Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past seve...Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.展开更多
In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cance...In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.展开更多
In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for...In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.展开更多
Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk...Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S.across the past three decades.Methods:Data were extracted from the Global Burden of Disease(GBD)Study in 2019,including cases,deaths,disability-adjusted life-years(DALYs),age-standardized rate(ASR),and summary exposure value(SEV)of CRC in China and the U.S.between 1990 and 2019.Annual average percentage changes(AAPCs)of CRC burden were calculated using the Joinpoint regression model.The mortality in CRC attributable to potential risk factors was characterized by countries,gender,and age groups.Results:In 2019,there were 607,900 and 227,241 CRC cases,and 261,777 and 84,026 CRC deaths in China and the U.S.,respectively.The age-standardized incidence rate(ASIR)was 30.55 per 100,000 in China and 41.86 per100,000 in the U.S.,and the age-standardized mortality rate(ASMR)was 13.86 per 100,000 in China and 14.77 per100,000 in the U.S.CRC incidence,mortality,and DALY rate in the U.S.showed downward trends in the past three decades(AAPC=-0.47,-1.06,and-0.88,respectively),while upward trends were observed in China(AAPC=3.11,1.05,and 0.91,respectively).Among the cause of CRC,the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S.,respectively.Conclusions:From 1990 to 2019,the burden of CRC in China increased dramatically,particularly for males and middle-aged and elderly people.The management of the major risk factors associated with the high burden of CRC should be enhanced.展开更多
Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest inc...Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.展开更多
Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung ca...Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung cancer incidence and mortality rates spanning 2000 to 2018 were extracted from the China Cancer Registry Annual Report and the Surveillance, Epidemiology, and End Results database for China and the U.S., respectively. Crude incidence and mortality rates were calculated by sex and age, with age-standardized incidence rates(ASIR) and mortality rates(ASMR) calculated using the Segi-Doll world standard population.Trend analyses employed Joinpoint regression models to determine average annual percentage change(AAPC).The study also assessed the proportion of new cases and deaths by sex and age.Results: In 2018, the ASIR of lung cancer for males in China was 50.72 per 100,000 and the ASMR was 39.69 per 100,000, the ASIR for females was 26.25 per 100,000 and the ASMR was 15.24 per 100,000. Both ASIR and ASMR were higher in males and the highest in the population aged 65 years and older, with the lowest among those aged 20-49 years. In China, female ASIR demonstrated an increasing trend(AAPC: 1.16%), while ASMR decreased in both sexes(AAPCs:-0.48% for males,-1.00% for females). The U.S. exhibited decreasing trends in both ASIR and ASMR across sexes and age groups.Conclusions: The study identified an increasing trend in lung cancer incidence among females and a decreasing mortality trend in both sexes in China. These trends are likely linked to factors such as smoking prevalence,advancements in cancer screening, and improved medical care. The findings underscore the need for tailored lung cancer prevention measures in China, particularly the reinforcement of anti-smoking policies.展开更多
Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals fr...Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals from 2003 to 2017.Methods: The latest incidence and mortality estimates of GC from 185 countries and regions were extracted from the GLOBOCAN 2022 database. The 5-year interval age-standardised incidence rates(ASIRs) were evaluated using cancer registry data from volumes X±XII of the Cancer Incidence in Five Continents(CI5). Correlation analysis was used to evaluate the relationship between ASIR or the age-standardised mortality rate(ASMR) and the Human Development Index(HDI).Results: There was an estimated global 968,000 new GC cases and 660,000 deaths in 2022, with male predominance. GC ASIRs and ASMRs were 9.2 and 6.1 per 100,000 persons, respectively. East Asia had the highest burden, with 53.8% of cases and 48.2% of deaths among all geographic regions. There was a significant correlation between ASIR and HDI. Over three 5-year intervals from 2003 to 2017, the incidence of GC notably decreased in most countries but peaked at 2008±2012 in New Zealand, Turkey, and South Africa. Several countries in Europe, Oceania, and America suggest an increasingly concerning trend among younger individuals, especially females.Conclusions: GC is a significant health issue, especially among males and in geographic regions with an HDI, such as eastern Asia. While the incidence of GC is decreasing in many countries due to prevention efforts and improved treatments, a rising trend persists among younger individuals. Comprehensive prevention strategies tailored to different age patterns are clearly needed.展开更多
Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in Chin...Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in China and worldwide.Methods: Global and China-specific data were collected on liver cancer deaths, DALYs, and age-standardized rates(ASRs) from the Global Burden of Disease Study 2019 database. Liver cancer etiologies were classified into five groups and risk factors were categorized into three levels. Each proportion of liver cancer burden was calculated in different geographic regions. The joinpoint regression model were used to assess the trends from 1990±2019.Results: Liver cancer accounted for 484,577 deaths worldwide in 2019 with an ASR of 5.9 per 100,000 population. China had an elevated liver cancer death ASR in 2019 and males had an ASR 1.7 times the global rate. The global ASR for DALYs peaked at 75±79 years of age but peaked earlier in China. Hepatitis B virus was the prominent etiology globally(39.5%) and in China(62.5%), followed by hepatitis C virus and alcohol consumption. In high sociodemographic index countries, non-alcoholic steatohepatitis has gained an increasing contribution as an etiologic factor. The liver cancer burden due to various etiologies has decreased globally in both genders. However, metabolic risk factors, particularly obesity, have had a growing contribution to the liver cancer burden, especially among males.Conclusions: Despite an overall decreasing trend in the liver cancer burden in China and worldwide, there has been a rising contribution from metabolic risk factors, highlighting the importance of implementing targeted prevention and control strategies that address regional and gender disparities.展开更多
Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less e...Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.展开更多
Background:Existing hepatocellular carcinoma(HCC)prediction models lack transferability and generalizability when applied to female populations,resulting in diminished performance and inadequate tools for accurate HCC...Background:Existing hepatocellular carcinoma(HCC)prediction models lack transferability and generalizability when applied to female populations,resulting in diminished performance and inadequate tools for accurate HCC risk stratification among females.This study aims to develop and validate a score-based prediction model for early detection of HCC in female hepatitis B surface antigen(HBsAg)carriers.Methods:Participants were recruited from a multicenter prospective cohort engaged in liver cancer screening across China including seven high-risk rural areas and one additional high-risk rural area.The study involved 7080 females as the derivation cohort and 2069 as the validation cohort,with all participants aged 35-70 years and HBsAg positive.Laboratory tests and epidemiological surveys were conducted.Key predictor variables were identified through LASSO regression analysis,and score-based prediction models were developed based on Cox proportional hazards model.Model performance including discrimination and calibration was evaluated,and compared to existing prediction models and screening strategies.Results:After a median follow-up of 3.69 and 5.42 years,147 and 45 HCC cases were identified in the derivation and validation cohorts,respectively.The female HCC(HCCF)model incorporating five independent variables:age,α-fetoprotein(AFP),albumin,alanine aminotransferase,and platelet,showed excellent performance with an area under the receiver operating characteristic curve(AUC)of 0.82(95%CI:0.78-0.86).The HCCF-Enhanced model which included cirrhosis,achieved an AUC of 0.85(95%CI:0.81-0.89).Both models demonstrated superior predictive performance than existing models,with strong predictive accuracy in the validation cohort:AUCs of 0.83(95%CI:0.77-0.89)and 0.88(95%CI:0.83-0.92),respectively.The HCCF model,at a score threshold of 7,achieved the largest Youden’s index and identified 32.80%of high-risk individuals.When combined with ultrasonography(US),the model detected 37 additional cases,significantly improved screening sensitivity and accuracy compared to the traditional AFP plus US strategy.Conclusions:The developed HCCF models with good performance for HCC prediction in HBsAg-positive females significantly improve screening efficiency and provide an effective tool for surveillance,ultimately helping to optimize prevention and management strategies for HCC.展开更多
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 co...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.展开更多
China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,...China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,and attribution to risk factors in China,the USA and worldwide from open-source databases.We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects,and compared cancer statistics between China and the USA.A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020,accounting for 25.1%and 30.2%of global cases,respectively.Lifestyle-related cancers including lung cancer,colorectal cancer,and breast cancer showed an upward trend and have been the leading cancer types in China.41.6%of new cancer cases and 49.3%of cancer deaths occurred in digestive-system cancers in China,and the cancers of esophagus,nasopharynx,liver,and stomach in China accounted for over 40%of global cases.Infection-related cancers showed the highest population-attributable fractions among Chinese adults,and most cancers could be attributed to behavioral and metabolic factors.The proportions of stage I for most cancer types were much higher in the USA than in China,except for esophageal cancer(78.2%vs.41.1%).The 5-year relative survival rates in China have improved substantially during 2000–2014,whereas survival for most cancer types in the USA was significantly higher than in China,except for upper gastrointestinal cancers.Our findings suggest that although substantial progress has been made in cancer control,especially in digestive system cancers in China,there was still a considerable disparity in cancer burden between China and the USA.More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.展开更多
