Benchmarking progress in cause-specific cancers in China: a nationwide analysis of premature mortality from 1990 to...

The United Nations passed Sustainable Development Goal 3.4 (SDG 3.4), which aims to reduce by one-third premature mortality from noncommunicable diseases, including cancer, by 2030. However, there is still no comprehensive assessment of the historical trends and projections in premature cancer mortality nationally, regionally, and by cancer type.

We estimated premature mortality by sex, age, and 33 provinces for China using the results of the Global Burden of Disease Study 2023. The premature mortality from total cancers and 29 cancer types was estimated for ages 30-69 years, using standard life table methods. The average annual rate of change was calculated to examine the past trends in premature mortality from 1990 to 2023. We further assessed whether historical trends would be sufficient to meet the SDG 3.4 targets for reducing premature mortality by 2030.

Over the period from 1990 to 2023, the cancer-related premature mortality declined from 13.11% to 6.66% (AAPC = -1.93%, 95% CI = -2.20% to -1.66%). In particular, stomach cancer (AAPC = -3.80%, 95% CI = -4.18% to -3.42%), esophageal cancer (AAPC = -3.40%, 95% CI = -3.75% to -3.06%), nasopharynx cancer (AAPC = -3.55%, 95% CI = -4.03% to -3.07%), and Hodgkin's lymphoma (AAPC = -4.89%, 95% CI = -5.12% to -4.66%) showed higher rates of decline. However, increasing premature mortality from pancreatic, breast, and kidney cancers was documented among males in northern, northeastern, and northwestern China. The causes of greatest premature mortality were lung cancer (1.97%), stomach cancer (0.98%), colon and rectum cancer (0.65%), esophageal cancer (0.65%), and liver cancer (0.48%) throughout the study period. In 2023, cancer-related premature mortality peaked in Heilongjiang (11.44%), followed by Chongqing (11.15%), Sichuan (10.49%), Liaoning (10.26%), and Shandong (10.00%) for males. Heilongjiang (6.63%), Jilin (5.63%), Liaoning (5.44%), Xinjiang (5.37%), and Inner Mongolia (4.98%) comprised the five provinces with the highest premature cancer mortality among females. Whereas cancer-related premature mortality declined at an average annual rate of 2.05% from 1990 to 2023, meeting the SDG 3.4 targets necessitates a future decline, 1.3 times faster. Hubei (2.89%), Shanghai (2.75%), and Hong Kong (2.71%) exhibited the fastest decline rates and were projected to meet the SDG 3.4 targets based on current trends.

From 1990 to 2023, the probability of dying from cancers declined across all provinces in China. Cancers with primary prevention or early detection strategies in place, such as stomach cancer, colorectal cancer, and cervical cancer, were performing better in premature mortality compared with cancers that lack such strategies, such as kidney cancer, multiple myeloma and pancreatic cancer.

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