Allegheny Health Network, 320 E North Ave, Pittsburgh, PA, 15212, USA.
School of Medicine, New York Medical College, NYC, NY, USA.
BMC Cancer. 2024 Sep 4;24(1):1098. doi: 10.1186/s12885-024-12869-4.
Liver cancer (LC) is frequently preceded by cirrhosis and poses a significant public health challenge in the United States (US). Recent decades have seen notable shifts in the epidemiological patterns of LC, yet national data guiding the optimal allocation of resources and preventive efforts remain limited. This study aims to investigate the current trends, risk factors, and outcomes of LC in the US.
This study utilized the Global Burden of Disease (GBD) dataset to collect data on the annual incident cases, deaths, Disability-Adjusted Life Years (DALYs), age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized DALY rates of primary LC and its etiologies and risk factors, between 1990 and 2019. Percentage changes in incident cases, DALYs, and deaths and the estimated annual percentage change (EAPC) in ASIR and deaths rates of LC were calculated to conduct temporal analysis. Linear regression was applied for the calculation of EAPCs. Correlations of EAPC with socio-demographic index (SDI) were separately evaluated by Pearson correlation analyses.
We observed a marked increase in the ASIR of LC, increasing from 2.22 (95% CI: 2.15-2.27) per 100,000 people in 1990 to 5.23 (95% CI: 4.28-6.29) per 100,000 people in 2019, a percentage change of 135.4%. LC due to hepatitis C followed by alcohol use were the primary factors driving this increase. The ASIR and age-standardized death rates of LC showed a significant average annual increase of 3.0% (95% CI: 2.7-3.2) and 2.6% (95% CI: 2.5-2.8), respectively. There was a significant negative correlation between the SDI and the EAPC in ASIR (ρ = -0.40, p = 0.004) and age-standardized death rates (ρ = -0.46, p < 0.001). In 2019, drug and alcohol use, followed by elevated body mass index (BMI) were the primary risk factors for age-standardized DALY rates attributable to LC.
The increased burden of LC in the US highlights the need for interventions. This is particularly important given that LC is mostly influenced by modifiable risk factors, such as drug and alcohol use, and elevated BMI. Our findings highlight the urgent need for public health interventions targeting socio-economic, lifestyle, and modifiable risk factors to mitigate the escalating burden of LC.
肝癌（LC）常发生于肝硬化之前，是美国面临的重大公共卫生挑战。近几十年来，LC 的流行病学模式发生了显著变化，但仍缺乏指导资源最佳配置和预防工作的国家数据。本研究旨在调查美国 LC 的当前趋势、风险因素和结局。
本研究利用全球疾病负担（GBD）数据集收集了 1990 年至 2019 年原发性 LC 及其病因和风险因素的年度发病病例、死亡人数、伤残调整生命年（DALYs）、年龄标准化发病率（ASIR）、年龄标准化死亡率和年龄标准化 DALY 率的数据。计算了 LC 发病病例、DALYs 和死亡人数的百分比变化以及 LC 的 ASIR 和死亡率的估计年百分比变化（EAPC），以进行时间趋势分析。线性回归用于计算 EAPC。通过 Pearson 相关分析分别评估 EAPC 与社会人口指数（SDI）的相关性。
我们观察到 LC 的 ASIR 显著增加，从 1990 年的每 10 万人 2.22（95%CI：2.15-2.27）增加到 2019 年的每 10 万人 5.23（95%CI：4.28-6.29），百分比变化为 135.4%。丙型肝炎和酒精使用导致的 LC 是导致这种增加的主要因素。LC 的 ASIR 和年龄标准化死亡率呈显著的平均年增长率，分别为 3.0%（95%CI：2.7-3.2）和 2.6%（95%CI：2.5-2.8）。SDI 与 ASIR（ρ=-0.40，p=0.004）和年龄标准化死亡率（ρ=-0.46，p<0.001）的 EAPC 呈显著负相关。2019 年，药物和酒精使用以及升高的体重指数（BMI）是导致 LC 年龄标准化 DALY 率的主要危险因素。
美国 LC 负担的增加凸显了干预的必要性。鉴于 LC 主要受药物和酒精使用以及升高的 BMI 等可改变的风险因素影响，这一点尤为重要。我们的研究结果强调了针对社会经济、生活方式和可改变的风险因素开展公共卫生干预的迫切需要，以减轻 LC 不断增加的负担。
