Disease burden of liver cancer attributable to specific etiologies in China from 1990 to 2019: An age-period-cohort analysis

Abstract

Temporal trends of total liver cancer have been well reported in China, especially the trends caused by hepatitis B (HBV); however, the trends of liver cancer attributable to specific etiologies have rarely been reported in China. Thus, this study aims to describe the temporal trends in the incidence, mortality and DALYs of total and etiology-specific liver cancer in China from 1990 to 2019. We extracted the incidence, mortality and disability-adjusted life years (DALYs) of total and etiology-specific liver cancer in China from 1990 to 2019 from global disease burden (GBD) 2019. We plotted the trends in the age-standardized rates for incidence, mortality, and DALYs using locally weighted regression (LOESS)-smoothed data from 1990 to 2019. The age-standardized rate for the incidence of liver cancer was analyzed with an age-period-cohort method. The age-standardized rates for incidence, death, and DALYs decreased by −58.8%, −63.8%, and −65.6%, respectively, between 1990 and 2019. The age-standardized rates of incidence, mortality, and DALYs of total liver cancer showed similar temporal patterns, presenting an overall decline, with the average annual percentage change (AAPC) ranging from −3.3% to −3.8%. People in the period before 2007 had a higher risk, and people after 2007 had a lower risk. The cohort risk ratios (RRs) showed decreasing patterns, with the most rapid decline observed in the 1910 to 1960 cohorts. Our study generally revealed favorable decreasing trends for total and etiology-specific liver cancer in China from 1990 to 2019. Despite the overall decline in liver cancer due to heavy alcohol use and obesity from 1990 to 2019, there have been apparent upward trends since 2006. Planned population-wide interventions targeting heavy alcohol use and obesity may mitigate the increasing trends in liver cancer attributable to alcohol use and NASH.

Global pattern of trends in incidence, mortality, and mortality-to-incidence ratio rates related to liver cancer, 1990–2019: a longitudinal analysis based on the global burden of disease study

“…The rises were partly due to the increase in healthcare availability in recent years [ 47 ]. On the contrary, a Chinese study with a follow-up period of 30 years documented that people between ages of 15 and 49 years had a greater reduction in incidence and deaths from 1990 to 2019 compared with people at 50–69 years of age [ 27 ]. Overall, temporal trends in LC incidence and mortality rates among all age groups have been decreasing in the world throughout the study period which is reflective of improved therapeutic strategies.…”

“…The APC was computed as APC i = [(exp( β i )-1)] × 100 where β i states the slope of the trend segment. Subsequently, the AAPC was calculated as a geometrically weighted average of the different APCs with weights being equivalent to the length of each segment during the specified time interval [ 27 ].…”

Gender disparity and temporal trend of liver cancer in China from 1990 to 2019 and predictions in a 25-year period

“…In China, LC is the second leading cause of cancer deaths, and the first leading cause is lung cancer (7). From 1990 to 2019, LC incidence and mortality declined in China (8), but the disease burden remains high due to the large population in China. In 2019, approximately 39.4% of global LC cases occurred in China (9).…”

“…According to the Global Burden of Disease (GBD) 2019, more than 23 million HBV infections occurred in China in 2019, and 0.6 million for HCV infections. Due to the dynamics of socioeconomic, dietary, lifestyle and living conditions, there is a growing concern for the impact of other LC-associated risk factors such as obesity, smoking, alcohol use, and non-alcoholic steatohepatitis (8,(15)(16)(17). Therefore, it remains important to evaluate the epidemic burden of LC from current and future perspectives.…”

“…Because China has the largest number of LC cases among all countries (8), this study aims to evaluate the disease burden of LC in China and estimate the future trend of liver cancer from 2019 to 2044 based on a multinational collaborative project from the GBD2019 (18,19). This study will report epidemiological features of liver cancer and shed light on the management of liver cancer in China.…”