Trends Of Death Caused By Liver Cancer (Lc)
Globally, the LC caused 484.58×103 (95% uncertainty interval [UI]: 444.09 ×103 to 525.80×103) death worldwide in 2019, with an increase of 32.68% since 1990 (Table 1). The overall age-standardized death rate (ASDR) decreased by an average 2.23% per year from 1990 to 2019 (EAPC = − 2.23, 95% CI: −2.61 to − 1.84) (Table 1, Fig. 1). Increasing changes of death number occurred in those aged over 50 years, particularly in the group of > 80 years (202.62%) (Table 2, Fig. 2A). The decreasing trends of LC were observed in both sexes and most socio-demographic index (SDI) areas, particularly the high-middle SDI area (EAPC = − 3.69, 95% CI: −4.23 to − 3.15) (Table 1, Fig. 2B). In terms of geographic regions, the ASDR of LC showed increasing trends in nine regions, particularly Central Asia (EAPC = 2.93, 95%CI: 2.42 to 3.45) (Table 1). However, decreasing trends were demonstrated in eight regions, particularly East Asia (EAPC = − 4.98, 95%CI: −5.73 to − 4.22) (Fig. 2C).
Table 2
The number of death due to liver cancer caused by specific etiologies in 2019 and the percentage changes in number during 1990–2019 in age groups
Age Groups | LC | LCHB | LCHC | LCAL | LCNA | |
Number ×103(95% UI) | Change in number (%) | Number ×103(95% UI) | Change in number (%) | Number ×103(95% UI) | Change in number (%) | Number ×103(95% UI) | Change in number (%) | Number ×103(95% UI) | Change in number (%) | |
5 to 9 | 0.63 (0.52–0.75) | −15.53 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
10 to 14 | 0.93 (0.78–1.11) | −16.37 | 0.34 (0.26–0.43) | −37.00 | 0.01 (0.01–0.02) | −1.61 | 0 | 0 | 0 | 0 |
15 to 19 | 0.70 (0.62–0.79) | −45.64 | 0.37 (0.30–0.45) | −56.92 | 0.01 (0.01–0.02) | −19.20 | 0.01 (0-0.02) | −4.66 | 0.14 (0.1–0.19) | 2.87 |
20 to 24 | 1.17 (1.05–1.3) | −46.46 | 0.75 (0.65–0.87) | −53.59 | 0.03 (0.02–0.05) | −18.53 | 0.05 (0.03–0.07) | 5.53 | 0.15 (0.11–0.20) | 0.56 |
25 to 29 | 2.33 (2.10–2.57) | −32.02 | 1.7 (1.45–1.96) | −37.00 | 0.08 (0.05–0.14) | −10.16 | 0.12 (0.07–0.20) | 17.13 | 0.17 (0.12–0.25) | 10.57 |
30 to 34 | 5.38 (4.78–6.05) | −21.95 | 4.10 (3.50–4.76) | −26.08 | 0.25 (0.17–0.36) | −2.27 | 0.34 (0.23–0.50) | 20.70 | 0.27 (0.19–0.37) | 16.16 |
35 to 39 | 8.99 (7.84–10.21) | −42.52 | 6.57 (5.44–7.77) | −47.01 | 0.59 (0.38–0.91) | −23.50 | 0.82 (0.51–1.25) | −2.49 | 0.40 (0.28–0.56) | −11.01 |
40 to 44 | 15.84 (13.81–18.10) | −28.78 | 11.06 (9.08–13.29) | −34.37 | 1.40 (0.96–1.92) | −12.30 | 1.74 (1.13–2.52) | 9.07 | 0.68 (0.48–0.93) | 3.10 |
45 to 49 | 26.19 (22.58–29.98) | −2.05 | 16.92 (13.64–20.87) | −10.33 | 3.15 (2.16–4.37) | 12.33 | 3.45 (2.15–5.01) | 39.08 | 1.20 (0.83–1.73) | 35.52 |
