Background: Smoking and alcohol use are two common behaviors that affect human health. However, few studies have examined their association with risk of lung cancer with ecological data. Methods: The dependent variable was the estimate of world agestandardized incidence of lung cancer in 2018. Independent variables included the smoking prevalence by gender in 2010 and 2000, which considered potential latency of lung cancer, the rate of alcohol use by gender in 2010, and the gross domestic product (GDP) per capita in 2010 and 2000. A linear regression model was used for statistical data analysis. Results: Both simple and multiple linear regression analysis showed that the prevalence of women's smoking affected the incidence of lung cancer overall (t = 4.96; P < 0.0001), in men (t = 4.56; P < 0.0001) and in women (t = 3.22; P < 0.0001) even when socioeconomic development measured by the GDP per capita was adjusted. These associations were consistent in the overall (t = 4.59; P < 0.0001) and men (t = 3.37; P = 0.001), but stronger in women (t = 4.67; P < 0.0001) when the estimates of smoking prevalence in 2000 were used; and the GDP per capita was significantly associated with the incidence of lung cancer as well. Interestingly, the ratio of smoking prevalence between men and women in 2000 explained about 10% (P = 0.0006; R 2 = 0.097) of the variation in the ratio of lung cancer incidence between men and women even after adjusting for socioeconomic development. However, we did not find an association of alcohol use with the incidence of lung cancer at an aggregated level. Conclusion: At an aggregated level, the women's smoking prevalence is associated with the incidence of lung cancer and gender difference in smoking is associated with the ratio of lung cancer incidence between men and women, providing strong evidence for the relationship of smoking and lung cancer.