Disease burden of liver cancer in China from 1997 to 2016: an observational study based on the Global Burden of Diseases

OBJECTIVE: To evaluate the trends in disease burden and the epidemiological features of liver cancer in China while identifying potential strategies to lower the disease burden. DESIGN: Observational study based on the Global Burden of Diseases. PARTICIPANTS: Data were publicly available and de-identified and individuals were not involved. MEASUREMENT AND METHODS: To measure the liver cancer burden, we extracted data from the Global Health Data Exchange using the metrics of prevalence, incidence, mortality and disability-adjusted life years (DALYs). Joinpoint and negative binomial regressions were applied to identify trends and risk factors. RESULTS: From 1997 to 2016, the prevalence, incidence, mortality and DALYs of liver cancer in China were from 28.22/100 000 to 60.04/100 000, from 27.33/100 000 to 41.40/100 000, from 27.40/100 000 to 31.49/100 000 and from 10 311 308 to 11 539 102, respectively. The prevalence, incidence and mortality were increasing, with the average annual percent changes (AAPCs) of 4.0% (95% CI 3.9% to 4.2%), 2.1% (95% CI 2.0% to 2.2%) and 0.5% (95% CI 0.2% to 0.9%), respectively. Meanwhile, the rate of DALYs was stable with the AAPCs of −0.1% (95% CI −0.4% to 0.3%). The mortality-to-incidence ratio of liver cancer decreased from 1.00 in 1997 to 0.76 in 2016 (β=−0.014, p<0.0001). Males (OR: 2.98, 95% CI 2.68 to 3.30 for prevalence, OR: 2.45, 95% CI 2.21 to 2.71 for incidence) and the elderly individuals (OR: 1.57, 95% CI 1.55 to 1.59 for prevalence, OR: 1.58, 95% CI 1.56 to 1.60 for incidence) had a higher risk. Hepatitis B accounted for the highest proportion of liver cancer cases (55.11%) and deaths (54.13%). CONCLUSIONS: The disease burden of liver cancer continued to increase in China with viral factors as one of the leading causes. Strategies such as promoting hepatitis B vaccinations, blocking the transmission of hepatitis C and reducing alcohol consumption should be prioritised.