ABSTRACT
BACKGROUND@#Large disparities exist in liver cancer burden trends across countries but are poorly understood. We aimed to investigate the global trajectories of liver cancer burden, explore the driving forces, and predict future trends.@*METHODS@#Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) trajectories were defined using growth mixture models. Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories. A Bayesian age-period-cohort model was used to predict future trends through 2035.@*RESULTS@#Three trajectories of liver cancer burden were identified: increasing, stable, and decreasing groups. Almost half of the American countries were classified in the decreasing group (48.6% for ASIR and ASMR), and the increasing group was the most common in the European region (ASIR, 49.1%; ASMR, 37.7%). In the decreasing group, the decrease of liver cancer due to hepatitis B contributed 63.4% and 60.4% of the total decreases in ASIR and ASMR, respectively. The increase of liver cancer due to alcohol use, hepatitis C, and hepatitis B contributed the most to the increase in the increasing group (30.8%, 31.1%, and 24.2% for ASIR; 33.7%, 30.2%, and 22.2% for ASMR, respectively). The increasing group was associated with a higher sociodemographic index, gross domestic product per capita, health expenditure per capita, and universal health coverage (all P <0.05). Significant variations in disease burden are predicted to continue through 2035, with a disproportionate burden in the decreasing group.@*CONCLUSION@#Global disparities were observed in liver cancer burden trajectories. Hepatitis B, alcohol use, and hepatitis C were identified as driving forces in different regions.
Subject(s)
Humans , Bayes Theorem , Liver Neoplasms , Risk Factors , Hepatitis C/complications , Hepatitis B , Hepacivirus , IncidenceABSTRACT
Objective:To analyze the changing trend of the incidence and mortality rates of liver cancer in the Chinese population from 1990 to 2019, and predict the future development trend of liver cancer.Methods:The descriptive epidemiologic method was conducted. Based on the Global Burden of Disease data from the Institute for Health Metrics and Evaluation at the University of Washington, the crude incidence rate and total number, crude mortality rate and total number, age- and sex-specific incidence rate and number, age- and sex-specific mortality rate and number of liver cancer in the Chinese population from 1990 to 2019 were collected. The age-standardized rate was calculated using the year 2000 China's standard population. Observation indicators: (1) the incidence and mortality of liver cancer in the Chinese population from 1990 to 2019; (2) changing trend of the age-standardized incidence and mortality rates of liver cancer in the Chinese population from 1990 to 2019; (3) prediction of the incidence and mortality of liver cancer in the Chinese population during 2020-2044. Count data were described as absolute numbers, percentages and ratios. The Joinpoint V.4.9.0.0 software was used to calculate the annual percent change (APC), average annual percent change (AAPC) and its 95% confidence interval ( CI) of age-standardized incidence and mortality rates of liver cancer in different time periods. The age-period-cohort model in the Nordpred package of R software (V.4.1.1) was used to predict the incidence and mortality of liver cancer in the Chinese population during 2020-2044. Results:(1) The incidence and mortality of liver cancer in the Chinese population from 1990 to 2019: the crude incidence rate and the age-standardized incidence rate of liver cancer in the Chinese population decreased from 20.01/100,000 and 24.31/100,000 in 1990 to 14.80/100,000 and 9.71/100,000 in 2019, respectively. The crude incidence rate and the age-standardized incidence rate of liver cancer in the Chinese male popula-tion decreased from 27.88/100,000 and 34.76/100,000 in 1990 to 22.05/100,000 and 15.22/100,000 in 2019, respectively. The crude incidence rate and the age-standardized incidence rate of liver cancer in the Chinese female population decreased from 11.63/100,000 and 13.51/100,000 in 1990 to 7.26/100,000 and 4.29/100,000 in 2019, respectively. The crude mortality rate and the age-standardized mortality rate of liver cancer in the Chinese population decreased from 19.64/100,000 and 23.97/100,000 in 1990 to 13.20/100,000 and 8.44/100,000 in 2019, respectively. The crude mortality rate and the age-standardized mortality rate of liver cancer in the Chinese male population decreased from 27.03/100,000 and 34.10/100,000 in 1990 to 19.18/100,000 and 13.03/100,000 in 2019, respectively. The crude mortality rate and the age-standardized mortality rate of liver cancer in the Chinese female population decreased from 11.78/100,000 and 13.64/100,000 in 1990 to 6.98/100,000 and 3.97/100,000 in 2019, respectively. (2) Changing trend of the age-standardized incidence and mortality rates of liver cancer in the Chinese population from 1990 to 2019: the trend of age-standardized incidence rate of liver cancer in the Chinese population could be divided into 5 periods, namely year 1990 to 1996, year 1996 to 2001, year 2001 to 2005, year 2005 to 2010 and year 2010 to 2019. In these 5 