TY  - JOUR
TI  - The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level
AU  - Tomi Akinyemiju
AU  - Semaw Ferede Abera
AU  - Muktar Beshir Ahmed
AU  - Noore Alam
AU  - Mulubirhan Assefa Alemayohu
AU  - Christine A. Allen
AU  - Rajaa Al‐Raddadi
AU  - Nelson Alvis‐Guzmán
AU  - Yaw Ampem Amoako
AU  - Al Artaman
AU  - Tadesse Awoke Ayele
AU  - Aleksandra Barać
AU  - Isabela M. Benseñor
AU  - Adugnaw Berhane
AU  - Zulfiqar A Bhutta
AU  - Jacqueline Castillo-Rivas
AU  - Abdulaal Chitheer
AU  - Jee-Young Jasmine Choi
AU  - Benjamin Cowie
AU  - Lalit Dandona
AU  - Rakhi Dandona
AU  - Subhojit Dey
AU  - Daniel Dicker
AU  - Huyen Phuc
AU  - Donatus U. Ekwueme
AU  - Maysaa El Sayed Zaki
AU  - Florian Fischer
AU  - Thomas Fürst
AU  - Jamie Hancock
AU  - Simon I Hay
AU  - Peter J. Hotez
AU  - Sun Ha Jee
AU  - Amir Kasaeian
AU  - Yousef Khader
AU  - Young‐Ho Khang
AU  - G Anil Kumar
AU  - Michael Kutz
AU  - Heidi J. Larson
AU  - Alan D Lopez
AU  - Raimundas Lunevičius
AU  - Reza Malekzadeh
AU  - Colm McAlinden
AU  - Toni Meier
AU  - Walter Mendoza
AU  - Ali H. Mokdad
AU  - Maziar Moradi‐Lakeh
AU  - Gabriele Nagel
AU  - Quyen Le Nguyen
AU  - Grant Nguyen
AU  - Felix Akpojene Ogbo
AU  - George Patton
AU  - David M. Pereira
AU  - Farshad Pourmalek
AU  - Mostafa Qorbani
AU  - Amir Radfar
AU  - Gholamreza Roshandel
AU  - Joshua A. Salomon
AU  - Juan Sanabria
AU  - Benn Sartorius
AU  - Maheswar Satpathy
AU  - Monika Sawhney
AU  - Sadaf G Sepanlou
AU  - Katya Anne Shackelford
AU  - Hirbo Shore Roba
AU  - Jiandong Sun
AU  - Desalegn Tadese Mengistu
AU  - Roman Topór-Mądry
AU  - Bach Xuan Tran
AU  - Kingsley Nnanna Ukwaja
AU  - Vasily Vlassov
AU  - Stein Emil Vollset
AU  - Theo Vos
AU  - Tolassa Wakayo
AU  - Elisabete Weiderpass
AU  - Andrea Werdecker
AU  - Naohiro Yonemoto
AU  - Mustafa Z Younis
AU  - Chuanhua Yu
AU  - Zoubida Zaidi
AU  - Liguo Zhu
AU  - Christopher J L Murray
AU  - Mohsen Naghavi
AU  - Christina Fitzmaurice
PY  - 2017
JO  - JAMA Oncology
DO  - 10.1001/jamaoncol.2017.3055
UR  - https://doi.org/10.1001/jamaoncol.2017.3055
AB  - Importance Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use. Objective To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes. Design, Settings, and Participants Mortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs. Main Outcomes and Measures Liver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year. Results There were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies. Conclusions and Relevance Liver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.
ER  -