Liver cancer mortality over six decades in an epidemic area: What we have learned

Jian Guo Chen, Jian Zhu, Yong Hui Zhang, Yong Sheng Chen, Jian Hua Lu, Yuan Rong Zhu, Hai Zhen Chen, Ai Guo Shen, Gao Ren Wang, John D. Groopman, Thomas W. Kensler

Research output: Contribution to journalArticlepeer-review


Background and aims:. Liver cancer is one of the most dominant malignant tumors in the world. The trends of liver cancer mortality over the past six decades have been tracked in the epidemic region of Qidong, China. Using epidemiological tools, we explore the dynamic changes in age-standardized rates to characterize important aspects of liver cancer etiology and prevention. Methods. Mortality data of liver cancer in Qidong from 1958 to 1971 (death retro- spective survey) and from 1972 to 2017 (cancer registration) were tabulated for the crude rate (CR), and age-standardized rate and age-birth cohorts. The average annual percentage change was calculated by the Joinpoint Regression Program. Results. The natural death rate during 1958-2017 decreased from 9h to 5.4h and then increased to 8has the population aged; cancer mortality rates rose continuously from 57/105 to 240/105. Liver cancer mortality increased from 20/105 to 80/105, and then dropped to less than 52/105 in 2017. Liver cancer deaths in 1972-2017 accounted for 30.53% of all cancers, with a CR of 60.48/105, age-standardized rate China (ASRC) of 34.78/105, and ASRW (world) of 45.71/105. Other key features were the CR for males and females of 91.86/105 and 29.92/105, respectively, with a sex ratio of 3.07.1. Period analysis showed that the ASRs for mortality of the age groups under 54 years old had a significant decreasing trend. Importantly, birth cohort analysis showed that the mortality rate of liver cancer in 40-44, 35-39, 30-34, 25-29, 20-24, 15-19 years cohort decreased considerably, but the rates in 70-74, and 75+ increased. Conclusions. The crude mortality rate of liver cancer in Qidong has experienced trends from lower to higher levels, and from continued increase at a high plateau to most recently a gradual decline, and a change greatest in younger people. Many years of comprehensive prevention and intervention measures have influenced the decline of the liver cancer epidemic in this area. The reduction of intake levels of aflatoxin might be one of the most significant factors as evidenced by the dramatic decline of exposure biomarkers in this population during the past three decades.

Original languageEnglish (US)
Article number10600
StatePublished - Feb 3 2021


  • Age-standardized rate
  • Annual percentage change
  • Birth cohort
  • Epidemiology
  • Liver cancer
  • Mortality
  • Trend

ASJC Scopus subject areas

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)


Dive into the research topics of 'Liver cancer mortality over six decades in an epidemic area: What we have learned'. Together they form a unique fingerprint.

Cite this