Colorectal cancer burden,trends and risk factors in China:A review and comparison with the United States

Objective:China and the United States(the U.S.)have the heaviest colorectal cancer(CRC)burden with considerable variations in temporal trends.This study aims to analyze the temporal patterns of CRC burden and its risk factors in China and the U.S.across the past three decades.Methods:Data were extracted from the Global Burden of Disease(GBD)Study in 2019,including cases,deaths,disability-adjusted life-years(DALYs),age-standardized rate(ASR),and summary exposure value(SEV)of CRC in China and the U.S.between 1990 and 2019.Annual average percentage changes(AAPCs)of CRC burden were calculated using the Joinpoint regression model.The mortality in CRC attributable to potential risk factors was characterized by countries,gender,and age groups.Results:In 2019,there were 607,900 and 227,241 CRC cases,and 261,777 and 84,026 CRC deaths in China and the U.S.,respectively.The age-standardized incidence rate(ASIR)was 30.55 per 100,000 in China and 41.86 per100,000 in the U.S.,and the age-standardized mortality rate(ASMR)was 13.86 per 100,000 in China and 14.77 per100,000 in the U.S.CRC incidence,mortality,and DALY rate in the U.S.showed downward trends in the past three decades(AAPC=-0.47,-1.06,and-0.88,respectively),while upward trends were observed in China(AAPC=3.11,1.05,and 0.91,respectively).Among the cause of CRC,the leading risk factor contributing to CRC death was low milk in China and smoking in the U.S.,respectively.Conclusions:From 1990 to 2019,the burden of CRC in China increased dramatically,particularly for males and middle-aged and elderly people.The management of the major risk factors associated with the high burden of CRC should be enhanced.

Lung cancer burden and trends from 2000 to 2018 in China:Comparison between China and the United States

Objective: This study aims to provide an analysis of the current status and trends of lung cancer incidence and mortality rates in China, comparing trends with those in the United States(U.S.).Methods: Data on lung cancer incidence and mortality rates spanning 2000 to 2018 were extracted from the China Cancer Registry Annual Report and the Surveillance, Epidemiology, and End Results database for China and the U.S., respectively. Crude incidence and mortality rates were calculated by sex and age, with age-standardized incidence rates(ASIR) and mortality rates(ASMR) calculated using the Segi-Doll world standard population.Trend analyses employed Joinpoint regression models to determine average annual percentage change(AAPC).The study also assessed the proportion of new cases and deaths by sex and age.Results: In 2018, the ASIR of lung cancer for males in China was 50.72 per 100,000 and the ASMR was 39.69 per 100,000, the ASIR for females was 26.25 per 100,000 and the ASMR was 15.24 per 100,000. Both ASIR and ASMR were higher in males and the highest in the population aged 65 years and older, with the lowest among those aged 20-49 years. In China, female ASIR demonstrated an increasing trend(AAPC: 1.16%), while ASMR decreased in both sexes(AAPCs:-0.48% for males,-1.00% for females). The U.S. exhibited decreasing trends in both ASIR and ASMR across sexes and age groups.Conclusions: The study identified an increasing trend in lung cancer incidence among females and a decreasing mortality trend in both sexes in China. These trends are likely linked to factors such as smoking prevalence,advancements in cancer screening, and improved medical care. The findings underscore the need for tailored lung cancer prevention measures in China, particularly the reinforcement of anti-smoking policies.

Trends in high-risk rates and screening rates for the population-based cancer screening program on esophageal,stomach and liver cancer in China,2010-2016

