Objective  To explore temporal-spatial distribution and risk factors of lung cancer mortality risk in Heilongjiang province, and to provide evidences for prevention and control of lung cancer.

  Methods  We collected the data on lung cancer and chronic obstructive pulmonary disease (COPD) mortality in Heilongjiang province from 2008 through 2017 and relevant data on demographics, ambient air pollutants, social economic development were also collected simultaneously. Integrated nested Laplace approximation-based Bayesian spatio-temporal model was used to estimate annual prefecture-specific and district/county-specific standardized mortality ratio (SMR) of lung cancer and to analyze relative risks of lung cancer mortality attributed to various known risk factors.

  Results   During the 10-year period in the province, the lung cancer mortality risk generally increased significantly, although the spatio-temporal pattern of lung cancer SMR was different in different districts/counties. From 2008 to 2017 among 132 districts/counties of the province, the number of district/county with higher lung cancer mortality risk (relative risk RR > 1.0 compared to overall risk of the province) increased from 9 to 69. The prefecture-specific age-standarized mortality rate (ASMR) of COPD was positively associated with the SMR of lung cancer (RR for all = 1.10, 95% confidence interval 95% CI: 1.04 – 1.16; RR for males = 1.09, 95% CI: 1.03 – 1.16; RR for females = 1.10, 95% CI: 1.04 – 1.16). No significant associations were observed between the SMR of lung cancer and other factors including the proportion of the population over 60 years old, annual cigarette consumption per capita (lag 20 years), particulate matter ≤ 2.5 μm in mean aerodynamic diameter (lag 8 years), regional gross domestic production per capita (lag 10 years), the proportion of employed population in urban mining industry (lag 5 years) and the proportion of agricultural population (lag 20 years). A 1/100 000 increment in ASMR of COPD was associated with a 0.34% (95% CI = 0.22% – 0.46%) increase in district/county-specific SMR of lung cancer for all population; while for male and female population, the increase were 0.29% (95% CI: 0.19% – 0.40%) and 0.33% (95% CI: 0.20% – 0.46%), respectively.

  Conclusion  The overall risk of lung cancer mortality was significantly increased from 2008 to 2017 in Heilongjiang province and COPD may be an important risk factor for the mortality. The results suggest that lung cancer screening should be carried out in COPD patients for effective prevention and control of lung cancer mortality.