09–0.47)	(68–82)	(3.78–4.6)	(1018–1763)	(3.92–6.45)	(‐0.05–0.53)
Uzbekistan	0.631	2079	12.03	3247	13.26	0.10	1510	19.67	2321	21.02	0.07	569	5.95	27 010	7.10	0.19
		(1979–2184)	(11.48–12.6)	(2682–3914)	(11.04–15.75)	(‐0.08–0.31)	(1414–1608)	(18.51–20.86)	(1882–2825)	(17.42–25.08)	(‐0.12–0.28)	(536–606)	(5.6–6.33)	(20 873–33 809)	(5.9–8.47)	(‐0.02–0.44)
Vietnam	0.617	18 774	26.15	28 987	28.89	0.11	13 812	44.07	21 179	47.41	0.08	4962	12.42	458	14.36	0.16
		(16 310–21 668)	(22.88–30.02)	(22 215–37 389)	(22.25–36.69)	(‐0.12–0.35)	(12 031–15 833)	(38.94–50.04)	(15 882–27 265)	(36.26–59.99)	(‐0.14–0.33)	(4043–6080)	(10.18–15.27)	(314–632)	(10.77–18.76)	(‐0.1–0.45)
Low‐middle SDI
Bangladesh	0.483	6760	7.45	9890	7.40	‐0.01	5531	11.41	7643	11.06	‐0.03	1229	2.84	7	3.43	0.21
		(4985–9276)	(5.55–10.1)	(6398–15 551)	(4.82–11.58)	(‐0.27–0.3)	(4064–7715)	(8.47–15.67)	(4841–12 420)	(7.05–17.81)	(‐0.32–0.3)	(857–1743)	(1.95–4.01)	(6–8)	(2.27–4.9)	(‐0.07–0.53)
Bhutan	0.455	32	7.01	43	7.58	0.08	24	10.23	31	10.78	0.05	8	3.54	3388	4.23	0.20
		(24–42)	(5.3–9.16)	(31–60)	(5.44–10.45)	(‐0.1–0.3)	(16–33)	(6.84–13.92)	(20–45)	(6.92–15.38)	(‐0.13–0.28)	(5–13)	(2.29–5.85)	(2596–4487)	(2.82–6.66)	(‐0.02–0.5)
Cambodia	0.469	1971	22.25	2962	23.96	0.08	1455	40.19	2137	42.08	0.05	516	9.79	15 925	11.46	0.17
		(1633–2416)	(18.43–27.5)	(2290–3681)	(18.86–29.67)	(‐0.11–0.28)	(1170–1825)	(32.6–51.57)	(1642–2702)	(32.44–53.93)	(‐0.14–0.26)	(418–635)	(8–12.06)	(8875–24 064)	(8.75–14.68)	(‐0.06–0.44)
Democratic People's Republic of Korea	0.558	8127	29.44	9574	29.05	‐0.01	5595	49.09	6535	46.15	‐0.06	2532	16.01	47	16.48	0.03
		(6172–10 588)	(22.51–38.09)	(7289–12 305)	(22.14–37.09)	(‐0.16–0.16)	(3941–7719)	(35.39–66.33)	(4626–8930)	(33.51–61.61)	(‐0.21–0.12)	(1892–3212)	(12–20.27)	(33–67)	(11.68–22.04)	(‐0.18–0.27)
India	0.566	60 661	6.82	90 058	7.63	0.12	45 985	10.53	63 048	10.95	0.04	14 676	3.25	4516	4.48	0.38
		(55 822–65 774)	(6.28–7.4)	(73 919–106 987)	(6.27–9.05)	(‐0.08–0.32)	(41 696–50 441)	(9.53–11.55)	(49 324–78 677)	(8.6–13.6)	(‐0.19–0.28)	(12 940–16 350)	(2.85–3.63)	(3333–5976)	(3.48–5.61)	(0.06–0.75)
Kyrgyzstan	0.596	503	13.66	636	12.91	‐0.05	390	24.23	483	22.29	‐0.08	112	5.37	136	5.67	0.05
		(480–524)	(13.04–14.25)	(550–726)	(11.21–14.63)	(‐0.18–0.08)	(370–409)	(23.06–25.39)	(415–552)	(19.31–25.41)	(‐0.21–0.06)	(105–120)	(4.98–5.76)	(92–181)	(4.7–6.72)	(‐0.12–0.25)
Lao People's Democratic Republic	0.49	732	21.23	1007	22.00	0.04	549	33.70	734	33.61	0.00	182	9.86	516	11.27	0.14
		(557–952)	(16.27–27.23)	(730–1330)	(16.25–28.49)	(‐0.16–0.27)	(404–737)	(25.05–45.08)	(525–963)	(24.54–43.13)	(‐0.2–0.24)	(137–258)	(7.58–13.9)	(396–657)	(8.1–16.21)	(‐0.09–0.4)
Maldives	0.562	19	9.55	29	9.72	0.02	14	13.80	22	13.78	0.00	4	4.52	925	5.02	0.11
		(17–21)	(8.55–10.63)	(24–35)	(7.95–11.65)	(‐0.16–0.22)	(13–16)	(12.08–15.7)	(18–27)	(11.12–16.7)	(‐0.2–0.23)	(4–5)	(3.89–5.22)	(757–1123)	(4.03–6.19)	(‐0.11–0.38)
Mongolia	0.606	446	28.88	691	29.55	0.02	354	52.33	549	54.16	0.03	92	11.31	263	11.58	0.02
		(368–535)	(23.89–34.11)	(532–911)	(23.23–38.17)	(‐0.19–0.3)	(288–429)	(43.3–62.07)	(405–733)	(40.88–70.52)	(‐0.2–0.33)	(75–113)	(9.3–13.77)	(216–312)	(9.1–14.83)	(‐0.21–0.3)
Myanmar	0.521	8067	21.71	10 552	21.88	0.01	5616	34.02	7165	34.08	0.00	2451	11.87	78	12.56	0.06
		(5843–11 322)	(15.91–30.39)	(7740–14 581)	(16.11–29.98)	(‐0.18–0.25)	(3737–8825)	(22.84–53.25)	(5031–10 664)	(24.19–50.42)	(‐0.2–0.26)	(1918–3172)	(9.29–15.44)	(60–101)	(9.67–16.55)	(‐0.13–0.3)
Palestine	0.588	333	18.77	568	22.43	0.20	259	32.36	435	36.28	0.12	74	7.45	3337	9.88	0.33
		(302–365)	(17.05–20.53)	(481–667)	(18.96–26.21)	(‐0.01–0.42)	(232–287)	(29.01–35.86)	(368–510)	(30.96–42.04)	(‐0.08–0.34)	(65–85)	(6.53–8.49)	(3012–3652)	(8.01–11.96)	(0.04–0.66)
Tajikistan	0.539	529	13.10	665	11.93	‐0.09	389	19.76	455	17.39	‐0.12	140	6.65	59	6.96	0.05
		(458–611)	(11.24–15.21)	(532–838)	(9.67–14.81)	(‐0.28–0.16)	(330–455)	(16.62–23.22)	(358–584)	(13.86–22.12)	(‐0.32–0.13)	(121–163)	(5.73–7.73)	(43–72)	(5.58–8.72)	(‐0.18–0.34)
Timor‐Leste	0.514	109	16.46	160	18.82	0.14	79	23.77	113	26.88	0.13	30	9.12	134	10.93	0.20
		(77–144)	(11.77–21.54)	(113–209)	(13.4–24.66)	(‐0.11–0.44)	(51–106)	(15.59–31.87)	(75–150)	(17.96–35.27)	(‐0.13–0.45)	(22–48)	(6.77–14.42)	(109–161)	(7.71–15.61)	(‐0.09–0.55)
Low SDI
Afghanistan	0.343	1112	11.06	1576	11.25	0.02	868	18.75	1170	18.26	‐0.03	245	4.22	825	5.05	0.20
		(610–1900)	(6.25–19.01)	(895–2505)	(6.78–17.88)	(‐0.17–0.3)	(441–1624)	(9.67–35.17)	(633–2054)	(10.39–31.65)	(‐0.21–0.26)	(163–360)	(2.97–6.03)	(626–1063)	(3.43–7.12)	(‐0.07–0.55)
Nepal	0.422	1184	6.72	1764	7.71	0.15	839	9.64	1194	10.97	0.14	345	3.83	45	4.71	0.23
		(862–1570)	(4.92–8.88)	(1267–2294)	(5.53–9.98)	(‐0.1–0.43)	(613–1115)	(7.09–12.76)	(856–1545)	(7.94–14.04)	(‐0.11–0.41)	(220–516)	(2.42–5.77)	(35–56)	(3.16–6.76)	(‐0.03–0.6)
Pakistan	0.449	15 392	17.22	19 632	16.44	‐0.05	13 304	28.50	16 467	26.68	‐0.06	2088	4.82	33	5.43	0.13
		(12 086–19 136)	(13.56–21.3)	(14 826–26 083)	(12.48–21.7)	(‐0.29–0.3)	(10 044–16 978)	(21.72–36.19)	(11 900–22 596)	(19.42–36.34)	(‐0.34–0.33)	(1631–2574)	(3.78–5.88)	(24–43)	(3.96–7.12)	(‐0.17–0.55)
Yemen	0.412	977	9.72	1345	9.57	‐0.02	776	15.56	1030	15.12	‐0.03	201	3.81	271	4.18	0.10
		(695–1409)	(7–14)	(909–2008)	(6.56–14.22)	(‐0.21–0.22)	(535–1165)	(10.83–23.11)	(669–1639)	(9.8–23.75)	(‐0.24–0.23)	(149–274)	(2.88–5.11)	(210–348)	(3.08–5.65)	(‐0.2–0.39)