Background:A population-based cancer screening program in rural China,targeting three types of cancer that are most prevalent in these areas,including esophageal,stomach,and liver cancer was awarded by the government in China since 2007.A two-step design with cancer risk assessment based on questionnaire interview and HBsAg test strip and subsequent clinical intervention for high-risk populations was adopted with free of charge at the local hospitals designated in the program.The participate rate including high-risk rates and screening rates was important to find appropriate strategies to improve the overall awareness of the program.Methods:Data from the cancer screening program between 2010 and 2016 were used to calculate higher rate(high-risk population/participants recruited)and screening rate(participants received screening/high-risk pop-ulation).Results:From 2010 to 2016,1,637,429 residents were recruited in the program and filled the questionnaires,350,646(21.4%)for esophagus cancer,273,715(16.7%)for stomach cancer and 1,013,068(61.9%)for liver can-cer.471,974 participants were assessed as high-risk population including 114,786(24.3%)high risk for esophagus cancer,161,809(34.3%)high risk for stomach cancer and 195,379(41.4%)high risk for liver cancer,respec-tively.249,185(52.8%)participants who were assessed as high risk received clinical screening.There were 64,710(26.0%)for esophagus cancer screening,71,365(28.6%)for stomach cancer screening and 113,110(45.4%)for liver cancer screening,respectively.Conclusion:Our findings will provide important references for designing effective population-based screening strategies to enhance the screening acceptance by health action plan in the future.

Esophageal cancer global burden profiles, trends, and contributors

Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.

Attributable liver cancer deaths and disability-adjusted life years in China and worldwide: profiles and changing trends

Objective: Liver cancer is a major health concern globally and in China. This analysis investigated deaths and disability-adjusted life years(DALYs) with respect to etiologies and risk factors for liver cancer in China and worldwide.Methods: Global and China-specific data were collected on liver cancer deaths, DALYs, and age-standardized rates(ASRs) from the Global Burden of Disease Study 2019 database. Liver cancer etiologies were classified into five groups and risk factors were categorized into three levels. Each proportion of liver cancer burden was calculated in different geographic regions. The joinpoint regression model were used to assess the trends from 1990±2019.Results: Liver cancer accounted for 484,577 deaths worldwide in 2019 with an ASR of 5.9 per 100,000 population. China had an elevated liver cancer death ASR in 2019 and males had an ASR 1.7 times the global rate. The global ASR for DALYs peaked at 75±79 years of age but peaked earlier in China. Hepatitis B virus was the prominent etiology globally(39.5%) and in China(62.5%), followed by hepatitis C virus and alcohol consumption. In high sociodemographic index countries, non-alcoholic steatohepatitis has gained an increasing contribution as an etiologic factor. The liver cancer burden due to various etiologies has decreased globally in both genders. However, metabolic risk factors, particularly obesity, have had a growing contribution to the liver cancer burden, especially among males.Conclusions: Despite an overall decreasing trend in the liver cancer burden in China and worldwide, there has been a rising contribution from metabolic risk factors, highlighting the importance of implementing targeted prevention and control strategies that address regional and gender disparities.

Global, regional, and national burden of early-onset gastric cancer

Objective: The burden of gastric cancer(GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals from 2003 to 2017.Methods: The latest incidence and mortality estimates of GC from 185 countries and regions were extracted from the GLOBOCAN 2022 database. The 5-year interval age-standardised incidence rates(ASIRs) were evaluated using cancer registry data from volumes X±XII of the Cancer Incidence in Five Continents(CI5). Correlation analysis was used to evaluate the relationship between ASIR or the age-standardised mortality rate(ASMR) and the Human Development Index(HDI).Results: There was an estimated global 968,000 new GC cases and 660,000 deaths in 2022, with male predominance. GC ASIRs and ASMRs were 9.2 and 6.1 per 100,000 persons, respectively. East Asia had the highest burden, with 53.8% of cases and 48.2% of deaths among all geographic regions. There was a significant correlation between ASIR and HDI. Over three 5-year intervals from 2003 to 2017, the incidence of GC notably decreased in most countries but peaked at 2008±2012 in New Zealand, Turkey, and South Africa. Several countries in Europe, Oceania, and America suggest an increasingly concerning trend among younger individuals, especially females.Conclusions: GC is a significant health issue, especially among males and in geographic regions with an HDI, such as eastern Asia. While the incidence of GC is decreasing in many countries due to prevention efforts and improved treatments, a rising trend persists among younger individuals. Comprehensive prevention strategies tailored to different age patterns are clearly needed.