50 to 54 | 40.26 (35.32–45.36) | 8.02 | 23.07 (18.59–28.25) | −4.34 | 6.70 (4.86–8.81) | 23.15 | 6.29 (4.09–9.02) | 52.13 | 2.06 (1.44–2.94) | 49.80 |
55 to 59 | 50.31 (45.15–56.27) | 6.37 | 24.94 (19.96–30.86) | −9.85 | 10.79 (7.83–14.35) | 16.75 | 9.30 (6.39–12.67) | 56.85 | 2.84 (1.92–4.04) | 49.42 |
60 to 64 | 59.69 (54.22–65.19) | 18.78 | 25.60 (20.19–31.80) | −0.29 | 15.06 (11.15–19.69) | 23.37 | 12.59 (8.83–16.83) | 65.73 | 3.76 (2.58–5.41) | 64.57 |
65 to 69 | 67.13 (61.81–72.56) | 38.91 | 25.17 (19.45–31.42) | 17.20 | 18.81 (14.96–22.83) | 40.11 | 15.64 (11.64–20.56) | 81.99 | 4.62 (3.26–6.56) | 83.97 |
70 to 74 | 64.25 (59.36–69.4) | 60.22 | 20.23 (14.99–25.75) | 29.52 | 20.94 (16.98–24.99) | 61.21 | 15.29 (11.4-20.14) | 115.08 | 5.09(3.71–6.93) | 106.67 |
75 to 79 | 55.89 (51.66–59.75) | 79.51 | 14.76 (11.47–18.47) | 49.36 | 21.51 (17.24–25.77) | 77.74 | 11.98 (9.17–14.99) | 126.15 | 5.25 (3.83–7.13) | 125.23 |
> 80 | 83.15 (70.45–90.63) | 202.62 | 16.15 (11.97–20.53) | 149.70 | 42.46 (34.28–49.41) | 210.77 | 13.12 (9.74–16.69) | 241.84 | 8.09 (5.76–10.76) | 257.80 |
LC: liver cancer; LCHB, liver cancer due to hepatitis B; LCHC, liver cancer due to hepatitis C; LCAL, liver cancer due to alcohol use; LCNA, liver cancer due to non-alcoholic steatohepatitis |
Among the 204 countries/territories, Mongolia and Cameroon had the greatest ASR of death in 1990, while Guinea had the lowest (Fig. 3A, Supplementary table 1). Mongolia continues to have the highest ASR of death in the world in 2019, at 115.23 (91.48-142.48), followed by Gambia; Niger has the lowest ASR of death (Fig. 3B). The most pronounced increasing percentage in number occurred in Cabo Verde (1786.75%), whereas the largest decreasing change was seen in Poland (− 55.12%) (Fig. 3C). Decreasing trends were observed in ninety-one countries/territories of which, particularly in China, with the respective EAPC of − 5.06 (95% CI: −5.84 to − 4.27). On the other hand, increasing trends were seen in eighty-three countries/territories, and the largest ones were Armenia (EAPC = 9.56, 95% CI: 8.02 to 11.12), followed by Uzbekistan (Fig. 4, Supplementary table 1).
The trends of EAPC of death caused by liver cancer had a negatively association with ASDR at a national level in 1990 (ρ = −0.23, P = 0.001, Fig. 5A), but not with the Human Development Index (HDI) in 2019 (ρ = 0.18, P = 0.013, Fig. 5B). Similar correlations were also seen in the four etiologies of liver cancer (Supplementary Fig. 1A-D, Supplementary Fig. 2A-D). Overall, the decreasing trends of death due to liver cancer and its etiologies generally occurred in the countries with high HDI, while increasing trends were more common in countries with low HDI.
