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. 2022 Mar;11(5):1357-1370.
doi: 10.1002/cam4.4530. Epub 2022 Jan 6.

The burden of primary liver cancer caused by specific etiologies from 1990 to 2019 at the global, regional, and national levels

Jianqing Yang  1 , Guangdong Pan  1 , Linjing Guan  2 , Zhipeng Liu  3 , Yongrong Wu  1 , Zhen Liu  1 , Wuchang Lu  1 , Shuai Li  1 , Honglai Xu  1 , Guoqing Ouyang  1
Affiliations

The burden of primary liver cancer caused by specific etiologies from 1990 to 2019 at the global, regional, and national levels

Jianqing Yang et al. Cancer Med. 2022 Mar.

Abstract

Background: Liver cancer is one of the most common cancers worldwide. We aimed to report the burden of liver cancer at the global, regional, and national levels in 204 countries from 1990 to 2019, stratified by etiology, sex, age, and sociodemographic index (SDI).

Methods: Data of mortality, incidence, and disability-adjusted life years (DALYs) of liver cancer and its etiology were available from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2019. The trends in the liver cancer burden were assessed by the annual percentage change. All estimates are presented as numbers and age-standardized rates (ASRs) per 100,000 population, with uncertainty intervals (UIs).

Results: Globally, 484,577 (95% UI 444,091-525,798) mortalities, 534,364 (486,550-588,639) incident cases, and 12,528,422 (11,400,671-13,687,675) disability-adjusted life years (DALYs) due to liver cancer occurred in 2019. The ASRs were 5.95 (5.44-6.44), 6.51 (5.95-7.16), and 151.08 (137.53-164.8) per 100,000 population for the mortalities, incidences, and DALYs, respectively. From 1990 to 2019, the numbers increased, whereas the ASRs decreased. Hepatitis B and Hepatitis C are the major causes of liver cancer mortality. The liver cancer mortality in 2019 increased with age, peaking at 65-69 and 70-74 age group in males and females, respectively, and the number was higher in males than in females. Generally, there were nonlinear associations between the ASR and SDIs values at the regional and national levels. China had the highest numbers of mortalities, incident cases, and DALYs, whereas Mongolia has the highest ASR in 2019.

Conclusion: Liver cancer remains a major public health issue worldwide, but etiological and geographical variations exist. It is necessary to increase awareness of the population regarding liver cancer, its etiologies and the importance of early detection, and diagnosis and treatment.

Keywords: disability-adjusted life years; global burden of disease; incidence; liver cancer; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Number of mortality and ASMR at the global level by etiology of primary liver cancer, 1990–2019. LCHB, liver cancer due to hepatitis B. LCHC, liver cancer due to hepatitis C. LCAU, liver cancer due to alcohol use. LCNA, liver cancer due to NASH. LCOC, liver cancer due to other cause. ASMR, age‐standardized mortality rate
FIGURE 2
FIGURE 2
Age‐standardized mortality rate for liver cancer, by region and etiology, 2019. LCHB, liver cancer due to hepatitis B. LCHC, liver cancer due to hepatitis C. LCAU, liver cancer due to alcohol use. LCNA, liver cancer due to NASH. LCOC, liver cancer due to other cause
FIGURE 3
FIGURE 3
Contribution of LCHB, LCHC, LCAU, LCNA, and LCOC to primary liver cancer mortality, both sexes, globally and by region, 2019. LCHB, liver cancer due to hepatitis B. LCHC, liver cancer due to hepatitis C. LCAU, liver cancer due to alcohol use. LCNA, liver cancer due to NASH. LCOC, liver cancer due to other cause
FIGURE 4
FIGURE 4
The global age‐standardized rate of primary liver cancer per 100,000 populations in 2019, by country and territory. (A) ASMR in 2019; (B) ASIR in 2019; and (C) ASDR in 2019. ASMR, age‐standardized mortality rate. ASIR, age‐standardized incidence rate. ASDR, age‐standardized DALYs rate
FIGURE 5
FIGURE 5
Global primary liver cancer mortality by etiology and age for females and males, 2019. For each group, the left column showed case data in female and the right column shows data in male. LCHB, liver cancer due to hepatitis B. LCHC, liver cancer due to hepatitis C. LCAU, liver cancer due to alcohol use. LCNA, liver cancer due to NASH. LCOC, liver cancer due to other cause
FIGURE 6
FIGURE 6
ASMR of primary liver cancer by SDI: (A) ASMR in global and 21 GBD regions, 1990–2019. (B) ASMR in 204 countries and territories, 2019. Expected values based on sociodemographic index and disease rates in all locations are shown as the black line. ASMR, age‐standardized mortality rate; GBD, global burden of diseases, injuries, and risk factors study; SDI, sociodemographic index
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