periods, the APC of age-standardized incidence rate changed from 1.27%(95% CI as 0.81% to 1.73%, P<0.001) to 1.12%(95% CI as 0.91% to 1.33%, P<0.001) of the total Chinese population, from 1.68%(95% CI as 1.19% to 2.17%, P<0.001) to 1.65%(95% CI as 1.42% to 1.87%, P<0.001) of the Chinese male population and from 0.21%(95% CI as -0.32 % to 0.75%, P=0.406) to -0.14%(95% CI as -0.40% to 0.11%, P=0.241) of the Chinese female population, respectively. The trend of age-standardized mortality rate of liver cancer in the Chinese population could be divided into 5 periods, namely year 1990 to 1996, year 1996 to 2000, year 2000 to 2005, year 2005 to 2012 and year 2012 to 2019. In these 5 periods, the APC of age-standardized mortality rate changed from 1.47%(95% CI as 0.74% to 2.20%, P=0.001) to 1.34%(95% CI as 0.78% to 1.90%, P<0.001) of the total Chinese population, from 1.96%(95% CI as 1.18% to 2.75%, P<0.001) to 1.79%(95% CI as 1.18% to 2.41%, P<0.001) of the Chinese male population and from 0.14%(95% CI as -0.54% to 0.82%, P=0.670 ) to 0.48%(95% CI as 0.02% to 0.93%, P=0.041) of the Chinese female population, respectively. From 1990 to 2019, the AAPC of age-standardized incidence and age-standardized mortality rates of liver cancer were -3.22%(95% CI as -3.41% to -3.03%) and -3.51%(95% CI as -3.82% to -3.19%) in the Chinese population, -2.90%(95% CI as -3.10% to -2.71%) and -3.22%(95% CI as -3.57% to -2.88%) in the Chinese male population, -3.96%(95% CI as -4.17% to -3.76%) and -4.13%(95% CI as -4.43% to -3.82%) in the Chinese female population, respectively. (3) Prediction of the incidence and mortality of liver cancer in the Chinese population during 2020-2044: the age-standardized incidence rate of liver cancer would decrease from 9.51/100,000 in 2015-2019 to 5.78/100,000 in 2040-2044 in the Chinese population, from 14.84/100,000 in 2015-2019 to 9.75/100,000 in 2040-2044 in the Chinese male population and from 4.28/100,000 in 2015-2019 to 1.88/100,000 in 2040-2044 in the Chinese female population, respectively. The age-standardized mortality rate of liver cancer would decrease from 8.40/100,000 in 2015-2019 to 4.62/100,000 in 2040-2044 in the Chinese population, from 12.91/100,000 in 2015-2019 to 7.59/100,000 in 2040-2044 in the Chinese male population and from 4.01/100,000 in 2015-2019 to 1.70/100,000 in 2040-2044 in the Chinese female population, respectively. The incidence number and mortality number of liver cancer from 2020 to 2044 would remain stable at around 160,000 per year and 140,000 per year in the Chinese population, 128,500 per year and 109,000 per year in the Chinese male population, 36,000 per year and 34,900 per year in the Chinese female population, respectively. Conclusion:The incidence and mortality rates of liver cancer in the Chinese popula-tion show a significant downward trend from 1990 to 2019, and the incidence number and mortality number of liver cancer in the Chinese population will remain stable above 100,000 during 2020-2044.
ABSTRACT
BACKGROUND@#The cancer burden in the United States of America (USA) has decreased gradually. However, China is experiencing a transition in its cancer profiles, with greater incidence of cancers that were previously more common in the USA. This study compared the latest cancer profiles, trends, and determinants between China and USA.@*METHODS@#This was a comparative study using open-source data. Cancer cases and deaths in 2022 were calculated using cancer estimates from GLOBOCAN 2020 and population estimates from the United Nations. Trends in cancer incidence and mortality rates in the USA used data from the Surveillance, Epidemiology, and End Results program and National Center for Health Statistics. Chinese data were obtained from cancer registry reports. Data from the Global Burden of Disease 2019 and a decomposition method were used to express cancer deaths as the product of four determinant factors.@*RESULTS@#In 2022, there will be approximately 4,820,000 and 2,370,000 new cancer cases, and 3,210,000 and 640,000 cancer deaths in China and the USA, respectively. The most common cancers are lung cancer in China and breast cancer in the USA, and lung cancer is the leading cause of cancer death in both. Age-standardized incidence and mortality rates for lung cancer and colorectal cancer in the USA have decreased significantly recently, but rates of liver cancer have increased slightly. Rates of stomach, liver, and esophageal cancer decreased gradually in China, but rates have increased for colorectal cancer in the whole population, prostate cancer in men, and other seven cancer types in women. Increases in adult population size and population aging were major determinants for incremental cancer deaths, and case-fatality rates contributed to reduced cancer deaths in both countries.@*CONCLUSIONS@#The decreasing cancer burden in liver, stomach, and esophagus, and increasing burden in lung, colorectum, breast, and prostate, mean that cancer profiles in China and the USA are converging. Population aging is a growing determinant of incremental cancer burden. Progress in cancer prevention and care in the USA, and measures to actively respond to population aging, may help China to reduce the cancer burden.