Objective  To analyze the long-term trends of liver cancer incidence and mortality in China from 1994 to 2023, quantify the age, period, and birth cohort effects, and explore the transitions in etiological proportions, thereby providing an evidence base for optimizing liver cancer prevention and control strategies. Methods Data were extracted from the Global Burden of Disease 2023 database. Joinpoint regression models were utilized to calculate the annual percent change (APC) and average annual percent change (AAPC) for analyzing trends in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR). An age-period-cohort model was applied to estimate the independent effects of age, period, and cohort. The etiological proportions of incidence and mortality across different subgroups were also calculated. Results From 1994 to 2023, the crude incidence and mortality rates of liver cancer in China increased from 9.22/100 000 and 8.37/100 000 to 11.54/100 000 and 10.03/100 000, respectively. However, both the ASIR and ASMR exhibited a significant downward trend, decreasing from 10.96/100 000 and 10.24/100 000 to 7.52/100 000 and 6.44/100 000, respectively. Joinpoint regression analysis revealed that the ASIR and ASMR declined significantly for both sexes, with females experiencing a greater magnitude of decrease (AAPC: –2.13% and –2.62%) than males (AAPC: –0.84% and –1.31%). Notably, both ASIR and ASMR demonstrated a rebound after 2020 (annual percent change of 4.36% and 3.79%, respectively). The age-period-cohort model analysis indicated that the peak age of incidence in males (65–69 years) occurred approximately 10 years earlier than in females (75–79 years). The estimated rate ratios for both period and cohort effects presented a continuous declining trend. Etiological attribution analysis demonstrated that although hepatitis B virus (HBV) infection remained the primary etiology (accounting for >60% in 2023), its relative proportion declined. Concurrently, the attributable proportions of hepatitis C virus (HCV) infection and non-alcoholic fatty liver disease (NAFLD) increased significantly, with NAFLD-associated liver cancer accounting for over 6% of the total cases in 2023. Conclusions Over the past three decades, the ASIR and ASMR of liver cancer in China have decreased significantly, largely driven by the widespread implementation of HBV vaccination and antiviral therapies. However, population aging has fueled a continuous rise in crude rates, and the post-2020 rebound in standardized rates highlights the need for vigilance regarding pandemic-related healthcare disruptions and the accelerating prevalence of metabolic risk factors. The increasing proportions of HCV and NAFLD indicate that future strategies should consolidate HBV control achievements, expand HCV screening, and implement precision screening targeted at older adults, males, and individuals at high metabolic risk, in order to continuously reduce the overall burden of liver cancer.

Citation： ZHENG Wenmin, TIAN Yuanyuan. Age-period-cohort and etiological attribution analysis of liver cancer incidence and mortality in China, 1994–2023. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(6): 769-776. doi: 10.7507/1007-9424.202512110 Copy

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