Abbreviations: CI, confidence interval; DALYs, disability‐adjusted life‐years; SDI, sociodemographic index; TBL, tracheal, bronchial and lung.

National comparison

Among Asian countries, 22 countries experienced a decreasing trend in the TBL cancer mortality rate between 2010 and 2019; the greatest increase was detected in Iraq (increase in ASPR = 0.22 [95% CI: 0–0.48]) and the greatest decrease was detected in Oman (decrease in ASPR = −0.17 [95% CI: −0.33–0.04]) (Figure 4).

In 2019, the highest ASPR (per 100 000) of TBL cancer was reported in the Republic of Korea (75.66), Japan (74.49), Singapore (61.39), China (55.13), and Brunei Darussalam (54.57). The lowest ASPR of TBL cancer was reported in Bangladesh (7.4), Bhutan (7.58), India (7.63), Nepal (7.71), and Saudi Arabia (9.01).

In Asian men, the highest ASPR (per 100 000) of TBL cancer was reported among men Republic of Korea (118.34), Japan (114.78), China (79), Singapore (78.05), and Georgia (68.25). The lowest ASPR (per 100 000) of TBL cancer was reported in Saudi Arabia (10.62), Bhutan (10.78), India (10.95), Nepal (10.97), and Bangladesh (11.06).

In women, the highest ASPR (per 100 000) of TBL cancer was reported in Brunei Darussalam (47.91), Singapore (46.9), the Republic of Korea (41.95), Japan (40.36), and China (33.69). The lowest ASPR (per 100 000) of TBL cancer was reported in Bangladesh (3.43), Yemen (4.18), Bhutan (4.23), India (4.48), and Nepal (4.71). Detailed results are presented in Table 6.

Burden of TBL cancer in Asia

Comparison with global data and continents

In Asia, the number of TBL cancer DALYs increased from 21 516 974 (95% CI: 20 162 682–22 913 727) in 2010 to 27 120 537 (95% CI: 23 951 875–30 414 194) in 2019, which is a 1.26‐fold increase. In 2019 more than 59% (27 120 537/45 857 963) of TBL cancer DALYs happened in Asian countries. During this period, the age‐standardized DALYs rate (DALYs ASR) of TBL cancer with a 4% change, decreased from 579.16 (95% CI: 543.52–616.66) per 100 000 in 2010 to 553.68 (95% CI: 488.57–619.78) per 100 000 in 2019, in the same period, this rate globally decreased by 7%, in America by 11%, and in Europe by 510%, Africa by 1% (Figure 1 and Table 1).

In Asian men, the number of TBL cancer DALYs increased from 15 471 795 (95% CI: 14 340 748–16 696 371) in 2010 to 19 032 930 (95% CI: 16 188 395–21 991 610) in 2019, which is over a 1.23‐fold increase. In 2019 approximately 70.2% of TBL cancer DALYs in Asia, occurred in men which included 60.3% (19 032 930/31 582 258) of global male TBL cancer DALYs cases. During this period, the DALYs ASR rate of TBL cancer with a 7% change, decreased from 862.61 (95% CI: 800.85–929.03) per 100 000 in 2010 to 806.43 (95% CI: 688.15–928.33) per 100 000 in 2019, in the same period, this rate globally decreased by 10%, in America by 13%, in Europe by 14%, and Africa by 3% (Table 2).

In Asian women, the number of TBL cancer DALYs increased from 6 045 179 (95% CI: 5 551 988–6 575 776) in 2010 to 8 087 606 (95% CI: 6 962 536–9 358 865) in 2019, which is over a 1.34‐fold increase. In 2019, approximately 29.8% of DALYs related to TBL cancer in Asia were women which included 56.6% (8 087 606/14 275 706) of global female TBL cancer DALYs cases. During this period, the DALYs ASR rate of TBL cancer with a 1% change, increased from 316.95 (95% CI: 290.95–344.55) per 100 000 in 2010 to 321.18 (95% CI: 276.65–371.34) per 100 000 in 2019, while in the same time, this rate globally decreased by 1%, and in American countries decreased by 10%. European countries experienced a stable trend and African countries experienced an increasing trend of 11% (Table 3).

