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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, Akinyemiju T1, Abera S2,3, Ahmed M4, Alam N5,6, Alemayohu MA7, Allen C8, Al-Raddadi R9, Alvis-Guzman N10, Amoako Y11, Artaman A12, Ayele TA13, Barac A14, Bensenor I15, Berhane A16, Bhutta Z17,18, Castillo-Rivas J19, Chitheer A20, Choi JY21, Cowie B22, Dandona L8,23, Dandona R8,23, Dey S24, Dicker D8, Phuc H25, Ekwueme DU26, Zaki MES27, Fischer F28, Fürst T29,30,31, Hancock J8, Hay SI8, Hotez P32,33, Jee SH34, Kasaeian A35, Khader Y36, Khang YH37, Kumar GA38, Kutz M8, Larson H39, Lopez A8,40, Lunevicius R41,42, Malekzadeh R43, McAlinden C44, Meier T45, Mendoza W46, Mokdad A8, Moradi-Lakeh M47,48, Nagel G49, Nguyen Q25, Nguyen G8, Ogbo F50,51, Patton G52, Pereira DM53, Pourmalek F54, Qorbani M55, Radfar A56, Roshandel G57, Salomon JA58, Sanabria J59,60, Sartorius B61, Satpathy M62,63, Sawhney M64, Sepanlou S43, Shackelford K8, Shore H65, Sun J66, Mengistu DT67, Topór-Madry R68,69, Tran B70,71, Ukwaja KN72, Vlassov V73, Vollset SE74,75, Vos T8, Wakayo T76, Weiderpass E77,78,79, Werdecker A80, Yonemoto N81, Younis M82,83, Yu C84, Zaidi Z85,86, Zhu L87, Murray CJL8, Naghavi M8, Fitzmaurice C8,88. JAMA Oncol. 2017 Oct 5. doi: 10.1001/jamaoncol.2017.3055. [Epub ahead of print]
School of Public Health, Birmingham, University of Alabama at Birmingham.
Mekelle University, School of Public Health, College of Health Sciences, Mekelle, Tigray, Ethiopia.
University of Hohenheim, Institute of Biological Chemistry and Nutrition, Stuttgart, Baden Württemberg, Germany.
Jimma University Institute of Health, Department of Epidemiology, Jimma, Oromiya, Ethiopia.
Department of Health, Queensland Government, Herston, QLD, Australia.
University of Queensland, School of Public Health, Herston, QLD, Australia.
Mekelle University Epidemiology, Mekelle, TNRS, Ethiopia.
University of Washington, Institute for Health Metrics and Evaluation, Seattle.
Ministry of Health Research Department, Jeddah, Saudi Arabia.
Universidad de Cartagena, Grupo de Investigación en Economía de la Salud, Cartagena, Bolivar, Colombia.
Komfo Anokye Teaching Hospital, Department of Medicine, Bantama, Ghana.
University of Manitoba, Community Health Sciences, Winnipeg, Manitoba, Canada.
University of Gondar, Epidemiology and Biostatistics, Gondar, Ethiopia.
Clinical Center of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia.
Hospital Universitário, University of São Paulo Division of Internal Medicine, São Paulo, São Paulo, Brazil.
Debre Berhan University, College of Health Sciences, Debre Berhan, Amhara, Ethiopia.
Aga Khan University, Centre of Excellence in Women & Child, Karachi, Sindh, Pakistan.
The Hospital for Sick Children, Centre for Global Child Health, Toronto, Ontario, Canada.
Caja Costarricense de Seguro Social, Dirección Actuarial y Economica, San Jose, San Jose, Costa Rica.
Iraq MOH FETP, MOH, Baghdad, Iraq.
Seoul National University, College of Medicine Medical Library, Seoul, South Korea.
Doherty Institute, WHO Collaborating Centre for Viral Hepatitis, Melbourne, Victoria, Australia.
Public Health Foundation of India, Research, Gurgaon, NCR, India.
Indian Institute of Public Health-Delhi, Environmental and Occupational Health, Gurgaon, Haryana, India.
Duy Tan University, Institute for Global Health Innovations, Da Nang, Vietnam.
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
Bielefeld University, School of Public Health, Bielefeld, Germany.
Swiss Tropical and Public Health Institute, Epidemiology and Public Health, Basel, Switzerland.
University of Basel, Switzerland.
Imperial College London, School of Public Health, London, England.