Trends of death caused by liver cancer due to hepatitis B (LCHB)
During the period 1990–2019, the death number of LCHB was 191.74×103 (95%UI: 161.86×103 to 223.73×103) worldwide in 2019, with an increase of 0.76% since 1990. The ASDR of LCHB showed a decreasing trend from 1990 to 2019 (EAPC = − 3.46, 95%CI: −4.01 to − 2.89) (Fig. 1, Supplementary table 2). In age groups, the highest death number of LCHB was seen in the group aged 60–64, and the increasing percentage changes occurred in those aged > 65 years (Table 2, Supplementary Fig. 3A). Decreasing trends of LCHB were observed in both sexes, most of SDI areas and geographic regions, particularly the high-middle SDI area and East Asia region, in which the respective EAPC were − 4.85 (95%CI: −5.54 to − 4.15) and − 5.11 (95%CI: −5.88 to − 4.33) (Supplementary Fig. 3B). However, the most pronounced increasing trends were seen in high-income North America and Australasia, with the respective EAPC were 2.34 (95%CI: 2.15 to 2.52) and 2.29 (95%CI: 2.08 to 2.50) (Supplementary Fig. 3C). At the national level, decreasing trends of LCHB were demonstrated in 113 countries/territories, particularly China (EAPC = − 5.17, 95% CI: −5.96 to − 4.37), followed by Saint Kitts and Nevis and Poland. On the contrary, increasing trends were observed in 72 countries/territories, particularly Uzbekistan and Armenia, in which the respective EAPC were 9.53 (95%CI: 8.31 to 10.77) and 9.21 (95%CI: 7.65 to 10.79) (Supplementary table 3, Supplementary Fig. 4A-C).
Trends of death caused by liver cancer due to hepatitis C (LCHC)
LCHC caused 141.81×103 (95%UI: 121.79×103 to 161.83×103) death in 2019, with an increase of 67.50% since 1990. Decreasing trend in ASDR of LCHC was observed worldwide from 1990 to 2019, in which the EAPC was − 1.35 (95%CI: −1.59 to − 1.11) (Fig. 1, Supplementary table 2). During the period 1990–2019, the death number of LCHC declined in the age groups under 65 years, while increased in those aged > 65 years (Table 2, Supplementary Fig. 5A). The trends of LCHC pronouncedly declined in SDI areas, expect the high SDI area (EAPC = 0.10, 95%CI: −0.37 to 0.58) (Supplementary table 2, Supplementary Fig. 5B). Among 21 geographic regions, increasing trends in ASDR were found in eleven regions, particularly Central Asia (EAPC = 3.28, 95%CI: 2.74 to 3.81). Whereas decreasing trends were seen in nine regions, and the most pronounced one was in East Asia (EAPC = − 4.92 (95%CI: −5.59 to − 4.24), Supplementary Fig. 5C). At the national level, decreasing trends of LCHC were seen in 92 countries/territories, particularly China (EAPC = − 5.07, 95%CI: −5.79 to − 4.35), followed by Poland and Bermuda. Whereas increasing trends occurred in 84 countries/territories, and the most pronounced ones were in Armenia and Uzbekistan, in which respective EAPC were 9.54 (95%CI: 7.99 to 11.12) and 9.03 (95%CI: 8.04–10.03) (Supplementary table 3, and Supplementary Fig. 6A-C).
