Temporal evolution of liver cancer etiology in China, 1990-2021: insights from the Global Burden of Disease Study 2021.
Primary liver cancer constitutes a significant public health issue in China. The hepatitis B virus (HBV) remains the primary etiological agent of liver cancer, whereas the role of metabolic liver diseases, particularly non-alcoholic steatohepatitis (NASH), is escalating. It is imperative to examine the temporal progression of liver cancer etiology to establish a scientifically grounded framework for developing targeted prevention and control strategies tailored to China's national context. This study aims to utilize the Global Burden of Disease (GBD) 2021 database to systematically evaluate the temporal trends in the liver cancer disease burden in China from 1990 to 2021, analyze the changing contributions of different etiologies [including HBV, hepatitis C virus (HCV), and NASH], assess the impact of sociodemographic factors, and predict future trends, thereby providing a scientific basis for formulating targeted prevention and control strategies tailored to China's national context.
This study performed long-term, large-scale time-series trend comparisons of liver cancer burden in China from 1990 to 2021, focusing on five primary etiologies (HBV, HCV, alcohol consumption, NASH, and other causes) using the GBD 2021 database. The Joinpoint regression model identified trend inflection points, while the age-period-cohort (APC) model elucidated the determinants of disease burden. The Slope Index of Inequality (SII) and Concentration Index (CI) assessed the correlation between various disease burden indicators and the Socio-Demographic Index (SDI), and the Autoregressive Integrated Moving Average (ARIMA) and Bayesian Age-Period-Cohort (BAPC) models were employed for future burden projections.
Between 1990 and 2021, the age-standardized incidence rate (ASIR) of liver cancer in China experienced a modest decline [estimated annual percentage change (EAPC) =-0.31], while the total number of cases escalated significantly (+103.91%), with aging contributing to a 141.91% rise in disability-adjusted life years (DALYs). The incidence of HBV-associated liver cancer diminished dramatically (ASIR EAPC =-0.55), whereas NASH-associated liver cancer escalated rapidly (ASIR EAPC =0.73). China, categorized as a medium-to-high SDI region, exhibits a greater incidence of liver cancer and various etiologies of the disease compared to other regions with equivalent SDI levels. Future forecasts indicate that liver cancer connected with alcohol consumption and NASH may persist in increasing.
The prevention and management of HBV infection in China have been efficient; however, the prevalence of metabolic illnesses in the etiology of liver cancer has escalated, and aging alongside population expansion has positively contributed to the increasing burden of liver cancer.
This study performed long-term, large-scale time-series trend comparisons of liver cancer burden in China from 1990 to 2021, focusing on five primary etiologies (HBV, HCV, alcohol consumption, NASH, and other causes) using the GBD 2021 database. The Joinpoint regression model identified trend inflection points, while the age-period-cohort (APC) model elucidated the determinants of disease burden. The Slope Index of Inequality (SII) and Concentration Index (CI) assessed the correlation between various disease burden indicators and the Socio-Demographic Index (SDI), and the Autoregressive Integrated Moving Average (ARIMA) and Bayesian Age-Period-Cohort (BAPC) models were employed for future burden projections.
Between 1990 and 2021, the age-standardized incidence rate (ASIR) of liver cancer in China experienced a modest decline [estimated annual percentage change (EAPC) =-0.31], while the total number of cases escalated significantly (+103.91%), with aging contributing to a 141.91% rise in disability-adjusted life years (DALYs). The incidence of HBV-associated liver cancer diminished dramatically (ASIR EAPC =-0.55), whereas NASH-associated liver cancer escalated rapidly (ASIR EAPC =0.73). China, categorized as a medium-to-high SDI region, exhibits a greater incidence of liver cancer and various etiologies of the disease compared to other regions with equivalent SDI levels. Future forecasts indicate that liver cancer connected with alcohol consumption and NASH may persist in increasing.
The prevention and management of HBV infection in China have been efficient; however, the prevalence of metabolic illnesses in the etiology of liver cancer has escalated, and aging alongside population expansion has positively contributed to the increasing burden of liver cancer.