Three-decade trends in risk factor-attributable cancer burden in China: insights from the Global Burden of Disease...

Cancer remains a major public health concern in China, with modifiable risk factors contributing substantially to its burden. However, comprehensive evaluations of long-term, hierarchical risk trends are limited. This study assessed cancer burden attributable to risk factors in China from 1990 to 2023 using data from the Global Burden of Disease Study 2023.

Cancer deaths, disability-adjusted life years (DALYs), age-standardized mortality rates, and age-standardized DALY rates (ASDR) attributable to level 1 (behavioral, metabolic, and environmental/occupational) and level 2 risk factors were analyzed to characterize temporal, sex-, and age-specific patterns. Comparative effect sizes between level 1 categories were quantified using prevalence ratios with 95% uncertainty intervals.

From 1990 to 2023, cancer deaths attributable to risk factors increased by 74.1%, reaching 1.28 million, while age-standardized mortality rates and ASDR declined by 36.2 and 24.2%, respectively. Behavioral risks consistently imposed the greatest burden, producing 7.65 times more deaths than metabolic risks and 4.29 times more than environmental/occupational risks in 2023. Tobacco remained the leading individual risk factor, whereas high BMI - particularly in males - showed the steepest increase, and alcohol use declined among females. Tracheal, bronchus, and lung cancer had the highest risk-attributable ASDR, and multiple myeloma showed the largest rise since 1990. Cancer burden peaked at ages 70-74 years, with males experiencing substantially higher mortality and DALY rates than females.

Despite declining age-standardized rates, the rising absolute burden of risk factor-attributable cancers underscores the need for strengthened tobacco control, obesity prevention, and environmental health interventions.