Trends of death caused by liver cancer due to alcohol consumption (LCAL)
Globally, the death number of LCAL increased 89.60% since 1990, and was 90.74×103(73.35×103 to 109.4×103) in 2019. Decreasing trend in ASDR of LCAL was observed worldwide from 1990 to 2019, with the EAPC of − 0.68 (95%CI: −0.87 to − 0.49) (Fig. 1, Supplementary table 4). During the period 1990–2019, percentages in death number of LCAL increased in most age group, particularly the group of > 80 (241.84%) (Table 2, Supplementary Fig. 7A). The ASDR of LCAL showed decreasing trends in both sexes, and most SDI areas, expect the high SDI area (EAPC = 1.03 (95%CI: 0.79 to 1.26) (Supplementary table 4, and Supplementary Fig. 7B). Among 21 geographic regions, decreasing trend was found in six regions, particularly East Asia (EAPC = − 4.40, 95%CI: −5.19 to − 3.60). Whereas increasing trends were seen in thirteen regions, particularly Eastern Europe and Central Asia regions, in which the respective EAPC were 2.97 (95%CI: 2.66 to 3.28) and 2.94 (95%CI: 2.41 to 3.46) (Supplementary Fig. 7C). At the national level, the highest increase in death number of LCAL was observed in Cabo Verde (2060.08%), whereas the largest decreasing one was in Hungary (− 51.16%). Decreasing trends of LCAL were demonstrated in 81 countries/territories, particularly in China and Saint Kitts and Nevis, in which the respective EAPC were − 4.46 (95%CI: −5.28 to − 3.63), and − 4.42 (95%CI: −5.47 to − 3.36). However, increasing trends were seen in 100 countries/territories, and the most pronounced ones were Armenia and Uzbekistan, with the respective EAPC of 10.45 (95%CI: 8.85–12.08) and 10.06 (95%CI: 8.97 to 11.17) (Supplementary table 5, Supplementary Fig. 8A-C).
Trends of death caused by liver cancer due to non-alcoholic steatohepatitis (LCNA)
The death number of LCNA was 34.73×103 (95%UI: 28.39×103 to 43.18×103) globally in 2019, with an increase of 95.10% since 1990. The ASDR of LCNA showed a decreasing trend from 1990 to 2019 (EAPC = − 0.74, 95%CI: −1.02 to − 0.46) (Fig. 1, Supplementary table 4). The death number of LCNA increased in most age groups, particularly in those above 80 years (257.80%) (Table 2, Supplementary Fig. 9A). Decreasing trends of LCNA were observed in both sexes and most SDI areas, but increasing trend was observed in the high SDI area (EAPC = 1.45, 95%CI: 1.09 to 1.81) (Supplementary table 4, Supplementary Fig. 9B). Among 21 geographic regions, increasing trends were seen in fourteen regions, particularly Central Asia (EAPC = 4.14, 95%CI: 3.64 to 4.65). However, decreasing trends were observed in five regions, particularly East Asia (EAPC = − 4.10, 95%CI: −4.86 to − 3.32) (Supplementary Fig. 9C). At the national level, increasing trends were observed in 123 countries/territories, particularly Armenia and Uzbekistan, with the respective EAPC were 10.87 (95%CI: 9.25–12.51) and 10.39 (95%CI: 9.44–11.34). On the other hand, decreasing trends were seen in 56 countries//territories, and the pronounced ones were in Poland and China, with the respective EAPC were − 4.38 (95%CI: −5.73 to − 3.01) and − 4.20 (95%CI: −5.01 to − 3.39) (Supplementary table 5, Supplementary Fig. 10A-C).
Trends in underlying etiologies attributable risks-related death caused by LC
During the period 1990–2019, decreasing trends were observed in smoking-, alcohol use-, and drug use-related death caused by LC worldwide particularly smoking-related (EAPC = − 2.62, 95%CI: −3.06 to − 2.16, Table 3, Fig. 6A). However, increasing trend was seen in the high body-mass index (BMI)-related one (EAPC = 0.31, 95%CI: 0.05 to 0.58)) (Table 3, Fig. 6A). After stratified analysis, we found that the overall rate of death caused by liver cancer by attributable risks in different age groups in 2019 demonstrated an increase in mortality with increasing age groups when compared to the results in 1990 (Fig. 7A). In the over-80s group in particular, there was a clear trend towards an increasing number of deaths due to the four attributable risks, particularly alcohol use and drug use (Fig. 7A). Compared with females, males had more pronounced decreasing trends in risks-related death of LC, particularly smoking-related one (EAPC = − 2.73, 95%CI: −3.19 to − 2.26) (Table 4, Fig. 6B and 6C ). Smoking is the most important contributory risk among male, while drug use is the most significant contributory risk among women (Figs. 7B and 7C).