Age distribution

In 2019, age‐specific DALYs cases of TBL cancer peaked at 65–69 years generally, in males, and females. In all age groups, DALYs cases of TBL cancer in males were higher than in females, except in ages above 90 years which in females was higher (Figure 7).

FIGURE 7.

Age specific DALYs cases of TBL cancer among sexes in Asia, 2019.

Within Asian regions

In 2019, the highest DALYs ASR of TBL was observed in East Asian countries (825.81 [95% CI: 696.85–969.46]); with a 5% decrease compared with 2010. Southeast Asian countries experienced a stable trend and South Asian countries experienced an increasing trend of 5%; other Asian countries experienced a decreasing trend from 2010 to 2019 (by 1%–14%) (Figure 3 and Table 1).

In men, the highest DALYs ASR of TBL was observed in East Asian countries (1195.54 [95% CI: 949.99–1478.03]); with a 6% decrease compared with 2010. Also, other Asian countries experienced a decreasing trend from 2010 to 2019 (by 1%–18%). High‐income Asia Pacific countries experienced the highest decrease (Table 2).

In women, the highest DALYs ASR of TBL was observed in East Asian countries (489.73 [95% CI: 396.14–597.18]); with a 2% decrease compared with 2010. Also, high‐income Asia Pacific countries experienced a decreasing trend from 2010 to 2019 by 7%. Other Asian countries experienced an increasing trend from 2010 to 2019 (by 1%–30%). South Asian countries experienced the highest decrease (Table 3).

Based on SDI

In 2019, among high SDI Asian countries, Brunei Darussalam (867.69) and Taiwan (Province of China) (638.74) had the highest DALYs ASR of TBL, and Saudi Arabia (208.01) had the lowest rate. Among high‐middle SDI Asian countries, Georgia (828.59) and Turkey (814.58) had the highest DALYs ASR of TBL, and Oman (211.73) had the lowest rate. In middle SDI Asian countries, China (831.27) and Armenia (772.08) had the highest DALYs ASR of TBL, and Turkmenistan (265.85) had the lowest rate. Among low‐middle SDI Asian countries, Mongolia (727.67) and the Democratic People's Republic of Korea (712.30) had the highest ASPR of TBL, and Bangladesh (181.71) had the lowest rate.

Among low SDI Asian countries, Pakistan (425.72) had the highest DALYs ASR of TBL, and Nepal (195.08) had the lowest rate. More details are presented in Table 7.

TABLE 7.

The DALYs of TBL cancer in Asian countries in 2010 and 2019 and the temporal trends between 2010 and 2019, by geographical region and SDI.

