Twenty-year sociodemographic trends in lung cancer in non-smokers: A UK-based cohort study of 3.7 million people

Introduction: There are reports that lung cancer in non-smokers (LCINS) is increasing in the United Kingdom (UK) and other high-income countries but evidence from large-scale cohort studies to support this claim is limited. Material and methods: Using The Health Improvement Network (THIN) IQVIA (TM) Medical Research Data, we identified a cohort of 3,679,831 people from the UK self-reporting to their primary care physician as never or non-smokers. We estimated age-adjusted incidence rates for recorded lung cancer before (1998 - 2007) and after (2008 - 2018) the introduction of smoke-free legislation using multivariable Poisson regression. We also explored the impact of geographic location, social deprivation and urbanicity. Results: The analysis included 3,212 lung cancer events and 28 million person-years (PYs). Between 1998 and 2007, the age-adjusted rates in men declined by 9% per year (95 %CI: 7-11%) from an estimated 5.6 to 1.5 per 10,000 PYs and by 3% per year (95 %CI: 1-5%) between 2008 and 2018. These trends for men were similar across sociodemographic strata. Between 1998 and 2007, age-adjusted rates were stable for women at 1.5 per 10,000 PYs. However, there was evidence that time trends for women differed depending on levels of social deprivation with rates increasing by 5% per year (95 %CI: 2-9%) from an estimated 1.3-2.1 per 10,000 PYs for women living in the least socially deprived areas. Sex-specific time trends from 2008 to 2016 were broadly similar in a separate cohort of self-reported never smokers from UK Biobank with cancer events linked to national registries. Conclusion: In summary, the incidence of LCINS has reduced or remained stable for most of the UK with the possible exception of women living in the least socially deprived areas.