Table 3
The number and age-standardized rate of death caused by liver cancer and underlying etiologies in risks globally, in both sexes, in 1990 and 2019, and percentage changes in number and the EAPCs from 1990 to 2019
| 1990 | 2019 | 1990 − 2019 |
Characteristics | Number ×103 (95% UI) | ASR per 100k (95% UI) | Number ×103 (95% UI) | ASR per 100k (95% UI) | Change in number (%) | EAPC (95%CI) |
LC | | | | | | |
Smoking | 66.46(36.89–95.85) | 1.64(0.91–2.36) | 85.88(50.01-122.99) | 1.04(0.61–1.49) | 29.23 | −2.62(− 3.06-−2.16) |
Alcohol use | 54.07(42.16–67.93) | 1.34(1.05–1.67) | 96.05(77.51-116.17) | 1.17(0.94–1.41) | 77.66 | −0.98(− 1.22-−0.74) |
Drug use | 38.52(28.99–49.48) | 0.96(0.72–1.23) | 71.45(57.09–89.24) | 0.88(0.71–1.1) | 85.48 | −1.19(− 1.57-−0.81) |
High fasting plasma glucose | 1.99(0.45–4.43) | 0.05(0.01–0.11) | 4.73(1.15–10.41) | 0.06(0.01–0.13) | 137.15 | −0.17(− 0.43 − 0.1) |
High body-mass index | 23.18(6.96–52.46) | 0.57(0.17–1.29) | 60.8(24.24-114.62) | 0.74(0.29–1.39) | 162.34 | 0.31(0.05–0.58) |
LCHB | | | | | | |
Smoking | 36.89(19.39–55.63) | 0.89(0.47–1.33) | 38.07(20.93–56.37) | 0.46(0.25–0.67) | 3.20 | −3.72(− 4.35-−3.09) |
Alcohol use | 5.58(0.15–14.60) | 0.12(0-0.33) | 4.58(0.2-11.74) | 0.05(0-0.14) | −17.92 | −4.52(− 5.34-−3.69) |
Drug use | 1.76(1.10–2.68) | 0.04(0.03–0.06) | 3.12(2.1–4.6) | 0.04(0.03–0.06) | 77.42 | −1.44(− 1.94-−0.95) |
High body-mass index | 10.8(2.69–26.45) | 0.25(0.06–0.62) | 24.07(8.74–48.33) | 0.29(0.1–0.58) | 122.95 | −0.57(− 1.04-−0.1) |
LCHC | | | | | | |
Smoking | 14.09(7.72–19.94) | 0.37(0.2–0.52) | 21.95(12.52–31.73) | 0.27(0.16–0.39) | 55.74 | −1.74(− 2.07-−1.41) |
Alcohol use | 0.63(0.01–2.25) | 0.02(0-0.06) | 0.73(0.01–2.65) | 0.01(0-0.03) | 16.52 | −3.34(− 3.91-−2.78) |
Drug use | 36.76(27.51–47.29) | 0.91(0.69–1.18) | 68.33(54.6–85.4) | 0.84(0.67–1.05) | 85.87 | −1.18(− 1.55-−0.8) |
High body-mass index | 6.59(2.13–14.13) | 0.17(0.06–0.37) | 19.07(7.58–35.43) | 0.24(0.09–0.44) | 189.50 | 0.77(0.6–0.95) |
LCAL | | | | | | |
Smoking | 10.22(5.65–15.05) | 0.26(0.14–0.38) | 17.66(9.74–26.16) | 0.21(0.12–0.32) | 72.78 | −1.12(− 1.33-−0.91) |
Alcohol use | 47.86(38.59–58.61) | 1.2(0.97–1.46) | 90.74(73.35–109.4) | 1.1(0.89–1.33) | 89.60 | −0.68(− 0.87-−0.49) |
High body-mass index | 4.55(1.56–9.70) | 0.11(0.04–0.24) | 14.64(5.56–28.32) | 0.18(0.07–0.34) | 221.53 | 1.37(1.28–1.46) |
LCNA | | | | | | |
Smoking | 2.58(1.42–3.87) | 0.07(0.04–0.10) | 4.96(2.79–7.54) | 0.06(0.03–0.09) | 92.28 | −1.04(− 1.38-−0.71) |