Cancer is a major public health problem and represents substantial disparities worldwide.This study reported estimates for 36 cancers across 185 countries by incidence,mortality,5-year prevalence,mortality-toprevalenc...Cancer is a major public health problem and represents substantial disparities worldwide.This study reported estimates for 36 cancers across 185 countries by incidence,mortality,5-year prevalence,mortality-toprevalence ratio(MPR),and mortality-to-incidence ratio(MIR)to examine its association with human development index(HDI)and gross national income(GNI).Data were collected from the GLOBOCAN 2020.MPR and MIR were calculated by sex,age group,country,and cancer type and then summarized into totals.Segi’s population and global cancer spectrum were used to calculate age-and type-standardized ratios.Correlation analyses were conducted to assess associations.Results showed that breast cancer was the most diagnosed cancer globally.Low-and middle-income countries had high MPR and MIR.Cancers of esophagus,pancreas,and liver had the highest ratios.Males and the older population had the highest ratios.HDI and GNI were positively correlated with incidence and mortality but negatively correlated with MPR/MIR.Substantial disparities in cancer burden were observed among 36 cancer types across 185 countries.Socioeconomic development may contribute to narrowing these disparities,and tailored strategies are crucial for regional-and country-specific cancer control.展开更多
An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries.We aimed to report cancer profiles and trends among young adults in China.Data from...An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries.We aimed to report cancer profiles and trends among young adults in China.Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults(ages 20–49 years)in China in 2017,and an age-period-cohort model was employed to estimate the average annual percent change(AAPC)in incidence and mortality from 2000 to 2017.All 25 cancer types were grouped into obesity-or overweight-associated cancers(12 cancer types)and additional cancers(13 cancer types).In 2017,there were 681,178new cases and 214,591 cancer deaths among young adults in China.Among young adults,the most common cancers were thyroid,breast,cervical,liver,lung,and colorectal cancer,and the leading causes of cancer deaths were liver,lung,cervical,stomach,breast,and colorectal cancer.From 2000 to 2017,the cancer incidence increased for all cancers combined among young adults,with the highest AAPC(1.46%)for adults aged 20–24 years,while cancer mortality decreased,with the highest AAPC(-1.63%)for those aged 35–39 years.In conclusion,the cancer incidence in China has increased among young adults,while cancer mortality has decreased for nearly all ages.Cancer control measures,such as obesity control and appropriate screening,may contribute to reducing the increasing cancer burden among young adults.展开更多
Background:Liver cancer remains the sixth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide,causing a heavy burden globally.An updated assessment of the global epidemiology ...Background:Liver cancer remains the sixth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide,causing a heavy burden globally.An updated assessment of the global epidemiology of the liver cancer burden that addresses geographical disparities is necessary to better understand and promote healthcare delivery.Methods:Data were extracted from the GLOBOCAN 2022 database,including the number,crude,and age-standardized rates of incidence and mortality at the global,country,continent,and human development index(HDI)regional levels.Age-standardized rates(incidence and mortality)per 100,000 person-years were adjusted based on the Segi-Doll World standard population.The mortality-to-incidence ratios(MIR)for each region and country were calculated.The HDI and gross national income(GNI)for 2022 were obtained,and a Pearson correlation analysis was conducted with the incidence,mortality,and MIR.Results:In 2022,approximately 866,136 new liver cancer cases and 758,725 related deaths were recorded worldwide,with a global MIR of 0.86.Males had a disproportionately higher burden than females across all levels,and the highest burden was observed in the elderly population.Geographically,the regions with the highest incidence rates included Micronesia,Eastern Asia,and Northern Africa,and the regions with the highest mortality rates included Northern Africa,Southeastern Asia,Eastern Asia,and Micronesia.Notably,Mongolia had a strikingly high burden compared to other countries.The highest MIR was observed in North America and the lowest in Africa.Negative associations of HDI and GNI with liver cancer mortality and MIR were identified,irrespective of sex.Conclusions:The current liver cancer burden underscores the presence of remarkable geographic heterogeneity,which is particularly evident across countries with varying HDI levels,highlighting the urgent need to prioritize health accessibility and availability to achieve health inequities.展开更多
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...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.展开更多
基金supported by grants from the Sanming Project of Medicine in Shenzhen(Grant No.SZSM201911015).
