Abstract
ObjectiveLiver cancer is one of the most common causes of cancer-related death. Understanding how demographic factors influence mortality due to liver cancer is crucial for optimizing disease-control strategies. We aimed to characterize the long-term trends in the mortality and years of life lost (YLL) of liver cancer in Shanghai, China, 1973–2019, and quantitatively analyze the contributions of demographic and non-demographic factors on the mortality of liver cancer.MethodsUsing mortality data from the Mortality Registration System of Pudong New Area, the largest district of Shanghai with a population of permanent resident of 5.68 million, during 1973–2019, we analyzed the temporal trends for the mortality rates and YLL by Joinpoint Regression Program. The difference decomposition method was employed to estimate the increasing mortality rates related to demographic and non-demographic factors.ResultsA total of 21,530 deaths from liver cancer occurred from 1973 to 2019. The crude mortality rates (CMR) and age-standardized mortality rate by Segi's world standard population (ASMRW) of liver cancer were 26.73/105 person-years and 15.72/105 person-years, respectively. The CMR, ASMRW, and YLL rates of liver cancer showed significantly decreasing trends in males, females and the total population from 1973 to 2019, whereas the upward trends in the YLL were seen in males, females and the total population (all P < 0.05). A significant upward trend was observed in the increased CMR caused by demographic factors, but the changing rate caused by non-demographic factors decreased.ConclusionsThe CMR and ASMRW of liver cancer continually decreased although YLL increased during 1973–2019 in Pudong New Area, Shanghai. The demographic factors, especially aging, might be responsible for the increase in the mortality of liver cancer. More effective prevention strategies tailored to liver cancer are needed to further reduce its disease burden in the elderly population.
Highlights
Liver cancer is expected to rank as the sixth most common cancer and the third leading cause of cancer-related death, with an estimated 906,000 new cases and 830,000 deaths occurring worldwide in 2020 [1]
A significant upward trend was observed in the increased crude mortality rates (CMR) caused by demographic factors during 1980– 2019 [average period percentage change (APPC) = 45.01% (25.87–67.06%), P < 0.001], whereas the changing rate caused by non-demographic factors decreased [APPC = −33.57% (−48.49 to −14.32%), P = 0.008]
Difference decomposition analysis revealed that the contribution caused by demographic factors on the changing value of CMR increased by 45.01% in the total population, by 39.00% in males, and by 46.06% in females (Figure 2). These results suggest that the increase in mortality rate of liver cancer is mainly attributed to demographic factors, especially population aging
Summary
Liver cancer is expected to rank as the sixth most common cancer and the third leading cause of cancer-related death, with an estimated 906,000 new cases and 830,000 deaths occurring worldwide in 2020 [1]. China accounts for more than half of the world’s incident and death cases of liver cancer. Liver cancer is the most commonly diagnosed cancer and the first leading cause of cancer-related death in men younger than 60 years old, and it remains a serious threat to human health and is the main cause of premature mortality [2, 3]. In China, during 1990– 2017, age-standardized incidence rate of liver cancer decreased from 27.16/105 to 26.04/105, and age-standardized mortality rate decreased from 26.72/105 to 21.30/105, respectively [4]. It is shown that the incidence rate of liver cancer declines in China, but the burden increases. The incidence and mortality rates may not completely reflect the burden of liver cancer, because it harms the younger population more than others. YLL is an important measure quantifying the burden of cancer, and the calculation of YLL is based on the age at death and the number of deaths at each age, eliminating the mismatch of disease impact solely derived from the number of deaths [6]
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