Long-term trends in incidence, mortality and disease burden of liver cancer due to specific etiologies in Hubei Province, 1990-2019
Authors: Zhu Shijie , Zhang Xupeng , Zhang Faxue , Zhao Gaichan , Zhang Xiaowei , Liu Hao , Zhu Wei 
Published: July 2022

Objective
To reveal the secular trends and estimate the age, period and cohort effects on incidence and mortality of primary liver cancer due to specific etiologies, as well as the changes of disease burden in Hubei Province from 1990 to 2019.
Methods
Incidence, mortality and disability adjusted life years (DALYs) of liver cancer, based on the Global Burden of Disease, were collected for each 5-year age group stratified by gender (males/females) from Chinese Centre for Disease Control and Prevention on request. The average 5 years percentage change (A5PC) of rates were analyzed by Joinpoint regression analysis; age, period and cohort effects on incidence and mortality were simultaneously estimated by age-period-cohort (APC) model; the variation of DALYs in 5-year age group were evaluated by net drift with local drift.
Results
Contrary to the overall prevalence trend of liver cancer in China, both the age-standardized incidence and mortality rate (ASIR and ASMR) of liver cancer is on the rise, although there are differences between gender groups. In Hubei Province, the disease burden of liver cancer due to specific etiologies is higher in males than in females. From 1990–2019, the age-standardized incidence rate (ASIR) significantly increased in males in all liver cancer group (P < 0.05), while no significant increasing trend was observed in females. In terms of age-standardized mortality rate (ASMR), a significant upward trend was observed only in liver cancer due to hepatitis C (LCHC) group for males (P < 0.05). From APC model analysis, the age effect demonstrated that the incidence and mortality increased with age in all liver cancer groups, which remained consistent between gender groups. While the incidence and mortality rates for liver cancer due to alcohol use (LCAU) were increasing faster in female than in males and exceeded that of liver cancer due to hepatitis B (LCHB) in two age groups: 65–69 and 70–74. The incidence of all liver cancer groups increased with time period in males, while this upward trend was observed in females only in LCAU group. Cohort effect indicated them decreased with birth cohorts, while cohort effect stopped decreasing and began to increase since 2000 in females. Local drifts analysis showed the age range at which the DALYs of liver cancer tends to increase is > 45 years for males and > 85 years for females in Hubei Province.
Conclusions
Over past three decades in Hubei Province, the incidence of all liver cancer groups keeps a significant upward trend in males, while no significant changes were observed in females. LCHB remains the type of liver cancer with the highest disease burden. However, the incidence and mortality of LCAU is higher in females than in males, which is regionally specific. The impact of an ageing population will continue in Hubei Province, the disease burden of liver cancer will continue to increase and personalized prevention policies must be adopted to address these changes.