Objective To analyze the incidence and mortality of liver cancer in China between 1992 and 2021, in order to provide data support for the prevention and treatment of liver cancer in the country. MethodsUsing the Global Burden of Disease (2021) database, we analyzed the trends and performed an age-period-cohort model analysis on the incidence and mortality of liver cancer by gender in China between 1992 and 2021. An autoregressive integrated moving average model was employed to forecast the age-standardized incidence and mortality rates of liver cancer in China from 2022 to 2030. ResultsCompared with 1992, the number of incident cases and deaths from liver cancer in China in 2021 increased significantly in the total population, males, and females. The percentage changes in the number of cases were 93.94% (101 392→196 637), 94.01% (74 113→143 788), and 93.73% (27 279→52 848), respectively. The corresponding percentage changes in the number of deaths were 75.26% (98 179→172 068), 72.16% (71 133→122 463), and 83.42% (27 045→49 605). The rate of change in incidence for the total population, males, and females in 2021 was 64.33% (8.41 per 100 000→13.82 per 100 000), 66.11% (11.89 per 100 000→19.75 per 100 000), and 62.61% (4.68 per 100 000→7.61 per 100 000), respectively; the rate of change in mortality rate was 48.53% (8.14 per 100 000→12.09 per 100 000), 47.41% (11.41 per 100 000→16.82 per 100 000), and 53.88% (4.64 per 100 000→7.14 per 100 000), respectively. The standardized incidence rates decreased compared to 1992, with changes of –9.16% (10.48 per 100 000→9.52 per 100 000), –4.14% (14.96 per 100 000→14.34 per 100 000), and –17.54% (5.93 per 100 000→4.89 per 100 000) for the total population, males, and females, respectively; the standardized mortality rates decreased by –20.32% (10.48 per 100 000→8.35 per 100 000), –16.61% (14.87 per 100 000→12.40 per 100 000), and –24.84% (6.08 per 100 000→4.57 per 100 000), respectively. The age effect showed significant variations in liver cancer risk with age, with the highest incidence risk in the 65–69 age group for the total population and females, and the 50–54 age group for males. The period effect overall showed an upward trend, with the most significant increase occurring from 2017 to 2021. Cohort effect analysis revealed an inverted U-shaped trend in liver cancer incidence and mortality across birth cohorts, with the peak risk for the total population occurring in the 1932 to 1936 cohort and that for both males and females occurring in the 1952 to 1956 cohort. The incidence and mortality risk for those born between 2017 and 2021 showed a significant downward trend. The prediction results indicated a continuous decline in standard liver cancer incidence and mortality rates for the total population, males, and females in China from 2022 to 2030. ConclusionsFrom 1992 to 2021, the incidence and mortality rates of liver cancer in China increased, while the standardized incidence and mortality rates showed a decreasing trend. Age, period, and cohort are significant factors influencing liver cancer. It is essential to further strengthen liver cancer prevention and control strategies and vaccine implementation.
