Abstract:

Objective　To analyze the current status and changing trends of the disease burden of hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV) infection in China. Methods　The global disease burden data from 1990 to 2021 were analyzed, so as to reveal the changing trends and influencing factors of the disease burden of HBV-related HCC. The estimated annual percentage change (EAPC) was used to assess the trends of the incidence rates globally and in China. The Bayesian Age-Period-Cohort (BAPC) model was used to separate the effects of age, period, and birth cohort on the disease burden. According to the GBD guidance in 2019, the global standard population was used to standardize the incidence rate, morbidity rate, disability adjusted life year (DALY) rate, and YLDs in age. The changing rate of each indicator from 1990 to 2021 was calculated. The disease burden of HBV-related HCC of different age groups was analyzed. The statistical analyses were performed by the SPSS 23.0 and R language software. Results　The standardized mortality rate, standardized DALYs, standardized morbidity rate, and standardized incidence rate of HBV-related HCC showed a significant downward trend globally and in China. In China, the number of male patients with HBV-related HCC was higher than that of females, with the peak incidence occurring in >50-70 years old males. The Joinpoint regression model showed that from 1990 to 1997, the standardized mortality rate of HBV-related HCC decreased significantly, increased obviously from 1997 to 2014, and decreased again from 2014 to 2024. From 1990 to 1995, the standardized morbidity rate of HBV-related HCC declined slowly, increased rapidly from 1995 to 2003, rose slowly from 2003 to 2011, and showed a significant downward trend from 2011 to 2021. From 1990 to 1995, the standardized incidence rate of HBV-related HCC declined slowly, increased rapidly from 1995 to 2013, and decreased sharply from 2013 to 2021. From 1990 to 1997, the standardized DALYs of HBV-related HCC declined slowly, increased rapidly from 1997 to 2012, and decreased sharply again from 2012 to 2021. Conclusions　The disease burden of HBV-related HCC has shown a decreasing trend globally and in China. The study reveals the impact of sociodemographic indices, age, period, and birth cohort on the disease. These findings provide some scientific evidences for formulating targeted prevention and control strategies.

Key words:

Hepatitis B virus infection, Hepatocellular carcinoma, Disease burden, Trend analysis

摘要：

目的　分析乙肝病毒感染相关的肝癌疾病负担现状及变化趋势。方法　通过1990年至2021年全球疾病负担研究数据，揭示乙型肝炎病毒（HBV）相关肝细胞癌（HCC）的疾病负担变化趋势及其影响因素。采用年估计百分比变化（EAPC）评估全球和中国的发病率变化趋势，运用贝叶斯年龄-时期-队列（BAPC）模型分离年龄、时期和出生队列效应对疾病负担的影响。根据GBD 2019指南，使用全球标准人口对发病率、患病率、伤残调整生命年（DALY）和伤残生命损失年（YLDs）进行年龄标准化，计算1990年至2021年间各项指标的变化率，并分析不同年龄段HBV相关的肝癌疾病负担。所有统计分析均通过SPSS 23.0和R语言软件进行。结果　全球及我国HBV相关的肝癌标化病死率（ASDR）、标化伤残调整生命年（DALYs）、标化患病率、标化发病率均呈明显下降趋势；我国HBV相关的肝癌男性患病人数高于女性，其中男性患病人数>50～70岁为高峰；Joinpoint回归模型显示，1990年至1997年，HBV相关的肝癌标化病死率明显降低，1997年至2014年明显升高，2014年至2024年又明显降低；1990年至1995年，HBV相关的肝癌标化患病率缓慢降低，1995年至2003年快速升高，2003年至2011年呈缓慢升高，2011年至2021年又呈现明显降低趋势；1990年至1995年，HBV相关的肝癌标化发病率缓慢降低，1995年至2013年呈快速升高，2013年至2021年又呈快速降低趋势；1990年至1997年，HBV相关的肝癌标化DALYs缓慢降低，1997年至2012年呈快速升高，2012年至2021年又呈快速降低趋势。结论　全球和我国乙肝导致的肝癌疾病负担呈降低趋势，揭示了社会人口学指数、年龄、时期和出生队列效应对疾病的影响，这些发现为制定针对性的防控策略提供了科学依据。

关键词:

乙肝病毒感染, 肝癌, 疾病负担, 趋势分析