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. 2017 Dec 1;3(12):1683-1691.
doi: 10.1001/jamaoncol.2017.3055.

The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015

Global Burden of Disease Liver Cancer Collaboration; Tomi Akinyemiju  1 , Semaw Abera  2   3 , Muktar Ahmed  4 , Noore Alam  5   6 , Mulubirhan Assefa Alemayohu  7 , Christine Allen  8 , Rajaa Al-Raddadi  9 , Nelson Alvis-Guzman  10 , Yaw Amoako  11 , Al Artaman  12 , Tadesse Awoke Ayele  13 , Aleksandra Barac  14 , Isabela Bensenor  15 , Adugnaw Berhane  16 , Zulfiqar Bhutta  17   18 , Jacqueline Castillo-Rivas  19 , Abdulaal Chitheer  20 , Jee-Young Choi  21 , Benjamin Cowie  22 , Lalit Dandona  8   23 , Rakhi Dandona  8   23 , Subhojit Dey  24 , Daniel Dicker  8 , Huyen Phuc  25 , Donatus U. Ekwueme  26 , Maysaa El Sayed Zaki  27 , Florian Fischer  28 , Thomas Fürst  29   30   31 , Jamie Hancock  8 , Simon I. Hay  8 , Peter Hotez  32   33 , Sun Ha Jee  34 , Amir Kasaeian  35 , Yousef Khader  36 , Young-Ho Khang  37 , Anil Kumar  38 , Michael Kutz  8 , Heidi Larson  39 , Alan Lopez  8   40 , Raimundas Lunevicius  41   42 , Reza Malekzadeh  43 , Colm McAlinden  44 , Toni Meier  45 , Walter Mendoza  46 , Ali Mokdad  8 , Maziar Moradi-Lakeh  47   48 , Gabriele Nagel  49 , Quyen Nguyen  25 , Grant Nguyen  8 , Felix Ogbo  50   51 , George Patton  52 , David M. Pereira  53 , Farshad Pourmalek  54 , Mostafa Qorbani  55 , Amir Radfar  56 , Gholamreza Roshandel  57 , Joshua A Salomon  58 , Juan Sanabria  59   60 , Benn Sartorius  61 , Maheswar Satpathy  62   63 , Monika Sawhney  64 , Sadaf Sepanlou  43 , Katya Shackelford  8 , Hirbo Shore  65 , Jiandong Sun  66 , Desalegn Tadese Mengistu  67 , Roman Topór-Mądry  68   69 , Bach Tran  70   71 , Kingsley Nnanna Ukwaja  72 , Vasiliy Vlassov  73 , Stein Emil Vollset  74   75 , Theo Vos  8 , Tolassa Wakayo  76 , Elisabete Weiderpass  77   78   79 , Andrea Werdecker  80 , Naohiro Yonemoto  81 , Mustafa Younis  82   83 , Chuanhua Yu  84 , Zoubida Zaidi  85   86 , Liguo Zhu  87 , Christopher J. L. Murray  8 , Mohsen Naghavi  8 , Christina Fitzmaurice  8   88
Affiliations

The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015

Global Burden of Disease Liver Cancer Collaboration et al. JAMA Oncol. .

Abstract

Importance: Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use.

Objective: To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes.

Design, Settings, and Participants: Mortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs.

Main Outcomes and Measures: Liver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year.

Results: There were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies.

Conclusions and Relevance: Liver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.

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Conflict of interest statement

Conflict of Interest Disclosures: Prof Larson reports that her research group has received funding from GlaxoSmithKline (GSK) and Merck to convene research symposia, as well as funding from GSK for advising on vaccine hesitancy issues. Prof Larson also reports that she has served on the Merck Vaccines Strategic Advisory Board. Dr Mendoza reports that he is currently the Program Analyst at the United Nations Population Fund Country Office in Peru, an institution that does not necessarily endorse this study. No other disclosures are reported.

Figures

Figure 1.
Figure 1.. Relative Changes in Age-Standardized Liver Cancer Mortality Between 1990 and 2015 for Both Sexes in 195 Countries and Territories
ATG indicates Antigua and Barbuda; BRB, Barbados; COM, Comoros; DMA, Dominica; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MHL, Marshall Islands; MLT, Malta; MUS, Mauritius; TLS, Timor-Leste; TON, Tonga; TTO, Trinidad and Tobago; SGP, Singapore; SLB, Soloman Islands; SYC, Seychelles; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; and WSM, Samoa (formerly Western Samoa).
Figure 2.
Figure 2.. Contribution of Hepatitis B, Hepatitis C, Alcohol, and Other Causes on Absolute Liver Cancer Deaths, Both Sexes, Globally and by Region, 2015
SDI indicates sociodemographic index.
See this image and copyright information in PMC

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