Objective To analyze the spatiotemporal trends in hepatitis B-related mortality and disability-adjusted life years (DALYs) attributable to high body mass index (BMI) at the global, regional, and national levels. Methods We extracted data on hepatitis B-related mortality numbers, DALYs, age-standardised mortality rates (ASMR), and age-standardised DALY rates (ASDR) attributed to high BMI from the GBD 2021 database for the period 1990-2021, stratified by gender, age, country, and social demographic index (SDI). Time trends were assessed using estimated annual percentage change (EAPC), and decomposition analysis and frontier analysis were employed to identify the drivers of burden changes and leading countries. Inequality indicators (inequality slope index SII and concentration index CI) were used to measure health disparities across SDI levels, and the Bayesian age period cohort model (BAPC) was applied to predict disease trends up to 2050. Results The global burden of hepatitis B disease attributable to high BMI continues to rise. In 2021, the number of DALYs reached 499 900 (four times that of 1990), and the number of deaths was five times that of 1990. The burden and rate of increase were most pronounced in Asia: in 2021, East Asia recorded 7 919.70 deaths (95%UI 2 984.05 to 14 386.39) and 257 954.31 DALYs (95%UI 97 807.17 to 482 232.54), ranked highest among the 21 GBD regions; From 1990 to 2021, South Asia recorded the fastest increase in ASMR (EAPC=4.99, 95%CI 4.83 to 5.16) and the highest growth rate in ASDR (EAPC=4.92, 95%CI 4.74 to 5.10); at the national level, China and the United States had the heaviest burden. Countries with medium SDI had the highest burden, peaking at an SDI of 0.65. Global and regional decomposition analyses indicated that epidemiological changes were the primary drivers of the increased burden. The CI and SII values derived from inequality analyses of ASDR and ASMR had both increased, indicating worsening health inequalities. Frontier analysis further confirmed that certain countries, such as Tonga and Mongolia, bear a significantly higher burden than expected for their developmental level, demonstrating marked disparities in disease burden across nations. The BAPC model predicts that the burden attributable to high BMI will continue to rise in the absence of interventions. Conclusion High BMI has become an important risk factor for hepatitis B-related diseases globally, with the burden particularly pronounced in Asian regions and middle-income countries. Health inequalities must not be overlooked. Precise interventions should be implemented based on regional, gender, and age differences.
ObjectiveTo analyze the incidence and mortality of cirrhosis in China from 1992 to 2021, and to explore the impacts of age, period, and birth cohort factors on the incidence and mortality of cirrhosis. MethodsBy means of the Global Burden of Disease (GBD) 2021 database, the incidence and mortality of cirrhosis in China from 1992 to 2021 were analyzed. The Joinpoint software was used to analyze the temporal trends of the standardized incidence rate and standardized mortality rate of cirrhosis, and the average annual percentage change was calculated. An age-period-cohort model was constructed to deeply explore the effects of age, period, and birth cohort factors on the changing trends of the incidence and mortality of cirrhosis. ResultsIn 2021, the incidence of cirrhosis in China was 772.07 per 100 000, and the mortality was 10.99 per 100 000, representing decreases of 5.53% and 26.98%, respectively, compared with 1992. By gender, in 2021, the incidence of cirrhosis in males (727.95 per 100 000) was lower than that in females (818.32 per 100 000), but the mortality in males (15.53 per 100 000) was higher than that in females (6.24 per 100 000). From 1992 to 2021, the age-standardized incidence rate (ASIR) of cirrhosis in China showed a decreasing trend, with an average annual decrease of 0.31%, which was statistically significant (P=0.014). Similarly, the age-standardized mortality rate (ASMR) of cirrhosis also showed a decreasing trend, with an average annual decrease of 3.21%, which was statistically significant (P=0.021). The age effect results showed that the incidence of cirrhosis in China generally followed a trend of first decreasing, then increasing, and then decreasing again. There was a significant downward trend in incidence in the 5–14 years old group, a significant upward trend in the 15–24 years old group, and a fluctuating downward trend after 25 years old. Mortality rates gradually increased, from 2.32 per 100 000 in the 0–4 years old group to 27.72 per 100 000 in the 85–89 years old group. The period effect results showed that the period relative risk (RR) for cirrhosis incidence first decreased and then increased, with the highest risk from 1992 to 1996 [RR=1.19, 95%CI (1.10, 1.29)]. The period RR for cirrhosis mortality showed a decreasing trend, with the highest mortality risk occurring from 1992 to 1996 [RR=1.41, 95%CI (1.36, 1.45)]. The cohort effect results indicated that the later the birth cohort, the lower the risk of cirrhosis incidence and mortality. In 2021, among the five types of cirrhosis, nonalcoholic fatty liver disease (NAFLD)-induced cirrhosis had the highest incidence (672.02 per 100 000), while cirrhosis caused by hepatitis B had the highest mortality (8.15 per 100 000). From 1992 to 2021, alcohol-related cirrhosis showed the most significant increase in incidence (37.50%), and NAFLD-induced cirrhosis showed the most significant increase in mortality (25.00%). ConclusionsFrom 1992 to 2021, the ASIR and ASMR of cirrhosis in China show a declining trend. Age, period, and cohort all have significant effects on the trends of cirrhosis incidence and mortality. NAFLD-induced cirrhosis has the highest incidence, while cirrhosis caused by hepatitis B has the highest mortality.