Cancer burden in China:trends,risk factors and prevention

As the most populous country in the world,China has made strides in health promotion in the past few decades.With the aging population,the burden of cancer in China continues to grow.Changes in risk factors for cancer,especially diet,obesity,diabetes,and air pollution,continue to fuel the shift of cancer transition in China.The burden of upper gastrointestinal cancer in China is decreasing,but still heavy.The rising burden of colorectal,prostate,and breast cancers is also significant.Lung cancer became the top cause of cancer-related deaths,together with smoking as the most important contributor to cancer deaths.The Chinese government has taken several approaches to control cancer and cancer-related risk factors.Many achievements have been made,but some challenges remain.Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China.The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments,public health organizations,and individuals.In this review,we describe the trends of cancer burden and discuss cancer-related risk factors in China,identifying strategies to reduce the burden of cancer in China.

Cancer burden and trends in China:A review and comparison with Japan and South Korea

Objective:To summarize the cancer burden and trends in China,compare the differences among China,Japan,and South Korea and discuss possible causes of the disparities.Methods:Incidence and mortality data were extracted from the online cancer database including the GLOBOCAN 2018 and the Global Burden of Disease Study 2017.Trend analysis was conducted using the joinpoint analysis,and annual percent changes were calculated.Results:Cancers resulted in approximately 62.9 million disability-adjusted life years(DALYs)in China in 2017.Lung cancer had the greatest contribution,followed by liver cancer,stomach cancer,and esophageal cancer.The trajectory of progress in the reduction of liver and stomach cancers was observed in China.However,China still faced a heavy burden of lung cancer and a growing burden of cancers related to westernized lifestyle such as colorectal cancer,while Japan and South Korea have achieved reductions in colorectal cancer and lung cancer,respectively.Besides,China had a lower age-standardized cancer incidence rate but higher cancer mortality and DALY rates than Japan and South Korea.Conclusions:China is in the cancer transition stage with a rising burden of colorectal,prostate,and breast cancers along with a heavy burden of lung and upper digestive tract cancers.Taking into consideration the effectiveness of screening and tobacco control in Japan and South Korea,improvement in the current tobacco control policy and cancer screening systems may contribute to cancer control in China.

Current cancer burden in China: epidemiology, etiology, and prevention

Cancer has become the most common cause of death in China.Owing to rapid economic development,improved livelihood,and shifts in risk factors,cancer epidemiology has experienced substantial changes during the past several decades.In this review,we aim to describe the current cancer epidemiology of the main types of cancer in China,report major risk factors associated with cancer development,and summarize the contributions of the Chinese government to controlling the cancer burden.A total of 4,064,000 new cases were diagnosed in China in 2016.The most frequent types are lung cancer(828,100;20.4%),colorectal cancer(408,000;10.0%),and gastric cancer(396,500;9.8%).Lung(657,000;27.2%),liver(336,400,13.9%),and stomach(288,500;12.0%)cancers are the 3 most deadly cancers in the general population.The 5-year survival rate for cancer has dramatically increased in recent decades.However,liver and particularly pancreatic cancers still have the poorest prognosis.The main modifiable risk factors associated with cancer development include infectious agents,smoking,alcohol consumption,obesity,unhealthful dietary habits,and inadequate physical activity.The Chinese government has made unremitting efforts to decrease the cancer burden,including cancer education and investment in cancer screening programs.

Esophageal cancer:Epidemiology,risk factors and screening

More than 600,000 people are diagnosed with esophageal cancer(EC)every year globally,and the five-year survival rate of EC is less than 20%.Two common histological subtypes of EC,esophageal squamous cell carcinoma(ESCC)and esophageal adenocarcinoma(EAC),have great geographical variations in incidence rates.About half of the world’s EC was diagnosed in China and a majority of which belong to ESCC.Globally,the overall incidence rate of EC is decreasing.In some high-risk Asian regions,such as China,the incidence rate of ESCC has generally declined,potentially due to economic growth and improvement of diet habits.In some European high-income countries and the United States,the decline is mainly attributed to the decrease in smoking and drinking.The risk factors of EC are not well understood,and the importance of environmental and genetic factors in the pathogenesis is also unclear.The incidence and mortality of advanced EC can be reduced through early diagnosis and screening.White light endoscopy is still the gold standard in the current screening technology.This article reviews the epidemiology,risk factors,and screening strategies of EC in recent years to help researchers determine the most effective management strategies to reduce the risk of EC.