		Both					Male
		2010		2019		% change 2010–2010	2010		2019		% change 2010‐2019
Location	SDI 2019	Number	ASR per 100 000	Number	ASR per 100 000		Number	ASR per 100 000	Number	ASR per 100 000
	lower	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
High SDI
Brunei Darussalam	0.823	1736	881.93	2578	867.69	‐0.02	964	1117.64	1402	1086.94	‐0.03
		(1579–1914)	(806.29–967.48)	(2268–2923)	(768.53–975.37)	(‐0.14–0.13)	(852–1089)	(990.1–1251.24)	(1163–1666)	(917.83–1259.12)	(‐0.19–0.15)
Cyprus	0.841	7851	543.85	9677	496.50	‐0.09	6146	905.87	7498	796.91	‐0.12
		(7365–8373)	(511.28–580.29)	(8511–10 948)	(437.29–562.21)	(‐0.2–0.03)	(5717–6629)	(844.61–975.76)	(6527–8559)	(695.12–911.42)	(‐0.24–0.01)
Israel	0.803	45 045	530.55	52 637	478.11	‐0.10	30 992	792.34	35 769	694.47	‐0.12
		(43 220–46 601)	(509.75–548.41)	(49 095–55 907)	(446.69–507.47)	(‐0.16–‐0.04)	(29 743–32 194)	(761.06–823.47)	(33 302–38 347)	(646.72–745.22)	(‐0.18–‐0.06)
Japan	0.87	1 354 942	475.84	1 347 365	408.04	‐0.14	1 005 355	778.59	966 169	638.55	‐0.18
		(1 244 988–1 409 971)	(445.3–491.42)	(1 211 168–1 426 790)	(378.67–427.43)	(‐0.17–‐0.12)	(945 825–1 037 352)	(737.05–801.79)	(890 896–1 017 886)	(595.3–669.43)	(‐0.21–‐0.15)
Kuwait	0.851	3187	221.34	5541	214.80	‐0.03	2429	278.57	4263	287.61	0.03
		(2983–3386)	(205.84–235.27)	(4539–6683)	(174.68–260.68)	(‐0.21–0.18)	(2244–2610)	(257.37–298.19)	(3277–5348)	(222.72–360.28)	(‐0.19–0.3)
Qatar	0.83	2037	457.40	3497	373.88	‐0.13	1742	555.43	2925	426.90	‐0.23
		(1638–2534)	(373.58–556.09)	(2442–4860)	(279.21–491.27)	(‐0.2–‐0.05)	(1339–2214)	(440.05–691.03)	(1985–4180)	(315.74–572.97)	(‐0.45–0.06)
Republic of Korea	0.878	363 214	572.49	448 177	498.37	‐0.05	270 501	989.99	329 780	812.08	‐0.18
		(345 908–385 465)	(543.45–608.08)	(407 150–489 987)	(452.28–545.03)	(‐0.24–0.15)	(258 260–289 258)	(942.81–1057.22)	(295 922–365 420)	(726.93–896.9)	(‐0.26–‐0.09)
Saudi Arabia	0.805	30 004	219.72	45 488	208.01	‐0.06	22 272	288.97	32 838	260.49	‐0.10
		(26 190–34 824)	(196.73–251.56)	(34 469–57 172)	(162.62–253.25)	(‐0.32–0.27)	(19 367–26 307)	(258.76–338.48)	(24 493–41 864)	(199.92–324.97)	(‐0.29–0.12)
Singapore	0.861	25 678	508.08	32 008	406.24	‐0.05	17 179	732.85	20 883	549.33	‐0.25
		(24 501–26 642)	(481.56–527.39)	(29 533–34 271)	(373.24–435.04)	(‐0.29–0.24)	(16 388–17 912)	(694.31–763.13)	(19 024–22 407)	(499.22–590.64)	(‐0.32–‐0.19)
Taiwan (Province of China)	0.868	201 116	663.19	250 042	638.74	‐0.11	130 642	889.24	156 142	847.27	‐0.05
		(191 569–208 015)	(630.62–686.06)	(195 264–323 024)	(500.04–824.72)	(‐0.35–0.2)	(124 689–135 612)	(847.68–923.17)	(122 385–204 204)	(665.16–1101.66)	(‐0.26–0.24)
United Arab Emirates	0.88	7069	491.67	16 698	406.46	0.07	5564	549.42	13 406	468.70	‐0.15
		(5634–8636)	(404.44–584.94)	(12 066–22 166)	(295.09–559.14)	(‐0.11–0.27)	(4352–6903)	(438.29–669.67)	(9528–18 308)	(343.4–645.66)	(‐0.33–0.09)
High‐middle SDI
Bahrain	0.751	2162	485.53	3546	392.08	‐0.19	1618	687.65	2677	518.94	‐0.25
		(1898–2450)	(429.2–542.66)	(2675–4751)	(294.96–503.78)	(‐0.37–0.02)	(1383–1865)	(596.79–783.11)	(1931–3710)	(386.88–684.76)	(‐0.43–‐0.01)
Georgia	0.702	43 531	797.62	45 743	828.59	0.04	37 079	1556.10	39 358	1623.55	0.04
		(39 541–47 494)	(724.62–872.98)	(37 925–54 188)	(684.05–980.38)	(‐0.16–0.26)	(33 184–40 916)	(1385.03–1718.34)	(32 601–46 938)	(1343.63–1925.24)	(‐0.16–0.28)
Jordan	0.731	12 952	360.35	24 231	338.02	‐0.06	10 217	556.96	18 653	497.83	‐0.11
		(11 485–14 706)	(321.08–405.56)	(19 817–29 413)	(276.61–409.77)	(‐0.25–0.14)	(8916–11 730)	(488.61–636.3)	(14 277–23 721)	(385.83–628.29)	(‐0.32–0.14)
Kazakhstan	0.723	100 157	667.21	99 098	529.99	‐0.21	82 595	1331.23	79 489	1011.22	‐0.24
		(95 150–105 761)	(633.87–703.56)	(84 119–114 547)	(452.01–608.74)	(‐0.33–‐0.07)	(77 609–88 472)	(1252.99–1420.47)	(66 646–93 305)	(856.32–1179.95)	(‐0.36–‐0.11)
Lebanon	0.708	27 614	653.49	32 712	629.57	‐0.04	19 893	985.74	21 762	926.00	‐0.06
		(23 464–34 891)	(555.91–825.18)	(26 403–42 585)	(507.29–817.1)	(‐0.19–0.13)	(16 580–25 367)	(824.21–1255.03)	(17 023–28 494)	(725.13–1215.38)	(‐0.21–0.11)
Malaysia	0.737	99 296	492.31	125 454	452.95	‐0.08	70 051	694.58	88 682	640.66	‐0.08
		(91 031–108 913)	(449.62–541.33)	(95 772–158 721)	(349.01–573.29)	(‐0.29–0.16)	(63 605–77 170)	(630.74–767.54)	(67 490–113 258)	(490.41–816.72)	(‐0.29–0.17)
Oman	0.783	3145	275.24	3876	211.73	‐0.06	2343	369.58	2755	274.30	‐0.26
		(2856–3450)	(250.81–302.08)	(3002–5245)	(170.66–267.77)	(‐0.3–0.27)	(2108–2612)	(332.63–411.06)	(2018–4078)	(211.84–366.38)	(‐0.42–0.01)
Sri Lanka	0.69	50 700	246.24	61 125	231.39	‐0.04	37 667	397.26	42 870	355.96	‐0.10
		(47 614–53 917)	(231.9–261.63)	(44 055–83 501)	(167.54–315.61)	(‐0.25–0.24)	(34 739–40 500)	(368.42–425.46)	(29 685–60 571)	(248.38–498.89)	(‐0.37–0.25)
Turkey	0.748	606 723	868.40	743 637	814.58	0.15	521 564	1564.61	625 682	1431.86	‐0.08
		(535 329–685 649)	(766.16–982.9)	(585 408–929 199)	(643.77–1017)	(‐0.1–0.45)	(455 485–593 194)	(1372.32–1780.42)	(493 490–787 341)	(1132.21–1796.08)	(‐0.3–0.2)
Middle SID
Armenia	0.689	32 931	881.64	32 530	772.08	‐0.12	27 383	1679.98	26 989	1456.82	‐0.13
		(31 610–34 420)	(847.73–919.95)	(27 097–38 700)	(644.04–919.53)	(‐0.27–0.05)	(26 166–28 753)	(1607.69–1765.83)	(22 437–32 354)	(1215.4–1753.28)	(‐0.28–0.04)
Azerbaijan	0.683	50 528	627.24	67 384	615.53	‐0.02	40 885	1103.50	55 020	1083.21	‐0.02
		(42 848–57 711)	(531.96–712.77)	(49 096–86 484)	(453.49–778.51)	(‐0.21–0.21)	(33 344–47 893)	(905.06–1286.31)	(37 056–73 911)	(739–1437.01)	(‐0.25–0.27)
China	0.686	13 706 787	878.34	17 128 584	831.27	‐0.05	9 750 174	1285.67	11 967 767	1203.78	‐0.06
		(12 490 817–14 986 265)	(802.07–956.93)	(14 340 491–20 231 342)	(699.11–979.99)	(‐0.22–0.14)	(8 652 617–10 933 563)	(1148.32–1434.13)	(9 374 367–14 952 335)	(950.19–1495.1)	(‐0.27–0.19)
Indonesia	0.66	951 020	531.75	1 279 981	555.79	0.05	652 011	771.88	872 361	795.96	0.03
		(768 970–1 118 598)	(432.67–622.97)	(927 626–1 596 040)	(404.21–685.35)	(‐0.15–0.26)	(522 694–808 743)	(627.82–940.17)	(632 434–1 170 979)	(584.55–1045.61)	(‐0.21–0.33)