Objective To explore the long-term trends and epidemiological characteristics of the disease burden of tetanus in China over the past 30 years and to predict its disease burden in 2050, in order to comprehensively assess the overall disease burden of tetanus in China. Methods Leveraging the methods and findings of the Global Burden of Disease Study 2021, we provided a detailed description of the disease burden of tetanus in China based on key indicators such as prevalence, incidence, mortality, disability-adjusted life years, years lived with disability, and years of life lost due to premature mortality. Joinpoint regression analysis, age-period-cohort analysis, decomposition analysis, and Bayesian age-period-cohort models were employed to further elucidate the epidemiological characteristics of tetanus and predict its disease burden in China by 2050. Results From 1990 to 2021, the overall disease burden of tetanus in China exhibited a significant year-by-year decline. The primary demographic group bearing the burden of tetanus in China had gradually shifted from newborns to middle-aged and elderly individuals, with males being more affected than females. Decomposition analysis indicated that epidemiological change was a significant factor contributing to tetanus in China, while the impacts of population and aging were relatively minor. According to predictions from the Bayesian age-period-cohort model, by 2050, only the prevalence rate was expected to slightly increase, while all other indicators were projected to decline and remain at low levels. Conclusion The disease burden of tetanus in China decreased from 1990 to 2021. In subsequent prevention efforts, newborns and middle-aged and elderly individuals should be prioritized as targets for prevention and control to maintain the disease burden of tetanus at a low level.
ObjectiveTo analyze the incidence trend and characteristics of gastric cancer in China from 1990 to 2023, and to provide a basis for prevention and control efforts. MethodsBased on the relevant data from the Global Burden of Disease 2023 Database, Joinpoint regression analysis was used to calculate the average annual percent change (AAPC) of the age-standardized incidence rate (ASIR) of gastric cancer; the age-period-cohort model was adopted to analyze the longitudinal age curve of gastric cancer incidence and the period/cohort rate ratio (RR), and to explore the variation in incidence risk with age, period, and cohort. ResultsFrom 1990 to 2023, the national ASIR of gastric cancer decreased from 54.23 per 100 000 to 25.04 per 100 000, with an AAPC of –2.19% (t=–9.21, P<0.001). For males, it decreased from 72.74 per 100 000 to 37.90 per 100 000, with an AAPC of –1.85% (t=–5.85, P<0.001); for females, it decreased from 36.92 per 100 000 in 1990 to 12.93 per 100 000, with an AAPC of –3.07% (t=–22.55, P<0.001). The results of age-period-cohort analysis showed that the risk of gastric cancer in Chinese residents first increased and then decreased with age, and the ASIR of the total population peaked at 143.74 per 100 000 in the 75–79 age group [95%CI (137.30 per 100 000, 150.48 per 100 000)]. After adjusting for age and cohort effects, the risk of gastric cancer in Chinese residents showed a downward trend between 1990 and 2023. Taking the 2005–2009 period as the reference, the risk of gastric cancer in Chinese residents was the highest in the 1990–1994 period group, which was 1.45 times that of the 2005–2009 period group [RR=1.45, 95%CI (1.39, 1.51)]. By 2020–2023, the incidence risk dropped to the lowest level during the study period, which was 0.68 times that of the 2005–2009 period group [RR=0.68, 95%CI (0.66, 0.71)]. After adjusting for age and period effects, the risk of gastric cancer in Chinese birth cohorts fluctuated slightly in the early stage, then decreased rapidly, and then increased slightly. Taking the 1955–1959 birth cohort as the reference, the risk of gastric cancer in Chinese residents born in 1900–1904 was the highest, which was 2.54 times that of the reference cohort [RR=2.54, 95%CI (1.48, 4.35)]. By 1995–1999, the incidence risk dropped to the lowest level during the study period, which was 0.29 times that of the reference cohort [RR=0.29, 95%CI (0.20, 0.41)]. Overall, the risk of gastric cancer in females was significantly lower than that in males. ConclusionsSignificant gender and age disparities exist in the risk of gastric cancer incidence in China, with males and middle-aged/older adults being high-risk groups. Age, period, and birth cohort all significantly influence the risk. It is recommended to strengthen the intervention of risk factors and expand the coverage of Helicobacter pylori infection screening and radical treatment for key groups such as males and the elderly to further reduce the risk of gastric cancer.