Trends and risk factors of lung cancer in China

China is faced with heavy burdens caused by lung cancer,which has climbed to the top of both cancer incidence and mortality spectrums.The age-standardized rates of incidence and mortality have shown a trend of gradual uptrends in the last decades,while the crude rates rise much quickly due to the aging of population.Although the improvement in health care has contributed to better survival of lung cancer,its prognosis is still challenging.Apart from the common risk factors such as tobacco use,air pollution,and occupational hazards,some specific factors like Chinese-style cooking also have posed great threats to human health.In light of such national conditions,specific interventions should be conducted to curb the burden of lung cancer including smoking cessation,improvement of air quality,early detection and effective treatment of lung cancer.

Burden of liver cancer:From epidemiology to prevention

In this review,we offer a concise overview of liver cancer epidemiology in China and worldwide from the official databases of GLOBOCAN 2020 and the National Cancer Registry in China.We also summarized the evidence for the main risk factors associated with liver cancer risk and discuss strategies implemented in China to control the liver cancer burden.Overall,liver cancer was the sixth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020.Although China contributed to nearly half of cases across the world alone,the incidence and mortality rates of liver cancer presented a declining trend owing to the persistent efforts from the governments at all levels.The current liver cancer burden in China still faces an arduous challenge due to the relatively large population base as well as the substantially low survival rate(12.1%).To better control the liver cancer burden with the lowest cost,specific measures should be conducted by reducing exposure to established risk factors such as hepatitis B infection and aflatoxin.The promotion of surveillance is also an important method to prolong the survival of liver cancer.This review will provide basic information for future direction on the control of liver cancer burden.

Stomach cancer burden in China: Epidemiology and prevention

In 2020, stomach cancer was the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related death worldwide. Due to the relatively huge population base and the poor survival rate, stomach cancer is still a threat in China, and accounts for nearly half of the cases worldwide. Fortunately, in China, the incidence and mortality rates of stomach cancer presented a declining trend owing to the change of individual life styles and the persistent efforts to prevent stomach cancer from the governments at all levels. Helicobacter pylori(H. pylori)infection, poor eating habits, smoking, history of gastrointestinal disorders, and family history of stomach cancer are the main risk factors for stomach cancer in China. As a result, by taking risk factors for stomach cancer into account, specific preventive measures, such as eradicating H. pylori and implementing stomach cancer screening projects, should be taken to better prevent and decrease the burden of stomach cancer.

Attributable deaths of liver cancer in China

Objective:There is little information about contributions of the well-known risk factors to the liver cancer burden.We conducted a comparative study to estimate the liver cancer burden attributable to major risk factors.Methods:Liver cancer deaths for adults were estimated from 978 county-level surveillance points in China in2014.Risk factors were identified from the International Agency for Research on Cancer and the World Cancer Research Fund International.Population attributable fraction(PAF)by age,sex,and province was calculated using multiple formulas.Results:In total,72.4%of liver cancer deaths could be attributable to the studied risk factors.Hepatitis B virus(HBV)was responsible for the largest fraction of liver cancer burden in both genders(PAF=55.6%in males,PAF=46.5%in females).PAFs for liver cancer burden attributable to smoking(15.7%vs.4.8%),and alcohol drinking(10.3%vs.1.6%)were significantly higher in males than in females.The burden of HBV-attributable deaths was the highest in Qinghai province.Conclusions:HBV still contributes to the majority of liver cancer burden than any other risk factors.Targeted preventive measures should be implemented based on the degree of contributions of risk factors to liver cancer deaths.