文摘Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.
基金supported by the National Natural Science Foundation of China(No.81974492)the National Natural Science Foundation of China(No.82273721)the Sanming project of Medicine in Shenzhen(No.SZSM201911015).
文摘In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.
基金supported by the National Natural Science Foundation of China(No.81974492)the National Natural Science Foundation of China(No.82273721)the Sanming project of Medicine in Shenzhen(No.SZSM201911015)。
文摘In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.
基金Sanming Project of Medicine in Shenzhen(No.SZSM201911015)。
文摘Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S.across the past three decades.Methods:Data were extracted from the Global Burden of Disease(GBD)Study in 2019,including cases,deaths,disability-adjusted life-years(DALYs),age-standardized rate(ASR),and summary exposure value(SEV)of CRC in China and the U.S.between 1990 and 2019.Annual average percentage changes(AAPCs)of CRC burden were calculated using the Joinpoint regression model.The mortality in CRC attributable to potential risk factors was characterized by countries,gender,and age groups.Results:In 2019,there were 607,900 and 227,241 CRC cases,and 261,777 and 84,026 CRC deaths in China and the U.S.,respectively.The age-standardized incidence rate(ASIR)was 30.55 per 100,000 in China and 41.86 per100,000 in the U.S.,and the age-standardized mortality rate(ASMR)was 13.86 per 100,000 in China and 14.77 per100,000 in the U.S.CRC incidence,mortality,and DALY rate in the U.S.showed downward trends in the past three decades(AAPC=-0.47,-1.06,and-0.88,respectively),while upward trends were observed in China(AAPC=3.11,1.05,and 0.91,respectively).Among the cause of CRC,the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S.,respectively.Conclusions:From 1990 to 2019,the burden of CRC in China increased dramatically,particularly for males and middle-aged and elderly people.The management of the major risk factors associated with the high burden of CRC should be enhanced.
基金funded by the National Natural Science Foundation of China(Grant No.82273721)Capital’s Funds for Health Improvement and Research(Grant No.2024-1G-4023)。
文摘Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.
基金funded by the Jing-jin-ji Special Projects for Basic Research Cooperation (No. J200017)the Sanming Project of the Medicine in Shenzhen (No. SZSM2019 11015)the National Natural Science Foundation of China (No. 82273721)。
文摘Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung cancer incidence and mortality rates spanning 2000 to 2018 were extracted from the China Cancer Registry Annual Report and the Surveillance, Epidemiology, and End Results database for China and the U.S., respectively. Crude incidence and mortality rates were calculated by sex and age, with age-standardized incidence rates(ASIR) and mortality rates(ASMR) calculated using the Segi-Doll world standard population.Trend analyses employed Joinpoint regression models to determine average annual percentage change(AAPC).The study also assessed the proportion of new cases and deaths by sex and age.Results: In 2018, the ASIR of lung cancer for males in China was 50.72 per 100,000 and the ASMR was 39.69 per 100,000, the ASIR for females was 26.25 per 100,000 and the ASMR was 15.24 per 100,000. Both ASIR and ASMR were higher in males and the highest in the population aged 65 years and older, with the lowest among those aged 20-49 years. In China, female ASIR demonstrated an increasing trend(AAPC: 1.16%), while ASMR decreased in both sexes(AAPCs:-0.48% for males,-1.00% for females). The U.S. exhibited decreasing trends in both ASIR and ASMR across sexes and age groups.Conclusions: The study identified an increasing trend in lung cancer incidence among females and a decreasing mortality trend in both sexes in China. These trends are likely linked to factors such as smoking prevalence,advancements in cancer screening, and improved medical care. The findings underscore the need for tailored lung cancer prevention measures in China, particularly the reinforcement of anti-smoking policies.