Objective To systematically analyze the long-term trends in the disease burden and quality of care index (QCI) of pancreatitis in China from 1990 to 2023, and to evaluate the effectiveness of prevention and control measures as well as changes in care quality. MethodsData on the incidence, prevalence, mortality, and disability adjusted life years (DALYs) of pancreatitis were extracted from the Global Burden of Disease (GBD) 2023 study, and the QCI was constructed. Joinpoint regression, age-period-cohort modeling (Wald test), and autoregressive integrated moving average model were employed for analysis and forecasting. ResultsFrom 1990 to 2023, the age-standardized incidence rate of pancreatitis in China decreased by 32.9% (from 35.35 to 23.70 per 100 000 population), the age-standardized prevalence rate decreased by 31.3% (from 35.32 to 24.26 per 100 000 population), the age-standardized mortality rate decreased by 47.8% (from 0.81 to 0.42 per 100 000 population), the age-standardized DALYs rate decreased by 47.6% (from 25.00 to 13.10 per 100 000 population), the age-standardized years lived with disability rate decreased by 31.0% (from 2.72 to 1.87 per 100 000 population), and the age-standardized years of life lost rate decreased by 49.6% (from 22.28 to 11.23 per 100 000 population). However, the crude number of incident cases increased by 26.7% (from 363 200 to 460 400), the crude number of prevalent cases increased by 45.5% (from 353 800 to 514 800), the crude number of deaths increased by 36.2% (from 6 600 to 9 000), DALYs increased by 6.3% (from 247 000 to 262 500 person-years), years lived with disability increased by 39.5% (from 27 700 to 38 600 person-years), and years of life lost increased by 2.1% (from 219 300 to 223 900 person-years). The QCI increased from 89.58 to 93.29 [with an increase of 6.72 in females (from 87.96 to 94.68) and 1.60 in males (from 90.71 to 92.31)]. Age-period-cohort analysis showed that period effects were the primary driving factor, with significant effects on incidence (χ2=154.93, P<0.01) and prevalence (χ2=316.78, P<0.01), indicating that period effects were the main drivers of changes in disease burden. Autoregressive integrated moving average model projections indicated that by 2035, the crude prevalence rate will continue to rise to 37.06 per 100 000 population, the crude mortality rate will stabilize (approximately 0.70 per 100 000 population), the crude DALYs rate will decrease to 17.12 per 100 000 population, and the QCI will increase to 100. ConclusionsFrom 1990 to 2023, the age-standardized incidence rate, prevalence rate, mortality rate, DALYs rate, years lived with disability rate, and years of life lost rate of pancreatitis in China all decreased significantly, but the crude numbers of incident cases, prevalent cases, and deaths continued to increase. The QCI steadily improved, with greater improvement in females than in males. Significant age and gender disparities existed in disease burden, with period effects being the main driving factor. Projections indicate a future transition towards a chronic disease pattern. Enhanced interventions targeting high-risk populations and the development of a comprehensive chronic disease management system are warranted.
