The trends in death of primary liver cancer caused by specific etiologies worldwide: results from the Global Burden of Disease Study 2019 and implications for liver cancer management

Background: Over past decades, epidemiological patterns of liver cancer (LC) have changed dramatically. The Global Burden Of Disease (GBD) study provides an opportunity to tracking the progress in cancer control with its annual updated reports at national, regional, global level, which can facilitate the health decision-making and the allocation of health resources. Therefore, we aim to estimate the global, regional and national trends of death caused by liver cancer due to specific etiologies and attributable risks from 1990 to 2019. Materials: and Methods: Data was collected from the GBD study 2019. Estimated annual percentage changes (EAPC) were used to quantify the trends of age-standardized death rate (ASDR). We applied a linear regression for the calculation of estimated annual percentage change in ASDR. Results: : From 1990 to 2019, the ASDR of liver cancer decreased globally (EAPC = −2.23, 95% confidence interval [CI]: −2.61 to −1.84). Meanwhile, declining trends were observed in both sexes, socio-demographic index (SDI) areas, and geographies, particularly East Asia (EAPC =−4.98, 95%CI: −5.73 to −4.22). The ASDR for all four major etiologies decreased globally, particularly LC owing to hepatitis B (EPAC = −3.46, 95% CI: −4.01 to −2.89). At the national level, China has seen dramatic decreases in death rates, particularly in the etiology of hepatitis B (EAPC = −5.17, 95% CI: −5.96 to −4.37). However, mortality from liver cancer increased in certain countries, including Armenia and Uzbekistan. Controlling smoking, alcohol, and drug use contributed to a drop in LC-related mortality in the majority of socio-demographic index areas. However, the excessive BMI was portrayed as the underlying cause for LC fatalities. Conclusion: From 1990 to 2019, there was a worldwide decrease in deaths caused by liver cancer and its underlying causes. However, rising tendencies have been observed in low-resource regions and countries. The trends in drug use- and high BMI-related death from liver cancer and its underlying etiologies were concerning. The findings indicated that efforts should be increased to prevent liver cancer deaths through improved etiology control and risk management.