Burden of liver cancer and underlying etiologies in China from 1990 to 2021: A systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND: Liver cancer continues to pose a global health challenge. In 2020, China accounted for nearly half of new liver cancer cases worldwide, with a low 5-year survival. This study aims to evaluate the evolving landscape of the liver cancer burden in China. METHODS: Data on prevalence, incidence, death, and disability-adjusted life year (DALY) attributed to liver cancer and its six etiologies in China between 1990 and 2021 were extracted from the Global Burden of Disease Study 2021. Temporal trends in liver cancer burden were determined by percent changes and average annual percent change (AAPC). Decomposition analysis was conducted to understand the contributions of population aging, population growth, and epidemiological change to the observed trends. RESULTS: In 2021, there were 265,539 prevalence cases of liver cancer in China accounting for 35.9% of the global total (739,300 prevalence cases). From 1990 to 2021, the prevalence cases, incidence cases, deaths, and DALYs attributed to liver cancer in China increased by 99.99%, 103.91%, 81.24%, and 48.41%, respectively, primarily driven by population aging, then population growth. Males experienced higher burden and percentage changes in prevalence, incidence, and DALYs than females. Meanwhile, decreasing trends were observed in overall age-standardized incidence, death, and DALY rates (AAPC: -0.32%, -0.79%, and -1.03%) and generally across sex groups and the six etiologies. Notably, there were increasing trends in age-standardized incidence rate of liver cancer due to alcohol use (AAPC: 0.36%) and metabolic dysfunction-associated steatotic liver disease (MASLD) (AAPC: 0.44%). In 2021, hepatitis B, hepatitis C, and alcohol use were the main causes of liver cancer burden in China. There were age differences in the burden of liver cancer. The overall 5-year relative survival rate was 12.27% in 2021. CONCLUSIONS: Liver cancer cases increased dramatically over the past 30 years, primarily driven by population aging and growth, posing challenges to the control of liver cancer. Targeted interventions by sex, etiology, and age are needed to address the burden effectively.