Iran (Islamic Republic of)	0.67	145 184	255.72	218 990	286.82	0.12	104 036	369.43	150 337	396.94	0.07
		(139 547–151 340)	(244.38–266.88)	(203 461–234 523)	(266.09–307.6)	(0.05–0.2)	(99 266–108 916)	(351.11–387.4)	(137 471–164 431)	(364.05–434.82)	(‐0.01–0.17)
Iraq	0.671	66 028	388.14	110 712	451.59	0.16	49 430	600.79	79 463	675.57	0.12
		(51 003–82 497)	(303.02–480.89)	(84 178–139 887)	(346.04–557.52)	(‐0.05–0.42)	(37 525–62 971)	(458.88–759.13)	(60 517–100 726)	(516.66–825.13)	(‐0.09–0.41)
Philippines	0.623	274 077	438.06	373 177	443.59	‐0.18	201 099	684.08	258 071	658.20	‐0.04
		(249 033–307 840)	(398.81–491.29)	(300 745–458 874)	(359.55–543.86)	(‐0.39–0.08)	(176 964–228 943)	(609.27–784.78)	(194 607–334 686)	(499.78–848.85)	(‐0.28–0.25)
Syrian Arab Republic	0.619	32 840	289.91	36 951	274.37	‐0.10	24 536	418.24	26 803	389.30	‐0.07
		(26 864–39 516)	(236.81–347.76)	(26 937–49 538)	(202.98–363.54)	(‐0.3–0.14)	(19 591–30 237)	(335.64–513.89)	(19 320–36 087)	(283.36–517.06)	(‐0.32–0.25)
Thailand	0.687	437 879	575.84	524 356	512.94	0.14	292 638	830.38	348 203	735.77	‐0.11
		(381 744–495 015)	(503.63–649.94)	(389 891–698 681)	(382.75–681.94)	(‐0.11–0.45)	(249 564–336 188)	(709.5–953.68)	(253 961–465 752)	(538.38–977.94)	(‐0.36–0.22)
Turkmenistan	0.67	7793	232.03	11 915	265.85	‐0.17	5868	387.83	9035	438.57	0.13
		(7379–8188)	(220.21–244.35)	(9357–15 098)	(209.71–336.07)	(‐0.36–0.07)	(5479–6243)	(363.74–411.91)	(7009–11 546)	(343.74–552.56)	(‐0.12–0.44)
Uzbekistan	0.631	53 638	300.38	80 570	320.85	0.05	38 995	490.90	57 824	510.33	0.04
		(51 091–56 334)	(286.41–314.34)	(66 295–96 841)	(266.53–380.72)	(‐0.16–0.28)	(36 607–41 509)	(462.79–520.87)	(47 028–70 213)	(421.64–610.42)	(‐0.15–0.26)
Vietnam	0.617	468 294	639.58	676 894	668.83	‐0.20	347 144	1079.86	498 965	1102.40	0.02
		(40 6280–541 940)	(557.93–736.21)	(514 966–873 765)	(512.02–853.16)	(‐0.25–‐0.15)	(300 374–398 441)	(950.74–1229.85)	(374 943–644 026)	(837.95–1402.61)	(‐0.19–0.26)
Low‐middle SDI
Bangladesh	0.483	175 070	188.69	245 789	181.71	‐0.04	142 318	288.19	188 736	271.23	‐0.06
		(128 455–241 803)	(139.99–257.39)	(158 426–385 218)	(117.75–284.34)	(‐0.29–0.26)	(103 834–198 827)	(212.87–398.06)	(119 496–309 965)	(172.15–441.53)	(‐0.34–0.26)
Bhutan	0.455	814	175.54	1072	184.25	0.05	612	254.70	774	261.11	0.03
		(615–1067)	(132.78–230.05)	(764–1474)	(132.46–253.15)	(‐0.13–0.27)	(416–836)	(171.66–346.08)	(504–1094)	(167.93–370.95)	(‐0.16–0.24)
Cambodia	0.469	52 251	579.09	76 026	606.82	0.05	38 540	1042.53	54 880	1062.37	0.02
		(43 259–63 797)	(482.12–712.77)	(58 767–94 334)	(473.95–750.69)	(‐0.14–0.25)	(30 944–48 299)	(846.07–1334.54)	(42 147–69 438)	(817.66–1358.8)	(‐0.17–0.23)
Democratic People's Republic of Korea	0.558	205 141	735.45	235 437	712.30	‐0.03	141 800	1220.58	161 707	1126.86	‐0.08
		(15 4525–270 707)	(556.37–962.31)	(177 717–306 193)	(539.32–920.19)	(‐0.18–0.15)	(99 397–197 104)	(876.92–1666.88)	(113 816–221 451)	(815.69–1514.4)	(‐0.22–0.1)
India	0.566	1 584 205	174.72	2 275 225	190.16	0.09	1 196 732	268.48	1 586 070	271.30	0.01
		(1 461 551–1 723 380)	(161.5–190.55)	(1 871 750–2 691 295)	(156.64–224.66)	(‐0.1–0.28)	(1 083 500–1 322 202)	(242.68–296.34)	(1 233 846–1 950 175)	(211.91–331.81)	(‐0.21–0.26)
Kyrgyzstan	0.596	12 824	341.57	15 377	308.12	‐0.10	9999	606.25	11 721	532.34	‐0.12
		(12 251–13 377)	(326.42–356.36)	(13 279–17 539)	(266.83–350.84)	(‐0.22–0.03)	(9501–10 474)	(576.85–634.81)	(10 038–13 425)	(460.12–608.84)	(‐0.25–0.01)
Lao People's Democratic Republic	0.49	19 739	559.56	26 518	566.50	0.01	14 738	883.09	19 216	861.29	‐0.02
		(14 969–25 758)	(428.19–720.42)	(19 142–35 092)	(418.1–736.93)	(‐0.18–0.24)	(10 766–19 870)	(657.67–1187.77)	(13 684–25 262)	(624.09–1112.8)	(‐0.22–0.21)
Maldives	0.562	416	208.86	620	199.38	‐0.05	322	302.61	478	283.47	‐0.06
		(373–462)	(186.77–232.2)	(511–742)	(163.94–237.7)	(‐0.22–0.15)	(283–365)	(266.27–343.46)	(389–577)	(229.69–342)	(‐0.25–0.14)
Mongolia	0.606	11 716	732.13	17 529	727.67	‐0.03	9349	1325.52	14 013	1335.28	0.01
		(9652–14 055)	(605.83–866.62)	(13 389–23 176)	(568.02–941.27)	(‐0.2–0.21)	(7605–11 305)	(1092.98–1580.67)	(10 355–18 720)	(1008.65–1737.42)	(‐0.22–0.3)
Myanmar	0.521	216 064	570.40	271 546	556.09	0.13	150 353	892.47	184 512	864.98	‐0.03
		(156 726–309 983)	(419.32–806.31)	(199 769–374 583)	(409.15–761.85)	(‐0.12–0.41)	(99 360–240 211)	(598.49–1412.17)	(129 789–274 994)	(613.93–1280.98)	(‐0.22–0.23)
Palestine	0.588	8584	469.81	14 203	546.36	0.01	6760	814.71	11 162	901.55	0.11
		(7778–9410)	(426.36–513.68)	(12 043–16 667)	(462.77–639.36)	(‐0.19–0.24)	(6054–7507)	(731.68–903.57)	(9466–13 136)	(768.02–1046.3)	(‐0.09–0.33)
Tajikistan	0.539	14 017	335.26	17 302	300.28	‐0.01	10 326	505.89	11 831	436.74	‐0.14
		(12 126–16 132)	(288.52–387.58)	(13 763–21 772)	(243.87–374.01)	(‐0.22–0.27)	(8779–12 028)	(428.03–593.24)	(9318–15 154)	(347–555.17)	(‐0.34–0.11)
Timor‐Leste	0.514	2822	421.11	4104	479.52	‐0.06	2027	606.06	2894	682.80	0.13
		(1958–3735)	(297.78–553.99)	(2888–5397)	(341.33–629.51)	(‐0.27–0.23)	(1311–2748)	(395.2–815.78)	(1898–3902)	(456.42–904.17)	(‐0.13–0.45)
Low SDI
Afghanistan	0.343	31 563	299.90	44 553	302.57	0.01	24 344	504.01	32 821	485.96	‐0.04
		(17 036–53 762)	(167.68–511.88)	(25 083–71 319)	(179.92–481.25)	(‐0.18–0.3)	(12 063–45 437)	(257.6–947.67)	(17 512–57 862)	(274.05–844.56)	(‐0.21–0.25)
Nepal	0.422	30 976	172.98	45 196	195.08	‐0.23	21 828	247.11	30 434	277.16	0.12
		(22 476–41 114)	(126.4–228.16)	(32 343–59 231)	(139.51–253.47)	(‐0.38–0)	(15 924–29 084)	(181.42–327.39)	(21 678–39 516)	(198.22–357.17)	(‐0.13–0.39)
Pakistan	0.449	416 861	453.80	522 648	425.72	0.16	359 222	749.59	436 968	689.89	‐0.08
		(321 808–524 148)	(350.78–567.63)	(400 317–680 663)	(327.1–550.78)	(‐0.04–0.38)	(267 008–467 611)	(559.17–968.14)	(318 323–591 600)	(504.54–928)	(‐0.35–0.3)
Yemen	0.412	26 197	253.64	36 208	248.83	‐0.02	20 790	405.89	27 748	393.94	‐0.03
		(18 556–37 800)	(182.15–366.57)	(24 430–53 799)	(169.31–368.91)	(‐0.21–0.22)	(14 324–31 221)	(281.88–605.7)	(17 997–44 272)	(254.61–622.7)	(‐0.24–0.22)

