Lifetime risk of respiratory system cancers across 185 countries: Global variation, socioeconomic inequalities, and ecological associations with air pollution

Abstract

Objective To estimate the lifetime risks of developing and dying from respiratory system cancers across 185 countries and territories and to examine their associations with socioeconomic development and air pollution. Methods GLOBOCAN 2022 data for 185 countries and territories were combined with United Nations life tables to estimate lifetime risks using an adjusted-for-multiple-primaries framework. Country-level air pollution indicators for 2022 were obtained from OpenWeather. Estimates were stratified by Human Development Index (HDI) and World Bank income groups, and associations between lifetime risk and PM2.5, PM10, NO2, and SO2 were assessed using univariable linear regression. Results Globally, the lifetime risk of developing and dying from lung cancer was 4.92% and 4.08%, respectively, far exceeding those for laryngeal cancer (0.33% and 0.20%). A marked socioeconomic gradient was identified: lung cancer incidence risk ranged from 0.34% in low-HDI countries to 5.45% in very high-HDI countries. All four pollutants were positively associated with lifetime risk, with PM2.5 showing the strongest correlation in the primary univariable analyses. Conclusions Substantial geographic and socioeconomic disparities exist in respiratory cancer lifetime risk, with lung cancer as the dominant driver. The observed ecological associations with air pollutants support further investigation of environmental factors in cancer prevention.