{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T14:30:41Z","timestamp":1794234641198,"version":"4.9.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides comprehensive data on liver cancer burden worldwide. This study aims to analyze and compare the trends in liver cancer burden in China and globally between 1990 and 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were extracted from the GBD 2021 database, which includes incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for liver cancer in 204 countries and territories. Age-standardized rates (ASIR, ASPR, ASMR, ASDR) and crude rates (CIR, CPR, CMR, CDR) were calculated. Joinpoint regression analysis was used to determine the average annual percentage change (AAPC) in liver cancer burden trends.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In China, the number of liver cancer cases increased from 96,434 in 1990 to 196,637 in 2021, while the age-standardized incidence rate (ASIR) decreased. Globally, cases increased from 244,689 to 529,202, with a slight increase in ASIR. The age-standardized prevalence rate (ASPR) in China remained stable, while globally it increased. Age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR) decreased in both China and globally. Males had higher rates than females in all age groups. The peak age for liver cancer burden occurred earlier in Chinese males compared to the global average.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The liver cancer burden in China has declined over the past three decades, with a more significant decrease in China than globally. However, China still faces a higher burden compared to the global average. The earlier peak in liver cancer burden among Chinese males suggests the need for targeted prevention and control measures, especially in light of the impact of risk factors like hepatitis B and C, alcohol consumption, drug abuse, obesity, diabetes and tobacco use. Globally, liver cancer remains a significant public health challenge with rising incidence and prevalence rates, emphasizing the need for a comprehensive global approach to liver cancer prevention.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1513210","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T05:29:52Z","timestamp":1747978192000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparative analysis of liver cancer burden trends in China and worldwide between 1990 and 2021"],"prefix":"10.3389","volume":"13","author":[{"given":"Chunrong","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianjie","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliang","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuhai","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaosheng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haike","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"679","DOI":"10.20892\/j.issn.2095-3941.2024.0149","article-title":"Attributable liver cancer deaths and disability-adjusted life years in China and worldwide: profiles and changing trends","volume":"21","author":"Cao","year":"2024","journal-title":"Cancer Biol Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.cld.2011.03.006","article-title":"The global epidemiology of hepatocellular carcinoma: present and future","volume":"15","author":"McGlynn","year":"2011","journal-title":"Clin Liver Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.cld.2015.01.001","article-title":"Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability","volume":"19","author":"McGlynn","year":"2015","journal-title":"Clin Liver Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1016\/S0140-6736(20)30977-6","article-title":"Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the global burden of disease study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1016\/S0140-6736(24)00367-2","article-title":"Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990\u20132021: A systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1002\/ijc.33313","article-title":"Is it possible to halve the incidence of liver cancer in China by 2050?","volume":"148","author":"Shi","year":"2021","journal-title":"Int J Cancer"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1002\/hep.29498","article-title":"Projections of primary liver cancer to 2030 in 30 countries worldwide","volume":"67","author":"Valery","year":"2018","journal-title":"Hepatology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1989","DOI":"10.1016\/S0140-6736(24)00476-8","article-title":"Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/S1473-3099(24)00176-2","article-title":"Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990-2021: a systematic analysis from the global burden of disease study 2021. The lancet","volume":"24","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.1016\/S0140-6736(24)00932-2","article-title":"Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2259","DOI":"10.1016\/S0140-6736(24)00769-4","article-title":"Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1016\/S0140-6736(24)00933-4","article-title":"Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1002\/cac2.12197","article-title":"Cancer incidence, mortality, and burden in China: a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020","volume":"41","author":"Qiu","year":"2021","journal-title":"Cancer Commun"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1186\/s12872-023-03552-w","article-title":"Analysis