中美核查新闻生产的比较分析——以俄乌冲突为例

本研究从新闻生产社会学视角出发,以俄乌冲突国际新闻核查为例,运用内容分析法,辅以深度访谈和二手资料,对五家中美事实核查机构的新闻生产展开比较,考察其在核查对象、核查信源透明度等九个维度上的异同,探索组织内外诸因素对生产的影响。研究发现,中美机构均注重时效性、公共性及可核查性。中国机构更新速度快,但在核查对象选择上相对受限,倾向于采取“策略突围”;美国机构的信源透明度更高,审核机制成熟,表达上主观情感更显豁。

Cancer profiles in China and comparisons with the USA:a comprehensive analysis in the incidence,mortality,survival,staging,and attribution to risk factors

China faces a disproportionate cancer burden to the population size and is undergoing a transition in the cancer spectrum.We extracted data in five aspects of cancer incidence,mortality,survival,staging distributions,and attribution to risk factors in China,the USA and worldwide from open-source databases.We conducted a comprehensive secondary analysis of cancer profiles in China in the above aspects,and compared cancer statistics between China and the USA.A total of 4,546,400 new cancer cases and 2,992,600 deaths occurred in China in 2020,accounting for 25.1%and 30.2%of global cases,respectively.Lifestyle-related cancers including lung cancer,colorectal cancer,and breast cancer showed an upward trend and have been the leading cancer types in China.41.6%of new cancer cases and 49.3%of cancer deaths occurred in digestive-system cancers in China,and the cancers of esophagus,nasopharynx,liver,and stomach in China accounted for over 40%of global cases.Infection-related cancers showed the highest population-attributable fractions among Chinese adults,and most cancers could be attributed to behavioral and metabolic factors.The proportions of stage I for most cancer types were much higher in the USA than in China,except for esophageal cancer(78.2%vs.41.1%).The 5-year relative survival rates in China have improved substantially during 2000–2014,whereas survival for most cancer types in the USA was significantly higher than in China,except for upper gastrointestinal cancers.Our findings suggest that although substantial progress has been made in cancer control,especially in digestive system cancers in China,there was still a considerable disparity in cancer burden between China and the USA.More robust policies on risk factors and standardized screening practices are urgently warranted to curb the cancer growth and improve the prognosis for cancer patients.

Cancer statistics for young adults aged 20 to 49 years in China from 2000 to 2017:a population-based registry study

An increasing cancer incidence among adults younger than 50 years has been reported for several types of cancer in multiple countries.We aimed to report cancer profiles and trends among young adults in China.Data from the China Cancer Registry Annual Report were used to estimate incidence and mortality among young adults(ages 20–49 years)in China in 2017,and an age-period-cohort model was employed to estimate the average annual percent change(AAPC)in incidence and mortality from 2000 to 2017.All 25 cancer types were grouped into obesity-or overweight-associated cancers(12 cancer types)and additional cancers(13 cancer types).In 2017,there were 681,178new cases and 214,591 cancer deaths among young adults in China.Among young adults,the most common cancers were thyroid,breast,cervical,liver,lung,and colorectal cancer,and the leading causes of cancer deaths were liver,lung,cervical,stomach,breast,and colorectal cancer.From 2000 to 2017,the cancer incidence increased for all cancers combined among young adults,with the highest AAPC(1.46%)for adults aged 20–24 years,while cancer mortality decreased,with the highest AAPC(-1.63%)for those aged 35–39 years.In conclusion,the cancer incidence in China has increased among young adults,while cancer mortality has decreased for nearly all ages.Cancer control measures,such as obesity control and appropriate screening,may contribute to reducing the increasing cancer burden among young adults.

Cancer statistics in China and United States,2022:profiles,trends,and determinants

