Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
JMIR Public Health Surveill. 2024 Aug 8;10:e54967. doi: 10.2196/54967.
China has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups.
The purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China.
Data from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude.
In China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05% to 29.07% and from 10.09% to 21.71%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (R=0.225; P<.001), while in women, it showed a negative correlation (R=0.083; P=.04). High LASMR areas among men aligned with subtropical zones, like Cwa and Cfa. The age group 65 years and older, the southern region, and the Cwa climate zone had the highest YLL rates at 4850.50, 495.50, and 440.17 per 100,000, respectively. However, the overall trends in these groups showed a decline over the period.
Despite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China.
中国是全球肝癌发病数最多的国家，肝癌也是中国所有癌症中发病率最高的。然而，目前中国的肝癌研究主要依赖外推数据或相对滞后的数据，对亚区域和特定人群群体的关注有限。
本研究旨在通过探讨中国不同地理区域、气候带和人群中肝癌死亡率的时空趋势以及由此导致的寿命损失年（years of life lost，YLL），来确定肝癌的地理差异。
利用 2013 年至 2020 年国家死亡监测系统的数据，计算中国肝癌的年龄标准化死亡率（age-standardized mortality rate，LASMR）和由肝癌导致的 YLL。通过性别、年龄、地区和气候分类对肝癌的空间分布和时间趋势进行亚组分析。采用估计年变化百分比来描述各地区的肝癌趋势，采用偏相关来探讨 LASMR 与纬度之间的关联。
在中国，男性的 LASMR 从 2013 年的 28.79 降至 2020 年的 26.38/100,000，女性从 11.09 降至 9.83/100,000。所有年龄组的死亡率均呈下降趋势。在地理上，广西的男性 LASMR 最高，为 50.15/100,000，而女性 LASMR 最高的是黑龙江，为 16.64/100,000。在这些地区，广西大部分地区男性的 LASMR 范围在 32.32 至 74.98/100,000，而黑龙江大部分地区女性的 LASMR 范围在 13.72 至 21.86/100,000。LASMR 的趋势因地区而异。对于男性和女性，贵州从 2013 年到 2020 年 LASMR 呈上升趋势，估计年变化百分比范围分别为 10.05%至 29.07%和 10.09%至 21.71%。男性和女性的 LASMR 均随纬度的升高而升高，但总体而言，男性的 LASMR 与纬度呈正相关（R=0.225；P<.001），而女性则呈负相关（R=0.083；P=.04）。男性的 LASMR 高值区与亚热带地区一致，如 Cwa 和 Cfa。年龄组 65 岁及以上、南部地区和 Cwa 气候区的 YLL 率最高，分别为 4850.50、495.50 和 440.17/100,000。然而，这些群体的总体趋势呈下降趋势。
尽管中国肝癌的整体下降趋势明显，但地区和人群之间仍存在显著差异。未来的预防和控制应重点关注高风险地区和人群，以进一步降低中国肝癌的负担。
