Global trends and regional differences in the burden of cancer attributable to secondhand smoke in 204 countries and territories, 1990-2019

Background: To describe the status quo and trends of the global burden of all cancers caused by secondhand smoke during 1990-2019. Methods: : Data on cancer associated with secondhand smoke were extracted from the Global Heath Data Exchange (GHDx). Cancer burden was measured by cancer-related deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Absolute numbers and age-standardized rates (per 100,000 people) were reported for all indicators. Estimated percentage changes in age-standardized rates by age, sex, region and Socio-demographic Index (SDI) were calculated to describe the temporal trends in cancer burden. Results: : In 2019, age-standardized rates of death, DALYs, and YLLs among the cancer population globally due to secondhand smoke were 1.60, 38.54, and 37.77, respectively, the proportions of which in the total cancer burden for all risk factors combined decreased slightly from 1990 to 2003 and then increased from 2004 to 2019. In 2019, over 50% of the cancer burden was concentrated in adults aged 55-75 for men and 50-70 for women. Between 1990 and 2019, there was an increase in age-standardized rates of death, DALYs, YLDs, and YLLs among those aged 70 years or older. The age-standardized YLDs rate attributable to secondhand smoke was higher among women; it decreased in men but increased in women, causing a wider gap between the two sexes. A greater cancer burden was mainly seen in North American countries in 1990 and in European countries in 2019. Reductions in the annual rate change of cancer burden were found mainly in North America and Oceania, while increases were found in Africa and Asia. In 2019, high-middle SDI countries and middle SDI countries had higher age-standardized rates of deaths, DALYs, YLDs and YLLs than the global level. During 1990 and 2019, the largest decline in cancer burden was seen in high SDI countries, while middle or lower SDI countries experienced increases in all age-standardized rates. Conclusion: Cancer burden attributable to secondhand smoke is concerning given the increasing health loss and differences in the distribution of cancer burden worldwide. Further studies are needed to investigate the causes of disparities in cancer burden attributable to secondhand smoke and to improve understanding of the contribution of secondhand smoke to the burden of different types of cancer. Trial registration: Retrospectively registered.