Trends in Liver Cancer Burden in China and G20: A Comparative Analysis Using GBD 2021

Xiaodi Ma¹Lining Jiang²Bing Han³Wenlong Ding⁴Bing Li¹Shaochun Liu^2,5*Mingjun Zhang^6*Senbang Yao⁶

• ¹Heilongjiang University of Chinese Medicine, Harbin, China
• ²Harbin Medical University, Harbin, China
• ³Qingyuan People's Hospital, Qingyuan, China
• ⁴Yichun Vocational College, Yichun, China
• ⁵Harbin Medical University Cancer Hospital, Harbin, China
• ⁶Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, China

Objective To compare liver cancer trends and risk factors in China with those in G20 countries (1990–2021) to inform prevention and resource allocation. Methods GBD 2021 data for liver cancer in China and G20 countries (1990 – 2021) were analyzed. Age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life-years rates (ASDR) were computed using standard population weights. Joinpoint regression estimates the annual percent change (APC; the year-on-year rate of change within each log-linear segment) and the average annual percent change (AAPC; the summary average trend across the entire period). Decomposition analysis partitioned changes into aging, population growth, and epidemiological factors. Trends in ASMR and ASDR attributable to risk factors from 1990 to 2021 in China and G20 countries were assessed. Results In 2021, the ASIR, ASMR, and ASDR of liver cancer in China were 29.05 (95% UI, 22.42 – 36.20), 21.51 (95% UI, 16.66 – 26.61), and 501.26 (95% UI, 387.29 – 627.98) per 100,000 population, respectively, reflecting a decline compared with 1990. In both 1990 and 2021, G20 countries had substantially lower liver cancer–related deaths than China. Joinpoint regression showed a significant overall decline in APC from 1990 to 2021 in both regions, with a more pronounced decline in China during 2000–2005 than in the G20. Decomposition analysis identified population aging as the primary contributor to ASIR, ASMR, and ASDR in both China and G20 countries. However, epidemiological improvements had a greater impact on reducing ASMR and ASDR in China, whereas population growth was the dominant factor in G20 countries. ASMR and ASDR attributable to high BMI and drug use increased in both settings, and rates attributable to high fasting plasma glucose (FPG) rose steadily, particularly in G20 nations. Conclusion Although age-standardized liver cancer rates declined in China, the absolute burden rose in both China and G20 countries. Increases in incidence and attributable burden from high BMI, drug use, and high FPG highlight the need for enhanced screening, risk factor control, and targeted prevention.