		Female
		2010		2019		% change 2010–2019
Location	SDI 2019	Number	ASR per 100 000	Number	ASR per 100 000
	lower	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
High SDI
Brunei Darussalam	0.823	772	706.37	1176	730.80	0.03
		(688–860)	(632.31–784.18)	(980–1385)	(618.67–850.63)	(‐0.13–0.21)
Cyprus	0.841	1705	227.50	2178	219.18	‐0.04
		(1557–1871)	(208.32–250.03)	(1844–2524)	(186.62–253.94)	(‐0.19–0.12)
Israel	0.803	14 052	304.03	16 867	285.32	‐0.06
		(13 208–14 792)	(286.9–319.84)	(15 241–18 355)	(258.62–310.37)	(‐0.14–0.03)
Japan	0.87	349 587	225.99	381 197	210.56	‐0.07
		(300 800–376 526)	(203.81–238.07)	(315 576–418 629)	(186.69–225.92)	(‐0.11–‐0.03)
Kuwait	0.851	758	125.97	1278	104.23	‐0.17
		(688–827)	(113.8–137.54)	(989–1618)	(82.26–130.24)	(‐0.34–0.03)
Qatar	0.83	295	241.22	572	220.52	‐0.09
		(233–366)	(193.55–293.68)	(421–734)	(170.71–275.17)	(‐0.27–0.13)
Republic of Korea	0.878	92 714	263.26	118 396	245.25	‐0.07
		(85 603–98 182)	(242.92–278.73)	(104 054–131 119)	(216.78–270.42)	(‐0.15–0.02)
Saudi Arabia	0.805	7733	123.21	12 650	127.19	0.03
		(6645–8978)	(107.08–140.84)	(9344–16 468)	(95.79–162.81)	(‐0.2–0.31)
Singapore	0.861	8499	318.79	11 125	277.03	‐0.13
		(7891–9022)	(295.34–338.85)	(9748–12 390)	(242.91–308.51)	(‐0.22–‐0.04)
Taiwan (Province of China)	0.868	70 474	451.64	93 900	457.18	0.01
		(65 968–73 910)	(421.7–473.69)	(73 474–120 865)	(355.86–591.97)	(‐0.21–0.31)
United Arab Emirates	0.88	1505	383.78	3292	274.87	‐0.28
		(1167–1859)	(305.93–468.78)	(2254–4366)	(164.71–396.5)	(‐0.54–0.08)
High‐middle SDI
Bahrain	0.751	544	272.77	869	238.46	‐0.13
		(472–629)	(237.79–315.2)	(682–1070)	(189.98–289.87)	(‐0.3–0.06)
Georgia	0.702	6452	208.47	6385	207.18	‐0.01
		(5824–7120)	(187.61–230.63)	(5261–7673)	(170.33–250.11)	(‐0.2–0.23)
Jordan	0.731	2735	149.93	5578	161.92	0.08
		(2345–3161)	(128.73–173.63)	(4366–7137)	(128.25–205.65)	(‐0.15–0.37)
Kazakhstan	0.723	17 562	202.47	19 608	187.71	‐0.07
		(16 578–18 646)	(191.3–214.83)	(16 256–23 097)	(156.51–220.87)	(‐0.24–0.1)
Lebanon	0.708	7722	350.95	10 949	384.97	0.10
		(6511–9720)	(296.83–442.46)	(8038–14 776)	(281.37–520.49)	(‐0.16–0.34)
Malaysia	0.737	29 244	291.69	36 772	266.48	‐0.09
		(26 440–32 255)	(263.54–322.87)	(28 061–47 106)	(203.45–339.35)	(‐0.29–0.16)
Oman	0.783	803	157.82	1121	141.83	‐0.10
		(704–913)	(137.42–180.41)	(800–1377)	(104.09–169.59)	(‐0.33–0.12)
Sri Lanka	0.69	13 033	119.16	18 254	128.58	0.08
		(11 992–14 229)	(109.67–129.9)	(13 292–24 267)	(94.22–170.76)	(‐0.21–0.43)
Turkey	0.748	85 158	233.33	117 955	250.26	0.07
		(74 588–96 867)	(204.61–265.97)	(93 375–146 975)	(198.42–311.87)	(‐0.17–0.4)
Middle SID
Armenia	0.689	5548	263.73	5540	242.58	‐0.08
		(5221–5921)	(247.62–281.46)	(4557–6581)	(198.59–288.26)	(‐0.25–0.11)
Azerbaijan	0.683	9643	223.93	12 364	222.46	‐0.01
		(8400–11 193)	(194.18–258.94)	(9432–15 634)	(172.67–281.07)	(‐0.22–0.26)
China	0.686	3 956 613	500.77	5 160 817	492.17	‐0.02
		(3 524 734–4 404 296)	(444.94–556.06)	(4 138 835–6 353 139)	(393.74–604.27)	(‐0.23–0.23)
Indonesia	0.66	299 009	315.66	407 620	339.17	0.07
		(182 599–424 669)	(194.98–443.91)	(226 898–623 490)	(189.97–516.37)	(‐0.17–0.39)
Iran (Islamic Republic of)	0.67	41 148	141.32	68 653	178.15	0.26
		(39 261–43 163)	(134.22–148.3)	(62 555–74 042)	(161.41–192.43)	(0.13–0.37)
Iraq	0.671	16 598	183.06	31 249	239.59	0.31
		(12 447–21 665)	(138.93–236.13)	(23 269–41 007)	(181.03–307.77)	(0.02–0.7)
Philippines	0.623	74 977	224.83	115 106	259.58	0.15
		(66 626–84 617)	(200.27–253.9)	(86 753–150 100)	(197.49–336.23)	(‐0.15–0.55)
Syrian Arab Republic	0.619	8304	149.22	10 148	155.27	0.04
		(6706–10 155)	(121.78–178.86)	(6956–13 953)	(106.32–210.2)	(‐0.25–0.4)
Thailand	0.687	145 242	357.80	176 154	321.69	‐0.10
		(126 649–165 290)	(312.22–406.92)	(131 468–234 593)	(238.79–427.89)	(‐0.36–0.21)
Turkmenistan	0.67	1925	104.73	2880	122.63	0.17
		(1737–2120)	(94.93–115.65)	(2203–3719)	(94.53–158.09)	(‐0.09–0.48)
Uzbekistan	0.631	14 642	147.49	22 746	169.49	0.15
		(13 757–15 641)	(139.11–156.73)	(18 516–27 581)	(140.38–203.1)	(‐0.06–0.39)
Vietnam	0.617	121 151	298.72	177 929	325.27	0.09
		(98 246–148 007)	(243.31–366.61)	(133 317–235 275)	(245.25–426.63)	(‐0.15–0.37)
Low‐middle SDI
Bangladesh	0.483	32 752	73.08	57 053	85.35	0.17
		(22 955–46 303)	(50.63–103.78)	(38 132–81 434)	(56.79–121.16)	(‐0.11–0.48)
Bhutan	0.455	202	89.76	297	103.59	0.15
		(130–335)	(58.16–148.43)	(194–475)	(68.51–165.05)	(‐0.06–0.45)
Cambodia	0.469	13 712	255.02	21 146	290.69	0.14
		(11 060–16 856)	(208.3–313.1)	(16 089–27 193)	(222–372.55)	(‐0.08–0.4)
Democratic People's Republic of Korea	0.558	63 341	399.33	73 730	403.09	0.01
		(46 751–80 830)	(295.05–507.97)	(52 217–98 877)	(281.86–545.06)	(‐0.2–0.25)
India	0.566	387 473	83.99	689 155	112.92	0.34
		(337 962–432 534)	(73.01–93.81)	(533 934–873 541)	(87.71–142.75)	(0.02–0.71)
Kyrgyzstan	0.596	2825	132.57	3656	133.43	0.01
		(2631–3014)	(123.23–141.85)	(3012–4338)	(110.79–157.91)	(‐0.17–0.19)
Lao People's Democratic Republic	0.49	5000	262.98	7302	292.87	0.11
		(3744–7061)	(200.26–370.62)	(5148–10 478)	(208.9–416.89)	(‐0.11–0.37)
Maldives	0.562	94	98.29	142	101.31	0.03
		(81–107)	(84.75–112.82)	(114–174)	(81.22–123.74)	(‐0.17–0.28)
Mongolia	0.606	2366	279.40	3517	277.36	‐0.01
		(1928–2906)	(228.98–340.45)	(2711–4617)	(216.31–357.36)	(‐0.23–0.26)
Myanmar	0.521	65 711	311.66	87 034	318.70	0.02
		(51 120–84 000)	(241.54–396.25)	(66 622–115 527)	(245.68–419.49)	(‐0.17–0.26)
Palestine	0.588	1824	178.40	3042	219.65	0.23
		(1606–2076)	(156.62–203.01)	(2491–3666)	(178.84–265.01)	(‐0.03–0.54)
Tajikistan	0.539	3691	169.53	5470	175.30	0.03
		(3184–4273)	(146.33–196.93)	(4327–6888)	(141.02–219.76)	(‐0.19–0.33)
Timor‐Leste	0.514	795	235.30	1210	280.22	0.19
		(566–1252)	(171.45–374.02)	(840–1736)	(196.83–400.22)	(‐0.1–0.54)
Low SDI
Afghanistan	0.343	7220	118.35	11 732	139.69	0.18
		(4658–10 796)	(81.42–170.34)	(7195–17 414)	(92.77–198.61)	(‐0.09–0.51)
Nepal	0.422	9148	99.40	14 762	119.79	0.21
		(5909–13 668)	(62.82–149.13)	(9894–21 002)	(80.4–171.49)	(‐0.06–0.57)
Pakistan	0.449	57 638	128.42	85 679	141.81	0.10
		(45 789–71 940)	(102.3–158.25)	(62 126–114 158)	(104.07–189.04)	(‐0.18–0.51)
Yemen	0.412	5407	98.81	8460	107.43	0.09
		(3996–7443)	(74.26–132.27)	(5985–11 599)	(78.67–145.39)	(‐0.2–0.38)