High fasting plasma glucose | 1.02(0.24–2.29) | 0.03(0.01–0.06) | 3.04(0.74–6.87) | 0.04(0.01–0.09) | 196.45 | 0.69(0.48–0.89) |
LCHB, liver cancer due to hepatitis B; LCHC, liver cancer due to hepatitis C; LCAL, liver cancer due to alcohol use; LCNA, liver cancer due to non − alcoholic steatohepatitis; EAPC: estimated annual percentage change; ASR, age-standardized rate; CI, confidence interval. |
Table 4
The age-standardized rate of liver cancer death attributed to risks globally in sexes and 2019, and percentage changes in number and the EAPCs from 1990 to 2019
| Male | Female |
Characteristics | ASR per 100k No. (95% UI) | Change in number (%) | EAPC No.(95%CI) | ASR per 100k No. (95% UI) | Change in number (%) | EAPC No.(95%CI) |
LC | | | | | | |
Smoking | 2.02(1.18–2.87) | 26.50 | −2.73(− 3.19-−2.26) | 0.19(0.10–0.30) | 60.75 | −1.36(− 1.59-−1.13) |
Alcohol use | 2.01(1.64–2.42) | 83.67 | −0.88(− 1.13-−0.64) | 0.44(0.34–0.55) | 57.10 | −1.34(− 1.55-−1.13) |
Drug use | 1.13(0.92–1.38) | 83.75 | −1.23(− 1.63-−0.82) | 0.67(0.50–0.88) | 87.99 | −1.11(− 1.45-−0.76) |
High fasting plasma glucose | 0.07(0.01–0.16) | 165.46 | 0.07(− 0.25–0.39) | 0.05(0.01–0.12) | 112.21 | −0.41(− 0.63-−0.19) |
High body-mass index | 1.19(0.40–2.41) | 172.72 | 0.41(0.12–0.70) | 0.33(0.06–0.74) | 134.06 | 0.06(− 0.10–0.23) |
LCHB | | | | | | |
Smoking | 0.92(0.52–1.35) | 2.52 | −3.76(− 4.40-−3.13) | 0.03(0.02–0.05) | 24.94 | −2.41(− 2.74-−2.09) |
Alcohol use | 0.11(0-0.28) | −18.06 | −4.49(− 5.31-−3.66) | 0 | 18.43 | −2.23(− 2.77-−1.69) |
Drug use | 0.07(0.05–0.10) | 73.04 | −1.59(− 2.13-−1.05) | 0.01(0.01–0.02) | 110.32 | −0.14(− 0.32 − 0.04) |
High body-mass index | 0.51(0.17–1.06) | 129.42 | −0.51(− 1.00-−0.01) | 0.08(0.01–0.18) | 91.44 | −0.81(− 1.11-−0.51) |
LCHC | | | | | | |
Smoking | 0.49(0.28–0.71) | 52.96 | −1.87(− 2.21-−1.52) | 0.1(0.05–0.15) | 68.44 | −1.23(− 1.48-−0.99) |
Alcohol use | 0.02(0-0.06) | 6.80 | −3.55(− 4.14-−2.95) | 0(0-0.01) | 99.20 | −1.35(− 2.00-−0.71) |
Drug use | 1.06(0.86–1.30) | 84.53 | −1.21(− 1.60-−0.81) | 0.66(0.49–0.87) | 87.69 | −1.12(− 1.46-−0.77) |
High body-mass index | 0.31(0.10–0.62) | 213.22 | 1.02(0.80–1.23) | 0.17(0.03–0.37) | 159.09 | 0.45(0.31–0.58) |
LCAL | | | | | | |
Smoking | 0.43(0.24–0.63) | 73.54 | −1.18(− 1.4-−0.97) | 0.03(0.01–0.05) | 63.43 | −1.03(− 1.13-−0.93) |
Alcohol use | 1.88(1.53–2.27) | 100.72 | −0.52(− 0.7-−0.34) | 0.44(0.33–0.55) | 56.95 | −1.34(− 1.55-−1.13) |
