Disease burden of liver cancer in China from 1997 to 2016: an observational study based on the Global Burden of Diseases

Abstract

Objective: To evaluate the trends in disease burden and the epidemiological features of liver cancer in China while identifying potential strategies to lower the disease burden.

Design: Observational study based on the Global Burden of Diseases.

Participants: Data were publicly available and de-identified and individuals were not involved.

Measurement and methods: To measure the liver cancer burden, we extracted data from the Global Health Data Exchange using the metrics of prevalence, incidence, mortality and disability-adjusted life years (DALYs). Joinpoint and negative binomial regressions were applied to identify trends and risk factors.

Results: From 1997 to 2016, the prevalence, incidence, mortality and DALYs of liver cancer in China were from 28.22/100 000 to 60.04/100 000, from 27.33/100 000 to 41.40/100 000, from 27.40/100 000 to 31.49/100 000 and from 10 311 308 to 11 539 102, respectively. The prevalence, incidence and mortality were increasing, with the average annual percent changes (AAPCs) of 4.0% (95% CI 3.9% to 4.2%), 2.1% (95% CI 2.0% to 2.2%) and 0.5% (95% CI 0.2% to 0.9%), respectively. Meanwhile, the rate of DALYs was stable with the AAPCs of -0.1% (95% CI -0.4% to 0.3%). The mortality-to-incidence ratio of liver cancer decreased from 1.00 in 1997 to 0.76 in 2016 (β=-0.014, p<0.0001). Males (OR: 2.98, 95% CI 2.68 to 3.30 for prevalence, OR: 2.45, 95% CI 2.21 to 2.71 for incidence) and the elderly individuals (OR: 1.57, 95% CI 1.55 to 1.59 for prevalence, OR: 1.58, 95% CI 1.56 to 1.60 for incidence) had a higher risk. Hepatitis B accounted for the highest proportion of liver cancer cases (55.11%) and deaths (54.13%).

Conclusions: The disease burden of liver cancer continued to increase in China with viral factors as one of the leading causes. Strategies such as promoting hepatitis B vaccinations, blocking the transmission of hepatitis C and reducing alcohol consumption should be prioritised.

Keywords: disease burden; epidemics; liver cancer; risk factors.

Figure 1

Observed and age-adjusted rates (ARs) of liver cancer from 1997 to 2016 in China. (A) The prevalence and ARs of liver cancer; (B) the incidence and ARs of liver cancer; (C) the mortality and ARs of liver cancer; (D) the observed and age-adjusted DALYs and rates of DALYs of liver cancer. DALYs, disability-adjusted life years.

Figure 2

Disease burden of liver cancer among different gender groups from 1997 to 2016 in China. (A) The differences in prevalence between males and females; (B) the differences in incidence between males and females; (C) the differences of mortality between males and females; (D) the differences in DALYs between males and females. DALYs, disability-adjusted life years.

Figure 3

Disease burden of liver cancer among different age groups from 1997 to 2016 in China. (A) The changes in prevalence of liver cancer among different age groups; (B) the changes in incidence of liver cancer among different age groups; (C) the changes in mortality of liver cancer among different age groups; (D) the changes in rates of DALYs for liver cancer among different age groups. DALYs, disability-adjusted life years.

Figure 4

Changes in mortality-to-incidence (MI) ratio of liver cancer among different genders from 1997 to 2016 in China.