Abbreviations: CI, confidence interval; DALYs, disability‐adjusted life‐years; SDI, sociodemographic index; TBL, tracheal, bronchial and lung.

National comparison

Among Asian countries, 33 countries experienced a decreasing trend in the TBL cancer DALYs ASR between 2010 and 2019; the greatest increase was detected in Iraq (increase in DALYs ASR = 0.16 [95% CI: −0.05–0.42]) and the greatest decrease was detected in Oman (decrease in DALYs ASR = −0.23 [95% CI: −0.38–0]) (Figure 4).

In 2019, the highest DALYs ASR (per 100 000) of TBL cancer was reported in Brunei Darussalam (867.69), China (831.27), Georgia (828.59), Turkey (814.58), and Armenia (772.08). The lowest DALYs ASR of TBL cancer was reported in Bangladesh (181.71), Bhutan (184.25), India (190.16), Nepal (195.08), and Maldives (199.38).

In Asian men, the highest DALYs ASR (per 100 000) of TBL cancer was reported in Georgia (1623.55), Armenia (1456.82), Turkey (1431.86), Mongolia (1335.28), and China (1203.78). The lowest DALYs ASR (per 100 000) of TBL cancer was reported in Saudi Arabia (260.49), Bhutan (261.11), Bangladesh (271.23), India (271.3), and Oman (274.3).

In women, the highest DALYs ASR (per 100 000) of TBL cancer was reported in Brunei Darussalam (730.8), China (492.17), Taiwan (Province of China) (457.18), Democratic People's Republic of Korea (403.09), and Lebanon (384.97). The lowest DALYs ASR (per 100 000) of TBL cancer was reported in Bangladesh (85.35), Maldives (101.31), Bhutan (103.59), Kuwait (104.23), and Yemen (107.43). Detailed results are presented in Table 7.

DISCUSSION

In this study, temporal trends of TBL cancer were estimated in 49 Asian countries and territories by geographical region and SDI and compared with the global data between 2010 and 2019. This study is the first in which calculated temporal trends of TBL cancer were estimated in Asian countries. The results showed that from 2010 to 2019 in the total population there was an over 1.34‐fold increase in the number of TBL cancer incidences. Also, ASIR, ASDR, and ASPR decreased while the age‐standardized DALY rate increased.

