Abstract:

Objective To analyze the temporal evolution pattern of the disease burden of liver cancer in China from 1990 to 2021， to construct a disease burden prediction system， to simulate the evolution trend of the disease spectrum up to 2050， and to identify core pathogenic factor clusters through an attribution risk analysis model， and to provide the evidence-based support for the formulation of public health policies. Methods Based on the Global Burden of Disease Study 2021 （GBD 2021） database， the trends in the incidence， mortality， and disability-adjusted life years （DALYs） of liver cancer in China from 1990 to 2021 were systematically analyzed； the Bayesian age-period-cohort （BAPC） model was used to predict the evolution trajectory up to 2050； the main attributable risk factors were evaluated， including smoking， alcohol abuse， high body mass index （BMI）， high fasting plasma glucose， and drug use. Results From 1990 to 2021， the age-standardized incidence rate （ASIR）， age-standardized mortality rate （ASMR）， and age-standardized disability-adjusted life years rate （ASDR） of liver cancer in China showed decreasing trends， with the estimated annual percentage change （EAPC） showing decreasing trends （-0.28， -0.76， and -0.82）， respectively， and the decrease was greater in females than in males； during the same period， the absolute number of cases， deaths， and total DALYs of liver cancer continued to increase. In 2021， the main attributable factors were smoking （13.71%）， alcohol use （11.49%）， and metabolic abnormalities （high BMI was 7.40% and high fasting plasma glucose was 2.01%）； the attribution patterns were different among different age and sex groups； the impact of smoking on liver cancer deaths in males was significantly higher than that in females； the burden of alcohol abuse and drug use was concentrated in the 70-74 years old age group； the peak risk exposure of high BMI shifted forward to the 45-49 years old age group； while the risk aggregation of high fasting plasma glucose was significantly delayed to the advanced age group of 80-84 years old. The BAPC model predicted that the ASIR， ASMR， and ASDR of liver cancer in China would continue to decrease by 2050. Conclusion Although the standardized burden of liver cancer in China shows a decreasing trend， its absolute number is still increasing； the main attributable risk factors， including smoking， alcohol abuse， and metabolic abnormalities （high BMI and high fasting plasma glucose）， show differential distributions among different age and sex groups. This suggests that future prevention and control strategies for liver cancer should focus on the multi-dimensional management of behavioral and metabolic risk factors， and implement precise preventive measures combined with the sex and age differences of the liver cancer patients.

Key words: Liver neoplasm, Epidemiology, Attribution analysis, Incidence, Mortality