了解吸烟和其他危险因素对肺腺癌 (ADC) 发病率的影响是否因性别而异，将为肺癌预防策略提供信息。 评估台湾女性的年龄和肿瘤分期特异性肺 ADC 发病率是否高于男性无论吸烟状况如何（即曾经吸烟或从不吸烟）。这项基于人群的队列研究使用了台湾癌症登记处 (TCR) 1979 年至 2019 年合成的数据集； 2011年至2019年的TCR长表（TCRLF），提供个人水平的吸烟和肿瘤分期信息； 1985年至2019年台湾死因数据库（TCOD）； 2000年至2020年国家健康保险研究数据库（NHIRD）； 2011年至2019年内部统计月报（MBIS）； 2001年、2005年、2009年、2013年和2017年全国健康访谈调查；和台湾生物银行2008年至2021年的数据。纳入的患者年龄为40至84岁，并且在2011年1月1日至2019年12月31日期间患有任何浸润性肺癌。吸烟状况。主要结果是年龄特定的女性与男性之间的差异按吸烟状况和肿瘤分期划分的肺 ADC 发生率比 (IRR)。使用 TCR、TCOD、NHIRD、台湾国民健康访问调查和 MBIS 的关联数据来估计 2011 年至 2019 年年中按吸烟状况划分的无癌症个体的年龄和性别人数。使用 TCR 和 TCRLF，估计了 2011 年至 2019 年按吸烟状况划分的特定年龄、性别、肿瘤分期和诊断年份的肺 ADC 患者数量。 共有 61285 名患者（32599 名女性 [53.2% ]) 2011 年至 2019 年间，台湾约有 2,300 万人口中年龄 40 至 84 岁（平均 [SD] 年龄，64.66 [10.79] 岁）的人被诊断出患有侵袭性肺 ADC，这是他们一生中首次罹患癌症。在吸烟者中，男性的患病率更高几乎所有检查指标的烟草使用情况，包括近两倍的平均吸烟包年数（例如，30-34 岁男性为 7.87 [8.30]，30-34 岁女性为 4.38 [5.27]）。对于 40 至 84 岁之间的 5 岁年龄组，几乎所有年龄组中，女性肺 ADC 的发病率均显着高于男性，无论肿瘤分期和吸烟状况如何（例如，对于 70-74 岁年龄组，女性从不吸烟者中晚期肺 ADC 的男性 IRR 为 1.38 [95% CI, 1.30-1.50]）。在这项队列研究中，台湾地区女性的年龄和分期特异性肺 ADC 发病率高于男性。从不吸烟和曾经吸烟的人，这表明性别之间对吸烟以外的危险因素的暴露程度可能存在差异，并且性别对 ADC 危险因素的潜在影响。需要进一步的工作来确定这种模式是否在其他人群中复制，发现肺 ADC 的原因，并采取预防措施。

Knowing whether the effects of smoking and other risk factors with lung adenocarcinoma (ADC) incidence varies by sex would provide information on lung cancer prevention strategies.To evaluate whether women in Taiwan have higher age- and tumor stage-specific lung ADC incidence rates than men irrespective of smoking status (ie, ever smoker or never smoker).This population-based cohort study used data sets synthesized from the Taiwan Cancer Registry (TCR) from 1979 to 2019; the TCR Long Form (TCRLF) from 2011 to 2019, which provides individual-level smoking and tumor stage information; the Taiwan Cause of Death Database (TCOD) from 1985 to 2019; the National Health Insurance Research Database (NHIRD) from 2000 to 2020; the Monthly Bulletin of Interior Statistics (MBIS) from 2011 to 2019; the National Health Interview Survey from 2001, 2005, 2009, 2013, and 2017; and Taiwan Biobank data from 2008 to 2021. Included patients were aged 40 to 84 years and had any invasive lung cancer from January 1, 2011, to December 31, 2019.Smoking status.The main outcomes were age-specific female-to-male incidence rate ratios (IRRs) of lung ADC by smoking status and tumor stage. Linked data from the TCR, TCOD, NHIRD, Taiwan National Health Interview Survey, and MBIS were used to estimate the age- and sex-specific numbers of cancer-free individuals at midyears from 2011 to 2019 by smoking status. Using the TCR and TCRLF, age-, sex-, tumor stage-, and diagnosis year-specific numbers of patients with lung ADC from 2011 to 2019 by smoking status were estimated.A total of 61 285 patients (32 599 women [53.2%]) aged 40 to 84 years (mean [SD] age, 64.66 [10.79] years) in the Taiwanese population of approximately 23 million were diagnosed with invasive lung ADC as their first lifetime cancer between 2011 and 2019. Among smokers, men had higher tobacco use by almost all examined metrics, including nearly twice the mean (SD) number of pack-years smoked (eg, 7.87 [8.30] for men aged 30-34 years vs 4.38 [5.27] for women aged 30-34 years). For 5-year age bands between 40 and 84 years, incidence of lung ADC was significantly higher among females than males for nearly all age groups irrespective of tumor stage and smoking status (eg, for the age group 70-74 years, the female-to-male IRR for late-stage lung ADC among never smokers was 1.38 [95% CI, 1.30-1.50]).In this cohort study, women had higher age- and stage-specific lung ADC incidence rates than men in Taiwan for both never and ever smokers, suggesting the possibility of differential exposures between sexes to risk factors other than smoking and the potential modification of ADC risk factors by sex. Further work is needed to determine whether this pattern replicates in other populations, discover the causes of lung ADC, and put preventive measures in place.