Abstract: Background　Background: Lung cancer represents a significant global public health concern. China, as one of the countries experiencing the highest burden of lung cancer, exhibits incidence and mortality trends shaped by a confluence of environmental, economic, and behavioral determinants, with notable regional variability. A comprehensive understanding of the spatiotemporal determinants of lung cancer burden, along with the development of targeted prevention and control strategies, is essential for the realization of the "Healthy China 2030" initiative. Objective　This study aims to analyze and forecast trends in lung cancer incidence and mortality in China from 1990 to 2035, investigate the spatial heterogeneity effects of regional environmental and economic factors on lung cancer trends, and offer targeted prevention and control recommendations. Methods　Utilizing data from the Global Burden of Disease (GBD) study, the Age-Period-Cohort (APC) model, Joinpoint Regression (JPR) model, and Holt’s Exponential Smoothing model were employed to identify trend inflection points. Environmental factors, such as PM2.5 and industrial pollution, along with economic factors, including per capita GDP and healthcare resources, were incorporated into the analysis using the Spatial Durbin Model to examine regional heterogeneity. Additionally, Holt’s Exponential Smoothing model was employed to forecast trends up to the year 2035. Results　 The findings indicate that, according to the JPR model, from 1990 to 2021, the age-standardized rate (ASR) of lung cancer incidence in China rose by 0.94% annually (95% CI: 0.87–1.01), while the ASR of mortality increased by 0.38% annually (95% CI: 0.31–0.45), both demonstrating significant spatial clustering (P < 0.05). The ASR in the Beijing-Tianjin-Hebei and Northeast regions exceeded the national average by 28%–35%. Key contributors to these trends were identified as PM2.5 exposure (β = 1.15, 95% CI: 1.02–1.28) and insufficient healthcare resources (β = -0.74, 95% CI: -0.89–-0.59). Notably, the incidence growth rate in females (AAPC = 1.15%) was significantly higher than that in males (AAPC = 0.85%). Projections suggest that by 2035, the national ASR will reach 46.18 per 100,000 (95% CI: 15.88–76.49), and the mortality ASR will attain 38.26 per 100,000 (95% CI: 7.56–68.97), with regional disparities anticipated to further expand.Conclusion　The disease burden attributable to lung cancer in China is projected to escalate by 2035. It is imperative to prioritize early screening, diagnosis, and treatment of cancer, particularly among individuals over 60 years of age with chronic conditions, in order to meet the objectives of the Healthy China 2030 initiative.

Key words: Lung cancer, Incidence trends, Mortality trends, Environmental exposure, High-risk subgroups, Targeted prevention and control

摘要： 背景　肺癌是全球重大公共卫生问题，中国作为肺癌负担最重的国家之一，其发病与死亡趋势受环境、经济及行为因素的多重影响，且存在显著区域异质性。解析肺癌疾病负担的时空驱动机制及提出精准防控策略，对实现“健康中国2030”目标至关重要。目的　分析并预测1990—2035年中国肺癌发病及死亡趋势，探讨区域环境与经济因素对肺癌流行趋势的空间异质性影响，提出精准防控建议。方法　基于全球疾病负担（GBD）数据，采用年龄-时期-队列（APC）模型、联结点回归（JPR）模型及Holt指数平滑模型识别趋势转折点；整合环境（PM2.5、工业污染）、经济（人均GDP、医疗资源）数据，利用空间杜宾模型解析区域异质性；通过Holt指数平滑模型预测2035年趋势。结果　JPR模型1990—2021年中国肺癌发病年龄标化率（age-standardized rate，ASR）年均增长0.94%（95%CI：0.87~1.01），死亡ASR增长0.38%（95%CI：0.31~0.45），且呈显著空间聚集性（均P < 0.05）；京津冀及东北地区ASR较全国均值高28%~35%，PM2.5暴露（β = 1.15, 95%CI：1.02~1.28）与医疗资源不足（β = -0.74, 95%CI：-0.89~-0.59）是主要驱动因素。女性发病率增速（AAPC=1.15%）显著高于男性（AAPC=0.85%）。预测到2035年，全国ASR将达46.18/10万（95%CI：15.88~76.49），死亡ASR将达到38.26/10万（95%CI：7.56~68.97），区域差异进一步扩大。结论　中国肺癌疾病负担呈现“北高南低”的空间分异特征，环境暴露与医疗资源不均是关键驱动因素。建议针对高风险区域（北方工业区）及人群（女性患者）实施精准筛查，以降低健康不平等，助力国家癌症防控目标实现。

关键词: 肺癌, 发病趋势, 死亡趋势, 环境暴露, 高风险亚群, 精准防控