基金funded by the National Natural Science Foundation of China (Grant No. 82273721)the National Natural Science Foundation of China (Grant No. 81974492)+1 种基金the Capital’s Funds for Health Improvement and Research Conflict of interest statement (Grant No. 2024-1G-4023)CAMS Innovation Fund for Medical Sciences (CIFMS)(Grant No. 2021-I2M-C&T-B-049)。
文摘Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals from 2003 to 2017.Methods: The latest incidence and mortality estimates of GC from 185 countries and regions were extracted from the GLOBOCAN 2022 database. The 5-year interval age-standardised incidence rates(ASIRs) were evaluated using cancer registry data from volumes X±XII of the Cancer Incidence in Five Continents(CI5). Correlation analysis was used to evaluate the relationship between ASIR or the age-standardised mortality rate(ASMR) and the Human Development Index(HDI).Results: There was an estimated global 968,000 new GC cases and 660,000 deaths in 2022, with male predominance. GC ASIRs and ASMRs were 9.2 and 6.1 per 100,000 persons, respectively. East Asia had the highest burden, with 53.8% of cases and 48.2% of deaths among all geographic regions. There was a significant correlation between ASIR and HDI. Over three 5-year intervals from 2003 to 2017, the incidence of GC notably decreased in most countries but peaked at 2008±2012 in New Zealand, Turkey, and South Africa. Several countries in Europe, Oceania, and America suggest an increasingly concerning trend among younger individuals, especially females.Conclusions: GC is a significant health issue, especially among males and in geographic regions with an HDI, such as eastern Asia. While the incidence of GC is decreasing in many countries due to prevention efforts and improved treatments, a rising trend persists among younger individuals. Comprehensive prevention strategies tailored to different age patterns are clearly needed.
基金supported by the Capital’s Funds for Health Improvement and Research (Grant No. 2024-1G-4023)。
文摘Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in China and worldwide.Methods: Global and China-specific data were collected on liver cancer deaths, DALYs, and age-standardized rates(ASRs) from the Global Burden of Disease Study 2019 database. Liver cancer etiologies were classified into five groups and risk factors were categorized into three levels. Each proportion of liver cancer burden was calculated in different geographic regions. The joinpoint regression model were used to assess the trends from 1990±2019.Results: Liver cancer accounted for 484,577 deaths worldwide in 2019 with an ASR of 5.9 per 100,000 population. China had an elevated liver cancer death ASR in 2019 and males had an ASR 1.7 times the global rate. The global ASR for DALYs peaked at 75±79 years of age but peaked earlier in China. Hepatitis B virus was the prominent etiology globally(39.5%) and in China(62.5%), followed by hepatitis C virus and alcohol consumption. In high sociodemographic index countries, non-alcoholic steatohepatitis has gained an increasing contribution as an etiologic factor. The liver cancer burden due to various etiologies has decreased globally in both genders. However, metabolic risk factors, particularly obesity, have had a growing contribution to the liver cancer burden, especially among males.Conclusions: Despite an overall decreasing trend in the liver cancer burden in China and worldwide, there has been a rising contribution from metabolic risk factors, highlighting the importance of implementing targeted prevention and control strategies that address regional and gender disparities.
基金supported by the National Natural Science Foundation of China(82273721)Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation(J200017)Sanming Project of Medicine in Shenzhen(SZSM201911015).
文摘Surveillance recommendations for gastric cancer(GC)in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions.We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool,and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance.In the multicenter communitybased cohort,75,051 participants receiving baseline endoscopy were enrolled during 2015–2017 and followed-up until 2021.Cumulative incidence rates(CIRs)of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests.Mixedeffects Cox regression models were used to detect potential factors for progression towards GC.A risk score was calculated as counts of selected factors.An independent cohort,including 26,586 participants was used for external validation.During a median follow-up of 6.25 years,CIRs of GC were 0.302%,0.436%,and 4.756%for normal group,non-neoplastic(atrophic gastritis/intestinal metaplasia)and neoplastic lesions(low-grade/high-grade dysplasia),respectively(Ptrend<0.001).Four predictors,including male,≥60 years,smoking,and limited vegetable consumption,were selected for risk-stratification.High-risk patients(≥3 risk factors)with non-neoplastic lesions showed higher GC risks(adjusted HR=7.73,95%CI:4.29–13.92),and their four-year CIR reached the one-year CIR of neoplastic lesions.Further categorizing non-neoplastic lesions by histological grade,both patients with moderate-to-severe lesions(aHR=3.07,95%CI:1.67–5.64)and high-risk patients with mild lesions(aHR=7.29,95%CI:3.58–14.86)showed higher risks.Consistent trends were observed in validation cohort.High-risk mild-precursor-lesion patients should receive surveillance within 3–5 years after baseline screening.Our study provides evidence on supplementing current guideline recommendations.
