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. 2023 Jan 17;15(1):6.
doi: 10.1186/s13098-022-00976-w.

Estimates and trends of the global burden of NASH-related liver cancer attributable to high fasting plasma glucose in 1990-2019: analysis of data from the 2019 Global Burden of Disease Study

Ziyi Li  1 , Na Yang  1 , Liyun He  1 , Jialu Wang  1 , Fan Ping  1 , Wei Li  1 , Lingling Xu  1 , Huabing Zhang  2 , Yuxiu Li  3
Affiliations

Estimates and trends of the global burden of NASH-related liver cancer attributable to high fasting plasma glucose in 1990-2019: analysis of data from the 2019 Global Burden of Disease Study

Ziyi Li et al. Diabetol Metab Syndr. .

Abstract

Background: Experimental and epidemiological studies have indicated an association between diabetes exposure and an increased risk of liver cancer due to nonalcoholic steatohepatitis (NASH). However, to date, no systematic study has specifically investigated the burden of NASH-related liver cancer due to exposure to high fasting plasma glucose (HFPG) levels worldwide.

Methods: The number and rate of deaths and disability-adjusted life years (DALYs) from HFPG-induced NASH-related liver cancer were estimated based on the results of the 2019 Global Burden of Disease Study. The estimated annual percentage changes (EAPCs) for age-standardized death or DALYs rates were calculated using a generalized linear model with a Gaussian distribution to quantify the temporal trends in the global burden of NASH-related liver cancer attributable to HFPG. The strength and direction of the association between the sociodemographic index (SDI) and death or DALY rate were measured using Spearman's rank-order correlation.

Results: Globally, approximately 7.59% of all DALY and 8.76% of all mortalities of NASH-related liver cancer in 2019 were due to HFPG. The age-standardized death and DALY rates of NASH-related liver cancer attributable to HFPG increased from 1990 to 2019. The corresponding EAPCs were 0.69 (95% UI 0.48-0.89), and 0.30 (95% UI 0.05-0.56), respectively. This increasing pattern was most obvious in the high- and low-SDI regions. The age-standardized mortality and DALYs rate of NASH-related liver cancer attributable to HFPG varies considerably worldwide, with the middle SDI region having the highest death and DALY rates in 2019 (DALY 0.96 [95% UI 0.23-2.18]; death 0.05 [95% UI 0.01-0.11]).

Conclusion: The burden of NASH-related liver cancer attributable to HFPG has increased over the past three decades, particularly in regions with high and low SDI.

Keywords: Disability-adjusted life years; Global disease burden; High fasting plasma glucose; Liver cancer; Mortality; Nonalcoholic steatohepatitis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The global disease burden of NASH-related liver cancer attributable to HFPG for different age groups. A The deaths number of NASH-related liver cancer attributable to HFPG for different age group in 1990 and 2019; B The ASMR of NASH-related liver cancer attributable to HFPG for different age group in 1990 and 2019; C The DALYs number of NASH-related liver cancer attributable to HFPG for different age group in 1990 and 2019; D The ASDR of NASH-related liver cancer attributable to HFPG for different age group in 1990 and 2019. NASH: nonalcoholic steatohepatitis; ASMR, age-standardized mortality rate; DALYs, disability adjusted life years; ASDR, age-standardized DALYs rate; SDI: socio-demographic index; EPAC: estimated annual percentage changes
Fig. 2
Fig. 2
Temporal trend in the deaths, DALYs, YLDs, and YLLs rate of NASH-related liver cancer attributable to HFPG for different SDI regions, 1990–2019. NASH: non-alcoholic fatty liver disease; SDI: socio-demographic index; HFPG: high fasting plasma glucose; ASR, age-standardized rate; DALYs, disability adjusted life years; YLLs: Years of Life Lost; YLDs: Years Lived with Disability; NASH: nonalcoholic steatohepatitis
Fig. 3
Fig. 3
Temporal trend of the PAFs of the NASH-related liver cancer burden attributable to HFPG, 1990–2019. NASH: nonalcoholic steatohepatitis; SDI: socio-demographic index; HFPG: high fasting plasma glucose; DALYs, disability adjusted life years; YLLs: Years of Life Lost; YLDs: Years Lived with Disability. PAF: population attributable fraction
Fig. 4
Fig. 4
The correlation between EAPC and ASR in 1990. A The correlation between EAPC and ASR of NASH-related liver cancer deaths attributable to HFPG in 1990. B The correlation between EAPC and ASR of NASH-related liver cancer DALYs in 1990. The circles represent countries that were available on data. The size of circle is increased with the death or DALY cases of NASH-related liver cancer. NASH: nonalcoholic steatohepatitis; HFPG: high fasting plasma glucose; ASR, age-standardized rate; EAPC, estimated annual percentage change
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