Increases in HCV-Related Liver Cancer Incidence, Mortality Suggest Rising Global Health Burden

Songqing He, MD, PhD

Credit: Loop

An analysis of data from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study 2019 is calling attention to the significant global health burden posed by liver cancer due to hepatitis C, highlighting an increase in the absolute number of incident cases, deaths, and disability-adjusted life years since 1990.

Among the 21 regions encompassed in the GBD study 2019, high-income Asia Pacific, North Africa and the Middle East, and Central Asia had the greatest age-standardized mortality and disability-adjusted life year rates, spotlighting the geographic variations of this burden as well as differences based on age and gender.¹

Globally, the World Health Organization estimates 58 million people have chronic hepatitis C virus infection, with about 1.5 million new cases occurring each year. A viral infection causing inflammation of the liver, hepatitis C can lead to cirrhosis and liver cancer over time if left untreated. Given the prevalence of hepatitis C and its known association with liver cancer, understanding its greater impact is essential for managing and reducing the associated burdens.^2,3

“Despite the burden of [liver cancer due to hepatitis C] based on regional and national factors being documented, comprehensive information on its epidemiology and burden, including the incidence, mortality, and disability-adjusted life years, is lacking at the global, regional, and national levels,” wrote investigators.¹ “Therefore, there is an urgent need to gain a deeper understanding of [liver cancer due to hepatitis C] and allocate adequate resources for disease management and prevention.”

Led by the Institute of Health Metrics and Evaluation, the GBD 2019 study analyzed epidemiological levels of 369 diseases and injuries, 282 causes of death, and 84 risk factors across 204 countries and territories, 21 regions, and 7 super-regions from 1990 to 2019. Songqing He, MD, PhD, of Guangxi Medical University in China, and a team of investigators used data obtained from the GBD 2019 study to assess the burden of liver cancer due to hepatitis C at the global, regional, and national levels stratified by etiology, sex, age, and sociodemographic index.¹

Globally, there were 152,225 (95% Uncertainty interval [UI], 131,581 to 174,627) new cases, 141,810 (95% UI, 121,787 to 161,828) deaths, and 2,878,024 (95% UI, 2,439,911 to 3,323,494) disability-adjusted life years attributed to liver cancer due to hepatitis C in 2019. These figures increased by 80.68%, 67.50%, and 37.20%, respectively, from 1990.1

Despite these increases, investigators pointed out the global age-standardized incidence rate decreased from 2.18 (95% UI, 1.90 to 2.49) per 100,000 populations in 1990 to 1.89 (95% UI, 1.64 to 2.17) per 100,000 populations in 2019. The age-standardized disability-adjusted life year rate also decreased between 1990 and 2019, dropping from 49.70 (95% UI, 42.99 to 57.44) to 34.99 (95% UI, 29.71 to 40.28), respectively, representing a 29.59% (95% UI, −36.94% to −20.47%) decrease.¹

Further analysis of the regional burden of liver cancer due to hepatitis C revealed the age-standardized mortality rate was the greatest in high-income Asia Pacific (5.42; 95% UI, 4.70 to 6.00]), North Africa and the Middle East (3.11; 95% UI, 2.31 to 4.09]), and Central Asia (3.08; 95% UI, 2.25 to 3.94]) in 2019. Investigators pointed out these regions also held the greatest age-standardized disability-adjusted life year rates (high-income Asia Pacific, 98.19; 95% UI, 109.03 to 87.14; North Africa and the Middle East, 70.9; 95% UI, 50.55 to 96.51; Central Asia, 64.25; 95% UI, 45.62 to 83.96).¹

National incidence and deaths in 2019 were the greatest in China (34,036 and 33,079, respectively), Japan (33,311 and 25,051, respectively), and the United States (10,408 and 9,231, respectively). Investigators noted the national age-standardized incidence rate was greatest in Mongolia (35.02; 95% UI, 24.73 to 46.77), Egypt (13.64; 95% UI, 9.44 to 19.19), and Japan (8.60; 95% UI, 7.06 to 10.25) in 2019, whereas Cameroon (0.11; 95% UI, 0.07 to 0.16]), Niger (0.13; 95% UI, 0.08 to 0.18), and Peru (0.19; 95% UI, 0.11 to 0.30) exhibited the lowest age-standardized incidence rate.¹

Similar to the national age-standardized incidence rate, the age-standardized mortality rate was greatest in Mongolia (40.31; 95% UI, 28.58 to 53.28) followed by Egypt (14.05; 95% UI, 9.83 to 19.71), although Honduras (6.82 [95%UI 2.82 to 10.85) was the third highest in 2019. Of note, these 3 countries also accounted for the highest age-standardized disability-adjusted life year rates in 2019.¹

The lowest national age-standardized mortality rate correlated with the lowest age-standardized incidence rate, again represented by Cameroon (0.12; 95% UI, 0.08 to 0.18), Niger (0.14; 95% UI, 0.09 to 0.20), and Peru (0.22; 95% UI, 0.13 to 0.34). Investigators pointed out these 3 countries also had the lowest rates of age-standardized disability-adjusted life years.¹

Globally, the incidence rates of liver cancer due to hepatitis C were higher in men and increased with age, with a peak incidence in the 95+ age group for women and the 85–89 age group for men in 2019. No statistically significant difference was found in the incidence and mortality rates between men and women in any age group.¹

“Our findings provide insight into the global burden trend of [liver cancer due to hepatitis C] and could assist policymakers in establishing appropriate methods for achieving the HCV elimination target by 2030 and reducing the burden of [liver cancer due to hepatitis C]. It is crucial to focus on these burden trends, particularly as the number of [liver cancer due to hepatitis C] cases and the aging population continue to rise,” investigators concluded.¹

References:

1. Wei J, Ouyang G, Huang G, et al. Burden of liver cancer due to hepatitis C from 1990 to 2019 at the global, regional, and national levels. Front. Oncol. https://doi.org/10.3389/fonc.2023.1218901
2. World Health Organization. Hepatitis C. Newsroom. July 18, 2023. Accessed January 8, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
3. Mayo Clinic. Hepatitis C. Symptoms & Causes. August 23, 2023. Accessed January 8, 2024. https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278