High body-mass index | 0.32(0.11–0.63) | 239.37 | 1.49(1.40–1.58) | 0.05(0.01–0.12) | 151.92 | 0.54(0.45–0.62) |
LCNA | | | | | | |
Smoking | 0.11(0.06–0.16) | 89.65 | −1.24(− 1.62-−0.87) | 0.02(0.01–0.04) | 103.35 | −0.38(− 0.57-−0.20) |
High fasting plasma glucose | 0.04(0.01–0.10) | 234.67 | 0.91(0.66–1.17) | 0.03(0.01–0.08) | 163.91 | 0.46(0.30–0.62) |
LCHB, liver cancer due to hepatitis B; LCHC, liver cancer due to hepatitis C; LCAL, liver cancer due to alcohol use; LCNA, liver cancer due to non-alcoholic steatohepatitis; EAPC: estimated annual percentage change; ASR, age-standardized rate; CI, confidence interval. |
In the SDI level, smoking- and alcohol consumption-related death of LC showed decreasing trends in most SDI areas, and the largest one was smoking-related death in high-middle SDI area (EAPC = − 3.91, 95%CI: −4.52 to − 3.29, Table 5). Whereas high fasting plasma glucose- and high BMI-related death presented increasing trends in most of SDI areas, particularly the high fasting plasma glucose-related deaths in high SDI area (EAPC = 2.82, 95%CI: 2.58 to 3.06). During the period 1990–2019, smoking-, alcohol use- and drug use-related death caused by four specific etiologies showed decreasing trends worldwide, and in both sexes, and most SDI areas, particularly the one caused by LCHB in the high-middle SDI area (EAPC = − 5.59, 95%I: −6.48 to − 4.69) (Table 5, Supplementary Fig. 11A, Supplementary Fig. 12). In terms of drug use, the most pronounced decreasing trend was observed in the etiology of LCHC in middle SDI area (EAPC = − 2.85, 95%CI: −3.51 to − 2.18). Whereas the increasing trends mainly occurred in low- and high- SDI areas, particularly in the four specific etiologies of LCHB in high SDI area, with EAPC of 2.17(95%CI: 1.94 to 2.40) (Table 5, Supplementary Fig. 11B, Supplementary Fig. 13). However, high BMI- and high fasting plasma glucose-related death caused by four specific etiologies showed increasing trends worldwide, and in both sexes, and most SDI areas. The most pronounced increasing trends were observed in the high fasting plasma glucose-related death caused by LCNA in high SDI area, with the EAPC of 3.11 (95%CI: 2.84 to 3.38) (Table 5, Supplementary Fig. 11C, Supplementary Fig. 14). In terms of high BMI, the largest decreasing trend was observed in the etiology of LCAL in low-middle SDI area (EAPC = 2.57, 95%CI: 2.41 to 2.73) (Table 5, Supplementary Fig. 11D, Supplementary Fig. 15).
