Temporal trends of liver cancer burden, comparative analysis of risk factors and trend forecasts to 2025 in China, the United States, Republic of Korea and Mongolia——systematic analysis based on multiple data sources from GBD 2019, GLOBOCAN, and CI5

Objective: This study aims to analyze the epidemiological burden of liver cancer in China, Mongolia, the Republic of Korea, and the United States, by combining multiple data sources. Design: An analysis of liver cancer burden (GLOBOCAN, GBD and CI5) data in four countries. Setting: China, Mongolia, the Republic of Korea, and the United States. Participant Data were obtained from the GLOBOCAN, GBD and CI5. This study assessed age-standardized incidence rates (ASR), age-standardized incidence ratios (ASIR) and age-standardized mortality rates (ASDR). Main outcome measures Time trends were calculated using Joinpoint regression, incidence rates were predicted using an ARIMA model, and aetiological studies were conducted for different countries based on changes in the percentage of causes of incidence. Results: Between 1990 and 2019, ASR values for liver cancer declined globally. The downward trend was most pronounced in China, where the AAPC of ASIR reached -3.13 (95 CI%: -2.90, -3.35), much higher than the world average of -1.16 (95% CI: -0.96, -1.36). The ASIR in the United States continues to improve and has reached 5.23 *10 5 in 2019. Relatively speaking, HBV remains the main causative agent of liver cancer in China and Korea. For Mongolia, both HBV and HCV account for a large proportion of the country's liver cancer burden. In the United States, the proportion of liver cancer cases caused by alcohol consumption has been increasing. Projections show that the burden of liver cancer in the United States, China, and the Republic of Korea will slowly increase in 2025, while the ASIR value in Mongolia will rapidly decrease. Conclusions: The ASR for liver cancer has declined over the past 30 years in most countries around the world, but in recent years the burden of liver cancer has begun to deteriorate in some countries due to aging and various unhealthy living habits.