Three-decade trends in risk factor-attributable cancer burden in China: insights from the Global Burden of Disease Study 2023.

[OBJECTIVE] 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.

[METHODS] 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.

[RESULTS] 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.

[CONCLUSION] 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.