Article Text

Download PDFPDF

Disease burden of liver cancer in China from 1997 to 2016: an observational study based on the Global Burden of Diseases
  1. Cheng Ding1,
  2. Xiaofang Fu1,
  3. Yuqing Zhou1,
  4. Xiaoxiao Liu1,
  5. Jie Wu1,
  6. Chenyang Huang1,
  7. Min Deng1,
  8. Yiping Li2,
  9. Lanjuan Li1,
  10. Shigui Yang1
  1. 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
  2. 2Digital medicine, Zhejiang Institute of Medical Care Information Technology, Hangzhou, Zhejiang, China
  1. Correspondence to Professor Lanjuan Li; ljli{at} and Dr Shigui Yang; YANGSHIGUI{at}


Objective To evaluate the trends in disease burden and the epidemiological features of liver cancer in China while identifying potential strategies to lower the disease burden.

Design Observational study based on the Global Burden of Diseases.

Participants Data were publicly available and de-identified and individuals were not involved.

Measurement and methods To measure the liver cancer burden, we extracted data from the Global Health Data Exchange using the metrics of prevalence, incidence, mortality and disability-adjusted life years (DALYs). Joinpoint and negative binomial regressions were applied to identify trends and risk factors.

Results From 1997 to 2016, the prevalence, incidence, mortality and DALYs of liver cancer in China were from 28.22/100 000 to 60.04/100 000, from 27.33/100 000 to 41.40/100 000, from 27.40/100 000 to 31.49/100 000 and from 10 311 308 to 11 539 102, respectively. The prevalence, incidence and mortality were increasing, with the average annual percent changes (AAPCs) of 4.0% (95% CI 3.9% to 4.2%), 2.1% (95% CI 2.0% to 2.2%) and 0.5% (95% CI 0.2% to 0.9%), respectively. Meanwhile, the rate of DALYs was stable with the AAPCs of −0.1% (95% CI −0.4% to 0.3%). The mortality-to-incidence ratio of liver cancer decreased from 1.00 in 1997 to 0.76 in 2016 (β=−0.014, p<0.0001). Males (OR: 2.98, 95% CI 2.68 to 3.30 for prevalence, OR: 2.45, 95% CI 2.21 to 2.71 for incidence) and the elderly individuals (OR: 1.57, 95% CI 1.55 to 1.59 for prevalence, OR: 1.58, 95% CI 1.56 to 1.60 for incidence) had a higher risk. Hepatitis B accounted for the highest proportion of liver cancer cases (55.11%) and deaths (54.13%).

Conclusions The disease burden of liver cancer continued to increase in China with viral factors as one of the leading causes. Strategies such as promoting hepatitis B vaccinations, blocking the transmission of hepatitis C and reducing alcohol consumption should be prioritised.

  • liver cancer
  • epidemics
  • disease burden
  • risk factors

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • CD and XF contributed equally.

  • Contributors SY, LL and CD conceived and designed the study. CD, SY, YZ, XL, JW, CH, MD and YL extracted, cleaned, analysed the data and revised the paper critically. CD and XF wrote the first draft of the paper, contributed to figures and paper preparation. All authors critically revised the paper and gave final approval for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Funding This work was supported by the National Natural Science Foundation of China, grant number [81672005, 81001271], the key joint project for data centre of the National Natural Science Foundation of China and Guangdong Provincial Government, grant number [U1611264], the Mega-Project of National Science and Technology of China, grant number [2018ZX10715014, 2013ZX10004904, 2014ZX10004008, 2013ZX10004901], Zhejiang Laboratory Project and the Fundamental Research Funds for the Central Universities.

  • Disclaimer The funders had no role in study design, data collection, data analysis or writing of the report.

  • Competing interests None declared.

  • Ethics approval Ethical approval was not obtained because the data included in this study were publicly available and de-identified data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.