and comparison of the trends in burden of rheumatic heart disease in China and worldwide from 1990 to 2019","volume":"23","author":"Shi","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"102451","DOI":"10.1016\/j.clinre.2024.102451","article-title":"Temporal trends in prevalence of liver cancer and etiology-specific liver cancer from 1990 to 2019","volume":"48","author":"Yang","year":"2024","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/CEJ.0000000000000428","article-title":"Worldwide incidence of hepatocellular carcinoma cases attributable to major risk factors","volume":"27","author":"Baecker","year":"2018","journal-title":"Eur J Cancer Prev"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1159\/000515304","article-title":"Disease burden, risk factors, and recent trends of liver cancer: a global country-level analysis","volume":"10","author":"Huang","year":"2021","journal-title":"Liver Cancer"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1017\/cts.2020.435","article-title":"4566 the impact of migration on viral hepatitis prevalence and elimination among 30 European nations: a modeling approach","volume":"4","author":"Valles","year":"2020","journal-title":"J Clin Transl Sci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"11941","DOI":"10.3748\/wjg.v21.i42.11941","article-title":"Hepatitis B virus burden in developing countries","volume":"21","author":"Zampino","year":"2015","journal-title":"World J Gastroenterol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.socscimed.2015.03.021","article-title":"Patient access to health care and medicines across low-income countries","volume":"133","author":"Srivastava","year":"1982","journal-title":"Soc Sci Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"956712","DOI":"10.3389\/fpubh.2022.956712","article-title":"Gender disparity and temporal trend of liver cancer in China from 1990 to 2019 and predictions in a 25-year period","volume":"10","author":"Yue","year":"2022","journal-title":"Front Public Health"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1111\/liv.15251","article-title":"Changing epidemiology of hepatocellular carcinoma in Asia","volume":"42","author":"Zhang","year":"2022","journal-title":"Liver Int"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"66","DOI":"10.20517\/2394-5079.2018.87","article-title":"Gender differences in hepatocellular cancer: disparities in non-alcoholic fatty liver disease\/steatohepatitis and liver transplantation","volume":"4","author":"Wu","year":"2018","journal-title":"Hepatoma Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s11427-016-9043-9","article-title":"Gender disparity in hepatocellular carcinoma (HCC): multiple underlying mechanisms","volume":"60","author":"Zheng","year":"2017","journal-title":"Sci China Life Sci"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/j.jhepr.2023.100742","article-title":"Endogenous sex steroid hormones and risk of liver cancer among US men: results from the liver Cancer pooling project","volume":"5","author":"Wu","year":"2023","journal-title":"JHEP Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1002\/cncr.32023","article-title":"Temporal trends in liver cancer mortality by educational attainment in the United States, 2000-2015","volume":"125","author":"Ma","year":"2019","journal-title":"Cancer"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1007\/s10552-018-1094-0","article-title":"Promising practices for the prevention of liver cancer: a review of the literature and cancer plan activities in the National Comprehensive Cancer Control Program","volume":"29","author":"Momin","year":"2018","journal-title":"Cancer Causes Control"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1002\/cncr.11528","article-title":"The clinical and pathogenetic significance of estrogen receptor-beta expression in chronic liver diseases and liver carcinoma","volume":"98","author":"Iavarone","year":"2003","journal-title":"Cancer"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1002\/hep.32758","article-title":"Global burden of liver cancer in males and females: changing etiological basis and the growing contribution of NASH","volume":"77","author":"Tan","year":"2023","journal-title":"Hepatology"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.3390\/cells12121604","article-title":"The influence of sex hormones in liver function and disease","volume":"12","author":"Kasarinaite","year":"2023","journal-title":"Cells"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1093\/carcin\/bgz107","article-title":"Sex hormone-binding globulin suppresses NAFLD-triggered hepatocarcinogenesis after menopause","volume":"40","author":"Lee","year":"2019","journal-title":"Carcinogenesis"},{"key":"ref37","first-page":"1347","article-title":"Expert consensus and call on actions for weight management in china: advancing healthy china initiative through strategic actions","volume-title":"China CDC Wkly","author":"Sun","year":"2024"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1513210\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T05:29:53Z","timestamp":1747978193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1513210\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":37,"alternative-id":["10.3389\/fpubh.2025.1513210"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1513210","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"article-number":"1513210"}}