Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2022; 28(21): 2361-2382
Published online Jun 7, 2022. doi: 10.3748/wjg.v28.i21.2361
Socioeconomics and attributable etiology of primary liver cancer, 1990-2019
Qing-Qing Xing, Jing-Mao Li, Xuan Dong, Dan-Yi Zeng, Zhi-Jian Chen, Xiao-Yun Lin, Jin-Shui Pan
Qing-Qing Xing, Xuan Dong, Dan-Yi Zeng, Zhi-Jian Chen, Xiao-Yun Lin, Jin-Shui Pan, Department of Hepatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian Province, China
Qing-Qing Xing, Xuan Dong, Dan-Yi Zeng, Zhi-Jian Chen, Xiao-Yun Lin, Jin-Shui Pan, Hepatology Research Institute, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Jing-Mao Li, Department of Statistics, Xiamen University, Xiamen 361000, Fujian Province, China
Xuan Dong, Dan-Yi Zeng, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
Author contributions: Pan JS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; Pan JS was responsible for its conception and design; Xing QQ, Li JM, Dong X, Zeng DY, Chen ZJ, and Lin XY were responsible for the acquisition, analysis, or interpretation of data; Pan JS drafted the manuscript; Li JM and Dong X made critical revision of the manuscript for important intellectual content; Li JM and Pan JS conducted the data analysis; Xing QQ, Li JM, and Dong X contributed equally to the study.
Supported by the National Natural Science Foundation of China, No. 81871645 (to Pan JS).
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of First Affiliated Hospital of Fujian Medical University (MTCA, ECFAH of FMU[2015]084-1).
Informed consent statement: Not required.
Conflict-of-interest statement: All authors report no conflicts interests.
Data sharing statement: All data are available in the Supplementary material.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Shui Pan, MD, PhD, Chief Doctor, Professor, Department of Hepatology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou 350005, Fujian Province, China. j.s.pan76@fjmu.edu.cn
Received: October 18, 2021
Peer-review started: October 18, 2021
First decision: December 27, 2021
Revised: January 7, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: June 7, 2022
Processing time: 227 Days and 5.4 Hours
Abstract
BACKGROUND

Primary liver cancer (PLC) is a major contributor to cancer-related deaths. Data on global and country-specific levels and trends of PLC are essential for understanding the effects of this disease and helping policymakers to allocate resources.

AIM

To investigate the association between the burden of PLC and socioeconomic development status.

METHODS

Cancer mortality and incidence rates were obtained from the Global Burden of Disease (GBD) 2019, and the data were stratified by country and territory, sex, and the Socio-demographic Index (SDI) level. The association between the attributable etiology of PLC and socioeconomic development status, represented using the SDI, was described. The attributable etiology of PLC included hepatitis B, hepatitis C, alcohol use, and nonalcoholic steatohepatitis. The association between the attributable etiology of PLC and SDI was further stratified by sex and geographical location. A confidence analysis was also performed based on bootstrap draw.

RESULTS

The age-standardized incidence rate of PLC was 6.5 [95% confidence intervals (CI): 5.9-7.2] per 100000 person-years, which decreased by -27.5% (-37.0 to -16.6) from 1990 to 2019. Several countries located in East Asia, South Asia, West Africa, and North Africa shouldered the heaviest burden of PLC in 2019. In terms of incidence rates, the first leading underlying cause of PLC identified was hepatitis B, followed by hepatitis C, alcohol use, and nonalcoholic steatohepatitis. Regarding stratification using the SDI, the incidence rate of PLC was the highest for high and middle SDI locations. Further, the leading attributable etiologies of PLC were hepatitis B for the middle and high middle SDI locations while hepatitis C and nonalcoholic steatohepatitis for the high SDI locations.

CONCLUSION

The pronounced association between socioeconomic development status and PLC burden indicates socioeconomic development status affects attributable etiologies for PLC. GBD 2019 data are valuable for policymakers implementing PLC cost-effective interventions.

Keywords: Epidemiology; Public health; Socioeconomics; Primary liver cancer; Hepatitis; Alcohol

Core Tip: Primary liver cancer (PLC) is a common cancer with high morbidity and mortality rates. PLC usually occurs as a preventable disease. An association was identified between socioeconomic development status and PLC burden. The leading attributable etiologies of PLC were hepatitis B for the middle and high middle Socio-demographic Index (SDI) locations, and hepatitis C and nonalcoholic steatohepatitis for the high SDI locations. Our findings are valuable to implement tailored prevention strategies for PLC.