New insights into lung cancer risks in middle-aged and older Chinese adults: A CHARLS prospective cohort study with...

Lung cancer represents a significant public health burden in China; however, prospective studies on nationally representative risk factors are limited.

This study identifies novel risk factors for lung cancer in middle-aged and older Chinese adults using prospective cohort data, with validation through multi-source methods.

The study analyzed 14,964 cancer-free participants from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). Cox proportional hazards models were used to evaluate demographic, lifestyle, comorbidity, and environmental factors. External validation included the NHANES cohort (n = 20,278), bibliometric analysis (21,820 papers), and single-center hospital data (200 cases/200 controls).

Key risk factors identified include urban residence (HR = 2.71, p = 0.014), diabetes (HR = 2.84, 95 % CI: 1.06-7.63), smoking behavior (each year of delayed smoking cessation increases risk by 4.8 %, each additional cigarette daily raises risk by 4.0 %), and biomass cooking fuel (HR = 5.98, p = 0.083). External validation confirmed the smoking metrics; however, the diabetes-lung cancer association was absent in the NHANES cohort. PM2.5 was also validated as a significant risk factor.

Urban residence, diabetes, and smoking behaviors (cessation age/daily quantity) are identified as novel lung cancer risk factors in Chinese adults. The study supports tailored interventions focusing on air quality, metabolic management, and personalized smoking cessation programs, with individualized smoking assessments rather than a simple "smoker/non-smoker" classification.