ObjectiveTo systematically analyze the trend of incidence, mortality and disease burden of chronic obstructive pulmonary disease (COPD) in China from 1994 to 2023, reveal the influence of age-period-cohort factors on COPD in China and the attribution characteristics of risk factors, and provide empirical basis for formulating precise prevention and control strategies. MethodsThe Global Burden of Disease (GBD) 2023 database was used to extract the data of the whole population, gender and age groups of COPD in China from 1994 to 2023. The Joinpoint regression model was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) of the standardized rate. The age-period-cohort model was adopted to quantify its impacts on the incidence and mortality of COPD. It also analyzed the attributable effects as well as temporal trend characteristics of seven GBD level-3 risk factors (including smoking, ambient particulate matter pollution, occupational exposure, etc.) in Chinese population in 1994 and 2023 on the standardized mortality rate and standardized disability-adjusted life years (DALYs) rate of COPD. ResultsFrom 1994 to 2023, the incidence and mortality of COPD in China showed an upward trend, but the standardized incidence [AAPC=?1.16%, 95%CI (?1.18, ?1.14), P<0.001] and standardized mortality [AAPC=?2.87%, 95%CI (?3.02, ?2.73), P<0.001] decreased significantly, and the decline rate of standardized incidence in females (AAPC=?1.29%) was slightly higher than that in males (AAPC=?1.04%). The decline rate of standardized mortality in males (AAPC=?3.65%) was higher than that in females (AAPC=?1.94%). The age-period-cohort model revealed a nonlinear increase in the age effect, a graded decline in the cohort effect, and a significant period effect on mortality and male morbidity (P<0.001). In terms of attribution of risk factors, the top three attribution risks of the whole population in 2023 were still smoking, particulate matter pollution and second-hand smoke. Compared with 1994, the attribution of environmental ozone pollution, second-hand smoke, high temperature, smoking and occupational particulate matter/gas/smoke exposure increased, and the attribution of particulate matter pollution decreased. Conclusion From 1994 to 2023, the overall disease burden of COPD in China shows a downward trend. Age and cohort are the core driving factors of the disease, and period factors have a more significant impact on death. The changes in the attribution structure suggest that while consolidating the effectiveness of particulate matter pollution control, it is necessary to strengthen the comprehensive prevention and control strategies of tobacco control, coordinated emission reduction of ozone and multiple pollutants, extreme temperature protection and protection of key occupational groups, so as to continuously reduce the disease burden of COPD.
ObjectiveTo analyze the trends in the disease burden of gallbladder and biliary tract cancer (GBTC) and the quality of care index (QCI) in China from 1990 to 2023, so as to provide references for targeted prevention and control. MethodsData from the Global Burden of Disease 2023 (GBD 2023) were used to extract indicators including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of GBTC, and the QCI was established. Joinpoint regression and age-period-cohort models with Wald test were adopted for trend analysis. The autoregressive integrated moving average model was applied to predict the changing trends from 2024 to 2035. ResultsCompared with the levels in 1990, the numbers of incident cases, prevalent cases, and deaths of GBTC in China in 2023 increased by 136.6%, 213.7%, and 82.8%, respectively; while DALYs, years lived with disability, and years of life lost increased by 52.8%, 151.8%, and 51.9%, respectively. The QCI for GBTC in China increased in the overall population and by gender (female and male), with increments of 59.90, 54.82, and 63.79, respectively. The age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALYs rate of GBTC in China all decreased from 1990 to 2023, with cumulative declines of 14.1%, 36.2%, and 40.8%, respectively; however, the age-standardized prevalence rate increased, with a cumulative increase of 19.8%. The age-period-cohort model analysis showed that age effects were statistically significant for crude incidence, crude prevalence, crude mortality, and crude DALYs rates (all P<0.01), while period and cohort effects were statistically significant only for crude DALYs rate (P<0.01). From 1990 to 2023, the crude incidence, prevalence, and mortality rates of GBTC in China fluctuated upward. These metrics are projected to continue rising, reaching 3.91, 6.15, and 2.66 per 100 000, respectively, by 2035. In contrast, the crude DALYs rate trended downward and is expected to decline slightly, stabilizing at approximately 51.74 per 100 000 during 2024–2035. The QCI also followed a fluctuating upward trajectory, with a projected further increase to 88.67 by 2035, with gender differences between males and females. ConclusionsThe absolute disease burden of GBTC in China increased continuously from 1990 to 2023. All age-standardized rates declined except the age-standardized prevalence rate, while care quality improved substantially. These trends suggest that, against the backdrop of population aging, sustained efforts are needed to strengthen prevention, control and standardize diagnosis and treatment in the future.
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. MethodsData 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. ResultsFrom 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. ConclusionsOver 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.