This study was aimed at analyzing temporal trends in lung cancer mortality from 2013 to 2021, and projecting future trends until 2030.

Mortality data were extracted from the China Causes of Death Surveillance Dataset, which covers 2.37 billion person-years. Age-standardized mortality rates (ASMRs) were calculated with Segi’s world standard population. Joinpoint regression was used to analyze temporal trends, and linear regression was applied to assess changes in mean age at death. A Bayesian age-period-cohort model was used to project mortality trends through 2030. Contributions of risk factors and demographic changes (population size and age structure) to mortality trends were decomposed with the population split method.

From 2013 to 2021, the crude lung cancer mortality rate increased by 2.3% annually, whereas the ASMR remained stable overall but showed significant 2.9% annual declines during 2015 and 2021. The ASMRs in urban areas (−2.9% per year) and eastern regions (−1.5% per year) showed significant decreasing trends throughout the entire period. The mean age at death increased across all areas, and the largest increases were observed in rural areas. Deaths among people ≥65 years of age rose by 1.6%–5.6% during the entire period. Decomposition analysis indicated that the increased death counts were driven primarily by population aging (32%–43%) and population growth (8%–31%), whereas risk factors contributed negatively (−3% to −29%). Projections suggested that the number of lung cancer deaths will reach approximately 760,200 by 2030, with continued increases in the crude mortality rate but slight declines in the ASMR.

The lung cancer burden in China shows marked regional disparities and challenges due to population aging. To further decrease lung cancer deaths, optimized allocation of medical resources, strengthened prevention and control of lung cancer risk factors, and integration of effective policies will be required.

This study aimed to analyze the temporal trends in cancer mortality in China from 2013–2021 and project the future trends through 2030.

This study was based on the China Causes of Death Surveillance Dataset, which covers 2.37 billion person-years. Age-standardized mortality rates (ASMRs) were calculated using Segi's world standard population and the trends were evaluated via Joinpoint regression. Bayesian age-period-cohort models were used for mortality projections. Contributions of demographic changes (population size and age structure) and risk factors to the mortality burden were quantified using the decomposition analysis.

The combined ASMRs for all cancers decreased annually by 2.3%, driven by significant declines in esophageal (4.8%), stomach (4.5%), and liver cancers (2.7%). In contrast, the pancreatic and prostate cancer ASMRs increased by 2.0% and 3.4% annually, respectively. Urban areas demonstrated a more rapid decline in the combined ASMRs for all cancers [average annual percent change (AAPC) = −3.0% in urban areas vs. −2.0% in rural areas], highlighting persistent disparities. Population aging contributed 20%–50% to death increases between 2013 and 2021. The combined ASMRs for all cancers, like the findings of temporal trend analyses, will continue to decrease and the regional (urban and rural) difference is projected to simulate that of the temporal trend through 2030. In fact, cancer deaths are projected to reach 2.4 million by 2030.

The cancer burden in China is facing the dual challenges of population aging and urban-rural disparities. It is necessary to prioritize rural screening, control risk factors, such as smoking and diet, and integrate more efficacious cancer prevention and control programmes into the policy to reduce mortality in the future.