基金supported by the Capital’s Funds for Health Improve-ment and Research(grant number:2024-1G-4023)。
文摘Background:Existing hepatocellular carcinoma(HCC)prediction models lack transferability and generalizability when applied to female populations,resulting in diminished performance and inadequate tools for accurate HCC risk stratification among females.This study aims to develop and validate a score-based prediction model for early detection of HCC in female hepatitis B surface antigen(HBsAg)carriers.Methods:Participants were recruited from a multicenter prospective cohort engaged in liver cancer screening across China including seven high-risk rural areas and one additional high-risk rural area.The study involved 7080 females as the derivation cohort and 2069 as the validation cohort,with all participants aged 35-70 years and HBsAg positive.Laboratory tests and epidemiological surveys were conducted.Key predictor variables were identified through LASSO regression analysis,and score-based prediction models were developed based on Cox proportional hazards model.Model performance including discrimination and calibration was evaluated,and compared to existing prediction models and screening strategies.Results:After a median follow-up of 3.69 and 5.42 years,147 and 45 HCC cases were identified in the derivation and validation cohorts,respectively.The female HCC(HCCF)model incorporating five independent variables:age,α-fetoprotein(AFP),albumin,alanine aminotransferase,and platelet,showed excellent performance with an area under the receiver operating characteristic curve(AUC)of 0.82(95%CI:0.78-0.86).The HCCF-Enhanced model which included cirrhosis,achieved an AUC of 0.85(95%CI:0.81-0.89).Both models demonstrated superior predictive performance than existing models,with strong predictive accuracy in the validation cohort:AUCs of 0.83(95%CI:0.77-0.89)and 0.88(95%CI:0.83-0.92),respectively.The HCCF model,at a score threshold of 7,achieved the largest Youden’s index and identified 32.80%of high-risk individuals.When combined with ultrasonography(US),the model detected 37 additional cases,significantly improved screening sensitivity and accuracy compared to the traditional AFP plus US strategy.Conclusions:The developed HCCF models with good performance for HCC prediction in HBsAg-positive females significantly improve screening efficiency and provide an effective tool for surveillance,ultimately helping to optimize prevention and management strategies for HCC.
基金Chinese Academy of Medical Sciences(No.2021-I2M-1-033)National Natural Science Foundation of China(No.81974492)+1 种基金Jing-jin-ji Special Projects for Basic Research Cooperation(No.J200017)Sanming Project of the Medicine in Shenzhen(No.SZSM201911015)。
文摘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.
基金This work was supported by the National Natural Science Foundation of China(82273721)the Jing-jin-ji Special Projects for Basic Research Cooperation(J200017)the Sanming Project of the Medicine in Shenzhen(SZSM201911015).
文摘China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,and attribution to risk factors in China,the USA and worldwide from open-source databases.We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects,and compared cancer statistics between China and the USA.A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020,accounting for 25.1%and 30.2%of global cases,respectively.Lifestyle-related cancers including lung cancer,colorectal cancer,and breast cancer showed an upward trend and have been the leading cancer types in China.41.6%of new cancer cases and 49.3%of cancer deaths occurred in digestive-system cancers in China,and the cancers of esophagus,nasopharynx,liver,and stomach in China accounted for over 40%of global cases.Infection-related cancers showed the highest population-attributable fractions among Chinese adults,and most cancers could be attributed to behavioral and metabolic factors.The proportions of stage I for most cancer types were much higher in the USA than in China,except for esophageal cancer(78.2%vs.41.1%).The 5-year relative survival rates in China have improved substantially during 2000–2014,whereas survival for most cancer types in the USA was significantly higher than in China,except for upper gastrointestinal cancers.Our findings suggest that although substantial progress has been made in cancer control,especially in digestive system cancers in China,there was still a considerable disparity in cancer burden between China and the USA.More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.
基金funded by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2021-I2M-1-033)the Jing-jin-ji Special Projects for Basic Research Cooperation(No.J200017)the Sanming Project of the Medicine in Shenzhen(No.SZSM201911015).