In 2019, more than half of TBL cancer cases (58%) occurred in Asian countries. However, during this period, the ASIR of TBL decreased by 1%. Also, the results of the study show that the number of TBL cancer increased more in women than in men so the number of TBL cancer cases in men increased 1.3‐fold and in women 1.42‐fold from 2010 to 2019. In men, the age group of 65–69 years had the higher number of TBL cancer, while in women, this number was greater in the age group of 70–74 years. Also, the ASIR decreased in men by 3% but in women increased by 5%.

In this period, ASIR decreased globally, in America and Europe in men but this index increased globally, in Europe, and Africa, and decreased in America in women.

The main risk factor is tobacco smoking; however, genetic sensitivity, unhealthy eating, occupational exposure, air pollution, chronic bronchitis, emphysema, tuberculosis, pneumonia, asthma, and environmental carcinogens (arsenic, asbestos, and radon) are other risk factors that can act independently, or together, with smoking. ³⁰ , ³¹ Another study in Europe showed that lung cancer rates were increasing in female smokers but decreasing in male smokers over time. ³² Other studies reported that women who are heavy smokers had a higher risk of lung cancer than men. ³³ , ³⁴ It has also been found that sex hormones can be associated with lung cancer. ³⁵ However, gender differences are important and must be considered. For lung cancer, behavioral factors such as smoking and gender‐related factors such as genetic susceptibility, exposure to sex hormones and molecular characteristics may increase a woman's susceptibility. ³⁶ , ³⁷ , ³⁸

One of the modifiable risk factors is cigarette smoking and quitting smoking can reduce the risk of lung cancer by up to 50% in 10 years. ³⁹ Because TBL cancer risk factors have various distributions in different geographical areas, for the prevention of TBL cancer, first we must not only know the geographic and temporal patterns of lung cancer incidence and mortality but also the risk factors. Research on the risk factors must be done in different areas to focus intervention programs on dominant and important risk factors in each area. Since smoking is the most important risk factor for lung cancer, for effective prevention and management of lung cancer, the determination of the risk factors in smokers and nonsmokers should be a useful action. On the other hand, education, tax increase, and government legislation, such as prohibiting smoking and introducing packaging for cigarettes, can achieve better outcomes. ⁴⁰

In 2019, the highest ASIR (per 100 000) of TBL cancer was reported in Brunei Darussalam, China, the Republic of Korea, Turkey, and Taiwan. The lowest ASIR of TBL cancer was reported in Bangladesh, India, Bhutan, Nepal, and Saudi Arabia. Deng et al. showed that the incident cases, deaths, and DALYs of TBL cancer in China growth ranged from 140% to 240%. ⁴¹

According to the results in men and women, the highest number of TBL cancer deaths was in the age group of 70 to 74 years. The results of the study also showed that the number of TBL cancer deaths was higher in men than in women (1.28‐fold vs. 1.4‐fold). However, ASDR of TBL cancer in women increased by 2% but decreased in men by 6% from 2010 to 2019. Also in 2019, ASDR of TBL cancer in men was higher than in women. In the meantime, ASDR decreased globally, in America and Europe in men while this index was globally stable in women, but increased in Europe and Africa, and decreased in America. Zang et al. showed that at all levels of cigarette smoke exposure, women are consistently at a greater risk for developing major types of lung cancer than men. ⁴² This difference between men and women is probably due to the greater susceptibility of women to tobacco carcinogens. ⁴³ Other studies in developed countries consistent with this study showed that lung cancer mortality has increased rapidly in women, while it has remained constant or decreased in men. ⁴⁴ , ⁴⁵ It should be noted that the risks and pathophysiology of lung cancer in nonsmoker women are different compared to nonsmoker men. In Asia, 60%–80% of women with lung cancer have never smoked, while 10%–15% of men with lung cancer have never smoked. ⁴⁶ , ⁴⁷

In this study, the prevalence of TBL cancer was also assessed. According to the results, from 2010 to 2019 the prevalence of TBL cancer increased in men by 1.36‐fold and women by 1.36‐fold. In 2019, the prevalence of TBL cancer was approximately 57% in Asian countries. During this period, the ASPR of TBL cancer increased by 4% in men. This increase was higher (10%) in women. Also, in this period in men, ASPR decreased globally, in America and Europe and in women, this index increased globally, in Africa, and Europe; while decreasing in American countries. As the ASIR decreased in men and increased in women within this period, the ASPR increased more in women than in men (10% vs. 2%). However, there is no information about the duration of TBL cancer in men and women. In the meantime, the survival rate of TBL cancer should also be considered. Cao et al. showed that the survival rate of lung cancer is higher in women (47.3% vs. men 29.3%). ⁴⁸ Therefore, the higher survival rate of TBL cancer in women may be one of the reasons for the increased ASPR in this group.

The results showed that in this period, the number of DALY of TBL cancer in men and women increased 1.23‐ and 1.34‐fold, respectively. However, the age‐standardized DALY rate in men decreased by 7% and in women increased by 1%. In men, the age‐standardized DALY rate decreased globally, in America, Europe, and Africa and women this index decreased globally and in America, but increased in Africa and was stable in Europe. Other studies showed that due to the improvement of lung cancer treatment worldwide, the age‐standardized DALY rate of TBL cancer decreased in men and women. ⁴⁹ , ⁵⁰ TBL cancer is still considered an important public health burden as the survival rate of this cancer is quite poor. ⁵¹ As a consequence, early screening and detection have a major role in decreasing TBL mortality. ⁵² , ⁵³ According to the American Cancer Society recommendations, for people aged 55–74, low‐dose helical computed tomography (LDCT) should be done for the annual screening of lung cancer. As shown by screening programs, the incidence and mortality of lung cancer have significantly decreased. ⁵⁴ , ⁵⁵ Due to differences in equipment, resources, and skill of personnel, early detection rates differ, and to improve the detection rate, skilled personnel as well as the latest tools and equipment must be used.

In conclusion, most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures to reduce the process of this cancer is considered urgent. These plans should include reducing the risk factors exposure, starting or expanding the screening and diagnostic programs especially for high‐risk smoker men, and expanding treatment procedures.

As online data were used in this study, the possibility of errors in the stored data is a major limitation of the study, such as problems of quantifying all sources, delays in accessing data, and changes in coding practices over time, gaps in reliable cancer reporting, and registries in low‐SDI countries.

AUTHOR CONTRIBUTIONS

HS, AM, FR and LA designed and conceived the study. AM collected thedata. LA, AM, HS, and FR analyzed and interpreted the data. AM, AR, FR, LA, andHS, drafted the manuscript. HS, FR and AM provided administrative, technical,or material support. All authors contributed to the article and approved thesubmitted version.

Rezaei F, Mazidimoradi A, Rayatinejad A, Allahqoli L, Salehiniya H. Temporal trends of tracheal, bronchus, and lung cancer between 2010 and 2019, in Asian countries by geographical region and sociodemographic index, comparison with global data. Thorac Cancer. 2023;14(18):1668–1706. 10.1111/1759-7714.14912