Table 5
The EAPCs of death due to liver cancers underlying etiologies in attributable risks in SDI quintiles from 1990 to 2019
| Low SDI | Low-middle SDI | Middle SDI | High-middle SDI | High SDI |
Characteristics | EAPC (95%CI) | EAPC (95%CI) | EAPC (95%CI) | EAPC (95%CI) | EAPC (95%CI) |
LC | | | | | |
Smoking | −0.65(− 0.76-−0.55) | −2.21(− 2.61-−1.81) | −3.35(− 3.94-−2.75) | −3.91(− 4.52-−3.29) | −0.45(− 0.89-−0.01) |
Alcohol use | −0.17(− 0.23-−0.11) | −0.48(− 0.67-−0.28) | −1.76(− 2.21-−1.31) | −2.26(− 2.61-−1.92) | 0.90(0.65–1.15) |
Drug use | 1.21(1.09–1.33) | −0.33(− 0.59-−0.08) | −2.82(− 3.48-−2.15) | −2.54(− 3.03-−2.05) | 1.78(1.41–2.15) |
High fasting plasma glucose | 1.11(1.01–1.20) | 0.34(0.10–0.58) | −1.30(− 1.75-−0.84) | −1.91(− 2.26-−1.56) | 2.82(2.58–3.06) |
High body-mass index | 1.62(1.57–1.67) | 1.31(1.07–1.56) | 0.05(− 0.37–0.47) | −1.02(− 1.38-−0.66) | 1.70(1.35–2.04) |
LCHB | | | | | |
Smoking | −0.88(− 1.02-−0.74) | −3.11(− 3.67-−2.56) | −4.09(− 4.78-−3.41) | −5.05(− 5.82-−4.27) | −0.47(− 1.08–0.13) |
Alcohol use | −0.73(− 0.94-−0.52) | −4.31(− 5.23-−3.38) | −4.48(− 5.39-−3.56) | −5.59(− 6.48-−4.69) | −1.68(− 2.33-−1.04) |
Drug use | 1.03(0.91–1.14) | −1.61(− 2.16-−1.05) | −2.11(− 2.73-−1.49) | −2.66(− 3.33-−1.98) | 2.17(1.94–2.40) |
High body-mass index | 1.37(1.33–1.42) | 0.47(0.08–0.86) | −0.75(− 1.34-−0.16) | −1.89(− 2.47-−1.31) | 1.42(0.96–1.89) |
LCHC | | | | | |
Smoking | −0.66(− 0.75-−0.58) | −1.25(− 1.44-−1.07) | −2.37(− 2.79-−1.94) | −2.74(− 3.18-−2.31) | −1.04(− 1.55-−0.54) |
Alcohol use | −0.87(− 0.96-−0.78) | −3.46(− 4.35-−2.56) | −4.48(− 5.54-−3.41) | −5.26(− 6.12-−4.39) | −2.71(− 3.40-−2.01) |
Drug use | 1.22(1.10–1.34) | −0.26(− 0.50-−0.03) | −2.85(− 3.51-−2.18) | −2.53(− 3.01-−2.05) | 1.77(1.39–2.14) |
High body-mass index | 1.56(1.49–1.63) | 1.82(1.69–1.95) | 0.82(0.62–1.01) | −0.43(− 0.63-−0.22) | 1.31(0.91–1.71) |
LCAL | | | | | |
Smoking | −0.49(− 0.58-−0.4) | −1.02(− 1.24-−0.79) | −1.72(− 2.10-−1.34) | −2.07(− 2.37-−1.78) | 0.28(0.02–0.54) |
Alcohol use | −0.17(− 0.23-−0.1) | −0.33(− 0.49-−0.16) | −1.41(− 1.80-−1.03) | −1.90(− 2.18-−1.62) | 1.03(0.79–1.26) |
High body-mass index | 2.13(2.09–2.17) | 2.57(2.41–2.73) | 1.68(1.43–1.92) | 0.06(− 0.07–0.19) | 2.36(2.15–2.57) |
LCNA | | | | | |
Smoking | −0.12(− 0.21-−0.03) | −1.04(− 1.3-−0.77) | −1.7(− 2.18-−1.21) | −2.41(− 2.93-−1.88) | 0.74(0.39–1.09) |
High fasting plasma glucose | 1.21(1.11–1.31) | 0.98(0.8–1.16) | −0.28(− 0.67 − 0.11) | −0.96(− 1.24-−0.68) | 3.11(2.84–3.38) |
LCHB, liver cancer due to hepatitis B; LCHC, liver cancer due to hepatitis C; LCAL, liver cancer due to alcohol use; LCNA, liver cancer due to non-alcoholic steatohepatitis; EAPC: estimated annual percentage change; ASR, age-standardized rate; CI, confidence interval. |