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. 2023 Apr;29(2):433-452.
doi: 10.3350/cmh.2022.0316. Epub 2023 Jan 4.

Global burden of primary liver cancer and its association with underlying aetiologies, sociodemographic status, and sex differences from 1990-2019: A DALY-based analysis of the Global Burden of Disease 2019 study

Sungchul Choi  1 , Beom Kyung Kim  2   3   4 , Dong Keon Yon  5 , Seung Won Lee  6 , Han Gyeol Lee  1 , Ho Hyeok Chang  1 , Seoyeon Park  1 , Ai Koyanagi  7   8 , Louis Jacob  7   9 , Elena Dragioti  10 , Joaquim Radua  11   12   13 , Jae Il Shin  14 , Seung Up Kim  2   3   4 , Lee Smith  15
Affiliations

Global burden of primary liver cancer and its association with underlying aetiologies, sociodemographic status, and sex differences from 1990-2019: A DALY-based analysis of the Global Burden of Disease 2019 study

Sungchul Choi et al. Clin Mol Hepatol. 2023 Apr.

Abstract

Background/aims: Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019.

Methods: The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions.

Results: The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY.

Conclusion: Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase.

Keywords: Aetiology; Global burden; Incidence; Mortality; Primary liver cancer.

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Conflict of interest statement

Conflicts of Interest

Seung Up Kim has served as an advisory committee member Gilead Sciences, Bayer, Eisai, and Novo Nordisk. He is a speaker for Gilead Sciences, GSK, Bayer, Eisai, Abbvie, EchoSens, MSD, Eisai, Otsuka, and Bristol-Myers Squibb. He has also received a research grant from Abbvie and Bristol-Myers Squibb. The other authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
Global burden of liver cancer. (A) World map of age-standardized disease-adjusted life year (DALY) rates (per 100,000 population) of liver cancer at the country level in 2019, (B) rates (per 100,000 population) of age-standardized and all-age DALYs of liver cancer at the global level between 1990 and 2019, and (C) rates (per 100,000 population) of age-standardized and all-age mortality from liver cancer at the global level from 1990 to 2019. Green line denotes age-standardized rates and orange line all-age rates.
Figure 2.
Figure 2.
Burden of liver cancer in the Republic of Korea. (A) Rates (per 100,000 population) of age-standardized and all-age disease-adjusted life years (DALYs) of liver cancer in the Republic of Korea between 1990 and 2019 and (B) DALY rates (per 100,000 population) of liver cancer based on aetiology in the Republic of Korea from 1990 to 2019. Additional data on liver cancer burden in the Republic of Korea is shown in Supplementary Figures 24-39. NASH, non-alcoholic steatohepatitis; NAFLD, non-alcoholic fatty liver disease.
Figure 3.
Figure 3.
Global trends of liver cancer based on aetiology from 1990 to 2019. (A) Disease-adjusted life year (DALY) rates (per 100,000 population) of liver cancer based on aetiology at the global level from 1990 to 2019 and (B) mortality rates (per 100,000 population) of liver cancer based on aetiology at the global level from 1990 to 2019. Age-standardized incidence rate data is shown in Supplementary Figure 7. NASH, non-alcoholic steatohepatitis; NAFLD, non-alcoholic fatty liver disease.
Figure 4.
Figure 4.
Global burden of liver cancer caused by hepatitis B virus (HBV). (A) World map of age-standardized disease-adjusted life year (DALY) rates (per 100,000 population) of liver cancer caused by HBV at the country level in 2019, (B) age-standardized DALY rates (per 100,000 population) of liver cancer due to HBV at the sociodemographic index (SDI) regional level, (C) age-standardized mortality rates (per 100,000 population) of liver cancer due to HBV at the SDI regional level (Age-standardized incidence rate data is shown in Supplementary Fig. 8), (D) number and age-standardized DALY rates (per 100,000 population) of liver cancer caused by HBV at the global level from 1990 to 2019 (number and Age-standardized rate of incidence is shown in Supplementary Fig. 9), and (E) number and DALY rates (per 100,000 population) of liver cancer caused by HBV at the global level by age group in 2019 (number and Age-standardized rate of mortality is shown in Supplementary Fig. 10).
Figure 5.
Figure 5.
Global burden of liver cancer caused by hepatitis C virus (HCV). (A) World map of age-standardized disease-adjusted life year (DALY) rates (per 100,000 population) of liver cancer caused by HCV at the country level in 2019, (B) age-standardized DALY rates (per 100,000 population) of liver cancer caused by HCV at the sociodemographic index (SDI) regional level, (C) age-standardized mortality rates (per 100,000 population) of liver cancer caused by HCV at the SDI regional level (Age-standardized incidence rate data is shown in Supplementary Fig. 11), (D) number and age-standardized DALY rates (per 100,000 population) of liver cancer caused by HCV at the global level from 1990 to 2019 (number and age-standardized rate of incidence is shown in Supplementary Fig. 12), and (E) number and DALY rates (per 100,000 population) of liver cancer due to HCV at the global level based on age group in 2019 (number and Age-standardized rate of mortality is shown in Supplementary Fig. 13).
Figure 6.
Figure 6.
Global burden of liver cancer caused by alcohol consumption. (A) World map of Age-standardized disease-adjusted life year (DALY) rates (per 100,000 population) of liver cancer caused by alcohol consumption at the country level in 2019, (B) age-standardized DALY rates (per 100,000 population) of liver cancer caused by alcohol consumption at the sociodemographic index (SDI) regional level, (C) Age-standardized mortality rates (per 100,000 population) of liver cancer caused by alcohol consumption at the SDI regional level (Age-standardized incidence rate data is shown in Supplementary Fig. 14), (D) number and age-standardized DALY rates (per 100,000 population) of liver cancer caused by alcohol consumption at the global level from 1990 to 2019 (number and Age-standardized rate of incidence is shown in Supplementary Fig. 15), and (E) number and DALY rates (per 100,000 population) of liver cancer caused by alcohol consumption at the global level based on age group in 2019 (number and Age-standardized rate of mortality is shown in Supplementary Fig. 16).
Figure 7.
Figure 7.
Global burden of liver cancer caused by non-alcoholic steatohepatitis/non-alcoholic fatty liver disease (NASH/NAFLD). (A) World map of age-standardized disease-adjusted life year (DALY) rates (per 100,000 population) of liver cancer caused by NASH/NAFLD at the country level in 2019, (B) age-standardized DALY rates (per 100,000 population) of liver cancer caused by NASH/NAFLD at the sociodemographic index (SDI) regional level, (C) age-standardized mortality rates (per 100,000 population) of liver cancer caused by NASH/NAFLD at the SDI regional level (Age-standardized incidence rate data is shown in Supplementary Fig. 17), (D) number and age-standardized DALY rates (per 100,000 population) of liver cancer caused by NASH/NAFLD at the global level from 1990 to 2019 (number and age-standardized rate of incidence is shown in Supplementary Fig. 18), and (E) number and DALY rates (per 100,000 population) of liver cancer caused by NASH/NAFLD at the global level based on age group in 2019 (number and Age-standardized rate of mortality is shown in Supplementary Fig. 19).
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