Projected epidemiological trends and burden of liver cancer by 2040 based on GBD, CI5plus, and WHO data

Abstract

Incidence of liver cancer as one of the most common cancers worldwide and become the significant contributor for the mortality among cancer patients. The disease burden, risk factors, and trends in incidence and mortality of liver cancer globally was described subsequently estimated the projections of liver cancer incidence or mortality by 2040. Data regarding age-standardized incidence and mortality rates for liver cancer was obtained from multiple databases, including GLOBOCAN 2020, CI5 volumes I-XI, WHO mortality database, and Global Burden of Disease (GBD)-2019. Concentrating on worldwide variations, this thorough analysis offers insights into patterns of incidence and mortality based on gender and age. Our findings encompass significant indicators, including age-standardized rates (ASRs), average annual percentage change (AAPC), and future projections extending up to the year 2040. Liver cancer holds the sixth position in terms of most frequently diagnosed cancers and stands as the sixth leading cause of cancer-related deaths worldwide in 2020, accounting for 905,677 new cases and 782,000 fatalities. Additionally, liver cancer contributed to 12,528,421 age-standardized disability-adjusted life years (DALYs), with an age-standardized DALYs rate of 161.92 in 2019 worldwide. The age-specific incidence rates exhibited significant variations across different regions, showing a fivefold difference in males and females. A significant increase in incidence was observed in North Europe and Asia, while North African countries reported a higher mortality burden (ASR, 10 per 100,000) compared to developed countries. Since last few years, the incidence and mortality rates have increased and attained Annual Average Percentage Change (AAPC) incidence rate of 7.7 (95% CI 3.9-11.6) for men and the highest AAPC mortality rate of 12.2 (95% CI 9.5-15.0) for women. In 2019, Western Europe emerged as the high-risk region for DALYs related to smoking and alcohol consumption, while high-income North America carried a high risk for DALYs associated with a high body-mass index. The projected trend indicates a surge in new liver cancer incident cases, expected to rise from around 905,347 to an estimated 1,392,474 by 2040. This study described the evidence pertinent to higher incidence trends in liver cancer, particularly among both young and older adults, encompassing males and females, as well as those who are HIV-infected and HBsAg positive. A significant rise in the young population poses a significant public health concern that warrants attention from healthcare professionals to prioritize the promotion of health awareness and the development of effective cancer prevention strategies, particularly in many developing countries.

Keywords: 2040 Projections rates; Age standardized mortality rate; CI5 volumes I–XI; GBD database; Gender; HDI; Liver cancer; WHO database.

Fig. 1

Liver cancer-related incidence and mortality rates estimates in 2020 for different age groups among males or females. (A) Age-standardized incidence rates (ASIR) and (B) Age-standardized mortality rates (ASMR).

Fig. 2

Significantly, a nonlinear correlation was observed between HBsAg and ASIRs. The ASIR of liver cancer exhibited a notable increasing trend with the increase in HBsAg prevalence until it reached 13.

Fig. 3

While a direct relationship between HIV and ASIR was not directly observed, the creation of a generalized additive model (GAM) incorporating HBsAg and HIV described an increasing trend in HBsAg as HIV prevalence increased, up to the point where HIV prevalence reached 1.

Fig. 4

(A) Among the male population, liver cancer incidence surged in 32 countries, with Average Annual Percent Changes (AAPCs) spanning from 0.3 to 7.7. (B) In the case of women in Iceland, Ireland, and Australia, the age-standardized incidence rates (ASIRs) demonstrated annual increases of 5.3%, 5.0%, and 4.1%, respectively. In gender-specific subgroups, more countries exhibited a downward trend for women than for men.

Fig. 5

(A, B) Liver cancer incidence rates have risen in nations with high age-standardized incidence rates (ASIRs), and a significant increase has been observed in nations with the lowest ASIRs, particularly among individuals aged over 60 years.

Fig. 6

(A, B) The age-standardized mortality rates (ASMRs) for liver cancer showed a significant decline (AAPC, − 10.9 [95% CI − 17.0 to − 4.3]) among the individuals aged 60 and older in Bahrain. Although there was a general increase in rates for female patients in various regions, more than half of the countries reported a decreasing AAPC of ASMRs, with decline ranging from 0.2 to 4.5%.

Fig. 7

(A, B) Among men, liver cancer Disability-Adjusted Life Years (DALYs) in most regions were primarily linked to hepatitis B and alcohol use, while almost all were attributed to hepatitis C for women, except for Sub-Saharan Africa, Southeast Asia, East Asia, and Oceania, where hepatitis B played a significant role. High-income Asia Pacific showed a higher prevalence of liver cancer DALYs, reaching 491.4%. Globally, smoking, alcohol use, and high body-mass index were major contributors to age-standardized DALYs, constituting proportions of 16.96%, 19%, and 12.88%, respectively. These contributions were generally higher in males compared to females, particularly for smoking and alcohol use.

Fig. 8

(A, B) Estimated number of new liver cancer cases and deaths from 2020 to 2040. Predicted number of new liver cancer cases and deaths by HDI classification, assuming seven scenarios of annual change in global rates between 2020 and 2040, for both sexes and all age groups (0–85+). Countries or regions with low HDI are projected to experience a significant increase of 101% in both incidence and mortality pertinent to liver cancer from 2020 to 2040, highlighting their increased vulnerability. Conversely, high HDI countries are expected to see a substantial increase of 150.2% in both incidence and mortality among individuals aged 75 years and older by 2040, based on GLOBOCAN global rates estimated in 2020.

Fig. 9

(A–D) In case of ASIR during 2020 remains unchanged, the future projections of liver cancer cancers is anticipated to enhanced in both sexes; mainly, the regions in transitional economies with minimal HDI resulted in a higher vulnerability, accompanied by the typical raise of 101% in both incidence as well as mortality from the period of 2020 to 2040. In case of nations with high HDI are expected to be associated with a greater enhancement in both incidence and morality by 2040 typically among the individuals of age greater than 75 years depending on global rates estimated in 2020.

Fig. 10

Projected trends of liver cancer incidence and mortality by 2040 depending on the low HDI, medium HDI, high HDI and very high HDI and the projection predictions are encompassed in the range of each representing annual changes in ASRs ranging from − 3% to + 3%.