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. 2022 Sep 23;101(38):e30614.
doi: 10.1097/MD.0000000000030614.

Time trends and geographic distribution of hepatocellular carcinoma in Brazil: An ecological study

Elizabeth Balbi  1   2 , Jessica Pronestino de Lima Moreira  3 , Ronir Raggio Luiz  3 , Renata de Mello Perez  1   4 , Heitor Siffert Pereira de Souza  1   4
Affiliations

Time trends and geographic distribution of hepatocellular carcinoma in Brazil: An ecological study

Elizabeth Balbi et al. Medicine (Baltimore). .

Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing globally, and HCC is the fourth leading cause of cancer-related death. This ecological study aimed to investigate the time trends and geographic distribution of HCC in Brazil. Data from the Brazilian Health Public System were retrospectively collected from January 2005 to December 2018. Hospitalization and intrahospital lethality rates for HCC were stratified by age and sex. Hospitalization rates and associated lethality per 100,000 inhabitants in each municipality were included in a worksheet to build maps displaying the estimates and the geographic distribution of HCC. From 2005 to 2018, a total of 75,466 admissions for HCC were registered and the mean hospitalizations increased from 2.1 to 5.8/100,000 inhabitants (176%). The greatest increase occurred among patients older than 50, particularly in males above 70 years old. Prevalence rates increased throughout the country, with the highest levels detected in the South and Southeast. However, the increase was proportionally higher in the Northeast (377%), especially in municipalities not integrated into metropolitan regions. The HCC lethality rate remained relatively stable in both sexes, ranging from 21% to 25% (19%), but it was higher among older patients. The length of hospital stay did not differ between survivors and nonsurvivors throughout the study period. HCC hospitalizations are rising, particularly above 50 years of age and in rural areas, not paralleled by lethality rates. This suggests ongoing changes in environmental and socioeconomic factors in Brazil.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Hepatocellular carcinoma hospitalizations (A) and intrahospital lethality (B) by sex, in Brazil from 2005 to 2018. Rates were calculated by dividing the total number of hospitalizations by the resident population and adjusted according to the total available hospital beds.
Figure 2.
Figure 2.
Age-stratified HCC hospitalizations by sex, estimated in Brazil from 2005 to 2018. Rates were calculated by dividing the total number of hospitalizations by the resident population and adjusted according to the total available hospital beds.
Figure 3.
Figure 3.
Age-stratified HCC lethality rates (%) by sex, estimated from intrahospital deaths in Brazil from 2005 to 2018.
Figure 4.
Figure 4.
HCC hospitalizations (A) and intrahospital lethality (B) in the 5 Brazilian macroregions in 2005 and 2018. Rates were calculated by dividing the total number of hospitalizations by the resident population and adjusted according to the total available hospital beds.
Figure 5.
Figure 5.
Geographic distribution of hepatocellular carcinoma in Brazil according to the municipal hospitalization rates (per 100,000 inhabitants) in 2005 and 2018. Standardized rates defined the following 3 ranges: <5, 5–15, and >15. CW indicates Central West; N, North; NE, Northeast; S, South; SE, Southeast.
Figure 6.
Figure 6.
Geographic distribution of hepatocellular carcinoma lethality in Brazil according to municipal rates of intrahospital deaths in 2005 and 2018. Standardized rates defined the following 4 ranges: <25%, 25%–49.9%, 50%–75%, and >75%. CW indicates Central West; N, North; NE, Northeast; S, South; SE, Southeast.
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References

    1. Mortality GBD, Causes of Death C. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544. - PMC - PubMed
    1. Balogh J, Victor D, 3rd, Asham EH, et al. . Hepatocellular carcinoma: a review. J Hepatocell Carcinoma. 2016;3:41–53. - PMC - PubMed
    1. Ryerson AB, Eheman CR, Altekruse SF, et al. . Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer. 2016;122:1312–37. - PMC - PubMed
    1. Globocan. Cancer incidence, mortality and prevalence worldwide. Globocan 2012. 2012.
    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90. - PubMed