Background:The cancer burden in the United States of America(USA)has decreased gradually.However,China is experiencing a transition in its cancer profiles,with greater incidence of cancers that were previously more common in the USA.This study compared the latest cancer profiles,trends,and determinants between China and USA.Methods:This was a comparative study using open-source data.Cancer cases and deaths in 2022 were calculated using cancer estimates from GLOBOCAN 2020 and population estimates from the United Nations.Trends in cancer incidence and mortality rates in the USA used data from the Surveillance,Epidemiology,and End Results program and National Center for Health Statistics.Chinese data were obtained from cancer registry reports.Data from the Global Burden of Disease 2019 and a decomposition method were used to express cancer deaths as the product of four determinant factors.Results:In 2022,there will be approximately 4,820,000 and 2,370,000 new cancer cases,and 3,210,000 and 640,000 cancer deaths in China and the USA,respectively.The most common cancers are lung cancer in China and breast cancer in the USA,and lung cancer is the leading cause of cancer death in both.Age-standardized incidence and mortality rates for lung cancer and colorectal cancer in the USA have decreased significantly recently,but rates of liver cancer have increased slightly.Rates of stomach,liver,and esophageal cancer decreased gradually in China,but rates have increased for colorectal cancer in the whole population,prostate cancer in men,and other seven cancer types in women.Increases in adult population size and population aging were major determinants for incremental cancer deaths,and case-fatality rates contributed to reduced cancer deaths in both countries.Conclusions:The decreasing cancer burden in liver,stomach,and esophagus,and increasing burden in lung,colorectum,breast,and prostate,mean that cancer profiles in China and the USA are converging.Population aging is a growing determinant of incremental cancer burden.Progress in cancer prevention and care in the USA,and measures to actively respond to population aging,may help China to reduce the cancer burden.

Improved esophageal squamous cell carcinoma screening effectiveness by risk-stratified endoscopic screening:evidence from high-risk areas in China

Background:Risk-stratified endoscopic screening(RSES),which offers endoscopy to those with a high risk of esophageal cancer,has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy(i.e.,endoscopic screening for all targets without risk prediction).Evidence of RSES in high-risk areas of China is limited.This study aimed to estimate whether RSES based on a 22-score esophageal squamous cell carcinoma(ESCC)risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high-risk areas of China.Methods:Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40-69 from three high-risk areas of China who underwent endoscopic screening betweenMay 2015 and July 2017.The model’s performance was estimated using the area under the curve(AUC).Participants were categorized into a high-risk group and a low-risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above(SDA)at more than 90.0%.Results:The ESCC risk prediction model had an AUC of 0.80(95% confidence interval:0.75-0.84)in this external population.We found that a score of 8(ranging from 0 to 22)had a sensitivity of 94.2% for ESCC and 92.5% for SDA.The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$0.59 million compared to universal endoscopic screening among 26,618 participants.In addition,a higher prevalence of SDA(1.7%vs.0.9%),a lower number need to screen(60 vs.111),and a lower average cost per detected SDA(US$3.22 thousand vs.US$5.45 thousand)could have been obtained by the RSES strategy.Conclusions:The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high-risk areas of China.

Global trajectories of liver cancer burden from 1990 to 2019 and projection to 2035

Background:Large disparities exist in liver cancer burden trends across countries but are poorly understood.We aimed to investigate the global trajectories of liver cancer burden,explore the driving forces,and predict future trends.Methods:Data on the liver cancer burden in 204 countries and territories from 1990 to 2019 were extracted from the Global Burden of Disease Study.The age-standardized incidence rate(ASIR)and age-standardized mortality rate(ASMR)trajectories were defined using growth mixture models.Five major risk factors contributing to changes in the ASIR or ASMR and socioeconomic determinants were explored using the identified trajectories.A Bayesian age-period-cohort model was used to predict future trends through 2035.Results:Three trajectories of liver cancer burden were identified:increasing,stable,and decreasing groups.Almost half of the American countries were classified in the decreasing group(48.6%for ASIR and ASMR),and the increasing group was the most common in the European region(ASIR,49.1%;ASMR,37.7%).In the decreasing group,the decrease of liver cancer due to hepatitis B contributed 63.4%and 60.4%of the total decreases in ASIR and ASMR,respectively.The increase of liver cancer due to alcohol use,hepatitis C,and hepatitis B contributed the most to the increase in the increasing group(30.8%,31.1%,and 24.2%for ASIR;33.7%,30.2%,and 22.2%for ASMR,respectively).The increasing group was associated with a higher sociodemographic index,gross domestic product per capita,health expenditure per capita,and universal health coverage(all P<0.05).Significant variations in disease burden are predicted to continue through 2035,with a disproportionate burden in the decreasing group.Conclusion:Global disparities were observed in liver cancer burden trajectories.Hepatitis B,alcohol use,and hepatitis C were identified as driving forces in different regions.