Baylor College of Medicine, National School of Tropical Medicine, Houston, Texas.
Sabin Vaccine Institute & Texas Children's Hospital Center for Vaccine Development, Houston.
Graduate School of Public Health, Yonsei University, Epidemiology and Health Promotion, Seoul, South Korea.
Tehran University of Medical Sciences, Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran, Tehran, Iran.
Jordan University of Science and Technology, Public Health, Irbid, Irbid, Jordan.
Seoul National University College of Medicine, Institute of Health Policy and Management, Seoul, Seoul Metropolitan City, South Korea.
Public Health Foundation of India Research, Gurgaon (NCR), Haryana, India.
Department Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England.
University of Melbourne, Melbourne School of Population and Global Health, Melbourne, VIC, Australia.
Aintree University Hospital NHS Foundation Trust, General Surgery Department, Liverpool, England.
School of Medicine, University of Liverpool, Liverpool, England.
Tehran University of Medical Sciences, Digestive Diseases Research Institute, Tehran, Tehran, Iran.
University Hospitals Bristol, Department of Medicine, Bristol, England.
Martin Luther University Halle-Wittenberg, Institute for Agricultural and Nutritional Sciences, Halle (Saale), Germany.
UNFPA Peru Country Office, Lima, Peru.
Iran University of Medical Sciences, Gastrointestinal and Liver Disease Research Center, Tehran, Tehran, Iran.
Iran University of Medical Sciences, Preventive Medicine and Public Health Research Center, Tehran, Tehran, Iran.
Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany.
Western Sydney University, Centre for Health Research, School of Medicine, Penrith, NSW, Australia.
Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
University of Melbourne, Paediatrics, Melbourne, Victoria, Australia.
REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal.
Department of Urology, University of British Columbia, Vancouver, British Columbia, Canada.
Alborz University of Medical Sciences, Noncommunicable Diseases Research Center, Karaj, Alborz, Iran.
A. T. Still University, College of Graduate Health Studies, Mesa, Arizona.
Golestan University of Medical Sciences, Golestan Research Center of Gastroenterology and Hepatology, Gorgan, Iran.
Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts.
Marshall University School of Medicine, Surgery, Huntington, West Virginia.
Case Western Reserve University, Nutrition and Preventive Medicine, Ohio.
University of KwaZulu-Natal, Public Health Medicine, Durban, KwaZulu-Natal, South Africa.
Utkal University, Centre for Advanced Study in Psychology, Bhubaneswar, Odisha, India.
AIIMS New Delhi, JPN Apex Trauma Centre, New Delhi, Delhi, India.
Marshall University Public Health, Huntington, West Virginia.
Haramaya University School of Public Health, Harari, Harari, Ethiopia.
Queensland University of Technology, School of Public Health and Social Work, Brisbane, Queensland, Australia.
Mekelle University, Institute of Biomedical Sciences, Mekelle, Tigrai, Ethiopia.
Faculty of Health Sciences Jagiellonian University Medical College, Institute of Public Health, Kraków, Poland.
Faculty of Health Sciences Wroclaw Medical University, Wroclaw, Poland.
Hanoi Medical University, Institute for Preventive Medicine and Public Health, Hanoi, Vietnam.
Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland.
Federal Teaching Hospital, Department of Medicine, Abakaliki, Ebonyi State, Nigeria.
Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia.
Norwegian Institute of Public Health, Centre for Disease Burden, Bergen, Norway.
University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway.
Jimma University, Population and Family Health, Oromia, Ethiopia.
Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway.
University of Tromsø, The Arctic University of Norway, Department of Community Medicine, Faculty of Health Sciences, Tromsø, Norway.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Federal Institute for Population Research, Competence Center Mortality-Follow-Up of the National Cohort, Wiesbaden, Hesse, Germany.
Kyoto University, School of Public Health Biostatistics, Sakyo, Kyoto, Japan.
Jackson State University, Health Policy & Management, Jackson, Mississippi.
Harvard Asia Aging Center, Harvard Medical School, Boston, Massachuetts.
Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, Hubei Province, China.
Department of Epidemiology, University Hospital of Setif, Setif, Algeria.
University Ferhat Abbas, Faculty of Medicine, Setif, Algeria.
Jiangsu Provincial Center for Disease Control and Prevention, Major Project Execution Office, Nanjing, Jiangsu, China.
Division of Hematology, Department of Medicine, University of Washington, Seattle.
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.
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.
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.