文摘Cancer is a major public health problem and represents substantial disparities worldwide.This study reported estimates for 36 cancers across 185 countries by incidence,mortality,5-year prevalence,mortality-toprevalence ratio(MPR),and mortality-to-incidence ratio(MIR)to examine its association with human development index(HDI)and gross national income(GNI).Data were collected from the GLOBOCAN 2020.MPR and MIR were calculated by sex,age group,country,and cancer type and then summarized into totals.Segi’s population and global cancer spectrum were used to calculate age-and type-standardized ratios.Correlation analyses were conducted to assess associations.Results showed that breast cancer was the most diagnosed cancer globally.Low-and middle-income countries had high MPR and MIR.Cancers of esophagus,pancreas,and liver had the highest ratios.Males and the older population had the highest ratios.HDI and GNI were positively correlated with incidence and mortality but negatively correlated with MPR/MIR.Substantial disparities in cancer burden were observed among 36 cancer types across 185 countries.Socioeconomic development may contribute to narrowing these disparities,and tailored strategies are crucial for regional-and country-specific cancer control.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2021-I2M-1-033)the Jing-jin-ji Special Projects for Basic Research Cooperation(J200017)the Sanming Project of the Medicine in Shenzhen(SZSM201911015)。
文摘An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries.We aimed to report cancer profiles and trends among young adults in China.Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults(ages 20–49 years)in China in 2017,and an age-period-cohort model was employed to estimate the average annual percent change(AAPC)in incidence and mortality from 2000 to 2017.All 25 cancer types were grouped into obesity-or overweight-associated cancers(12 cancer types)and additional cancers(13 cancer types).In 2017,there were 681,178new cases and 214,591 cancer deaths among young adults in China.Among young adults,the most common cancers were thyroid,breast,cervical,liver,lung,and colorectal cancer,and the leading causes of cancer deaths were liver,lung,cervical,stomach,breast,and colorectal cancer.From 2000 to 2017,the cancer incidence increased for all cancers combined among young adults,with the highest AAPC(1.46%)for adults aged 20–24 years,while cancer mortality decreased,with the highest AAPC(-1.63%)for those aged 35–39 years.In conclusion,the cancer incidence in China has increased among young adults,while cancer mortality has decreased for nearly all ages.Cancer control measures,such as obesity control and appropriate screening,may contribute to reducing the increasing cancer burden among young adults.
基金supported by a grant from the Capital’s Funds for Health Improvement and Research(No.2024-1G-4023).
文摘Background:Liver cancer remains the sixth most commonly diagnosed cancer and the third leading cause of cancer-related deaths worldwide,causing a heavy burden globally.An updated assessment of the global epidemiology of the liver cancer burden that addresses geographical disparities is necessary to better understand and promote healthcare delivery.Methods:Data were extracted from the GLOBOCAN 2022 database,including the number,crude,and age-standardized rates of incidence and mortality at the global,country,continent,and human development index(HDI)regional levels.Age-standardized rates(incidence and mortality)per 100,000 person-years were adjusted based on the Segi-Doll World standard population.The mortality-to-incidence ratios(MIR)for each region and country were calculated.The HDI and gross national income(GNI)for 2022 were obtained,and a Pearson correlation analysis was conducted with the incidence,mortality,and MIR.Results:In 2022,approximately 866,136 new liver cancer cases and 758,725 related deaths were recorded worldwide,with a global MIR of 0.86.Males had a disproportionately higher burden than females across all levels,and the highest burden was observed in the elderly population.Geographically,the regions with the highest incidence rates included Micronesia,Eastern Asia,and Northern Africa,and the regions with the highest mortality rates included Northern Africa,Southeastern Asia,Eastern Asia,and Micronesia.Notably,Mongolia had a strikingly high burden compared to other countries.The highest MIR was observed in North America and the lowest in Africa.Negative associations of HDI and GNI with liver cancer mortality and MIR were identified,irrespective of sex.Conclusions:The current liver cancer burden underscores the presence of remarkable geographic heterogeneity,which is particularly evident across countries with varying HDI levels,highlighting the urgent need to prioritize health accessibility and availability to achieve health inequities.
基金National Natural Science Foundation of China(Nos.82273721,81974492)Sanming Project of Medicine in Shenzhen(No.SZSM201911015)
文摘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.
