Burden of liver cancer in adolescents and young adults aged 15-49 years in China: a comprehensive analysis based on the Global Burden of Disease study (1990-2021)

Yi-Xin Zou , Zhuo-Ying Li , Xiao-Hui Zhou , Dan-Ni Yang , Jia-Yi Tuo , Qiu-Ming Shen , Yu-Ting Tan , Hong-Lan Li , Yong-Bing Xiang

Hepatoma Research ›› 2025, Vol. 11 : 20

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Hepatoma Research ›› 2025, Vol. 11:20 DOI: 10.20517/2394-5079.2025.02
Original Article

Burden of liver cancer in adolescents and young adults aged 15-49 years in China: a comprehensive analysis based on the Global Burden of Disease study (1990-2021)

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Abstract

Aim: Globally, primary liver cancer ranks as the third most common cause of mortality among cancer patients. China reports the highest number of cases in the world, with chronic hepatitis B virus (HBV) infection being the most common cause. Recent studies have shown an increasing risk among adolescents and young adults aged 15-49 years, posing a significant public health challenge.

Methods: This study uses the latest data from the Global Burden of Disease (GBD) 2021 to systematically evaluate the disease burden of liver cancer among individuals aged 15-49 years in China from 1990 to 2021.

Results: The results show an increase in liver cancer cases and deaths in this age group, with a decreasing trend in incidence and mortality rates. The highest incidence and mortality rates were observed in the 45-49-year age group, with a significant increase in disease burden in men and a decrease in women. The annual net decreases in incidence and mortality rates are 1.65% and 2.31%, respectively. In the Chinese adolescent population aged 15-49 years, more than 80% of liver cancer cases are attributable to HBV. Other major risk factors include hepatitis C virus (HCV), alcohol consumption, non-alcoholic steatohepatitis (NASH), smoking, high body mass index (BMI), and high fasting plasma glucose.

Conclusion: Our study underscores the potential of HBV vaccination and lifestyle interventions in controlling Chinese adolescents’ liver cancer incidence, and provides valuable insights for other countries and regions facing similar stages of development and major health challenges related to liver cancer.

Keywords

Primary liver cancer / adolescents and young adults / global burden of diseases / time trend / China

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Yi-Xin Zou, Zhuo-Ying Li, Xiao-Hui Zhou, Dan-Ni Yang, Jia-Yi Tuo, Qiu-Ming Shen, Yu-Ting Tan, Hong-Lan Li, Yong-Bing Xiang. Burden of liver cancer in adolescents and young adults aged 15-49 years in China: a comprehensive analysis based on the Global Burden of Disease study (1990-2021). Hepatoma Research, 2025, 11: 20 DOI:10.20517/2394-5079.2025.02

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References

[1]

Rumgay H,Ferlay J.Global burden of primary liver cancer in 2020 and predictions to 2040.J Hepatol2022;77:1598-606 PMCID:PMC9670241

[2]

Bray F,Sung H.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin2024;74:229-63

[3]

Shi JF,Wang Y.Is it possible to halve the incidence of liver cancer in China by 2050?.Int J Cancer2021;148:1051-65

[4]

Liu Z,Yuan H.The trends in incidence of primary liver cancer caused by specific etiologies: results from the Global Burden of Disease Study 2016 and implications for liver cancer prevention.J Hepatol2019;70:674-83

[5]

Omata M,Kokudo N.Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update.Hepatol Int2017;11:317-70 PMCID:PMC5491694

[6]

Martel C, Maucort-Boulch D, Plummer M, Franceschi S. World-wide relative contribution of hepatitis B and C viruses in hepatocellular carcinoma.Hepatology2015;62:1190-200 PMCID:PMC5019261

[7]

Mittal S.Epidemiology of hepatocellular carcinoma: consider the population.J Clin Gastroenterol2013;47:S2-6 PMCID:PMC3683119

[8]

Shi J,Liu S.A meta-analysis of case-control studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma in China.Br J Cancer2005;92:607-12 PMCID:PMC2362087

[9]

WHO/IARC monographs on the evaluation of carcinogenic risks to humans, vol. 59, hepatitis viruses: international agency for research on cancer, lyon, 1994 (ISBN 92-832-1259-2). 280 pp. price SF 65.00.Anal Chim Acta1995;306:366

[10]

Liang X,Yang W.Epidemiological serosurvey of hepatitis B in China--declining HBV prevalence due to hepatitis B vaccination.Vaccine2009;27:6550-7

[11]

Wang FZ,Shen LP.[Comparative analyze on hepatitis B seroepidemiological surveys among population aged 1-29 years in different epidemic regions of China in 1992 and 2014].Zhonghua Yu Fang Yi Xue Za Zhi2017;51:462-8

[12]

Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study.Lancet Gastroenterol Hepatol2018;3:383-403

[13]

Chang MH.Prevention of hepatitis B virus infection and liver cancer.Recent Results Cancer Res2021;217:71-90

[14]

Wong GL,Yip TC.Universal HBV vaccination dramatically reduces the prevalence of HBV infection and incidence of hepatocellular carcinoma.Aliment Pharmacol Ther2022;56:869-77

[15]

Lee YC,Yang YC,Hashibe M.Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer.Int J Epidemiol2009;38:1497-511

[16]

Chen Y,Wang J,Luo J.Excess body weight and the risk of primary liver cancer: an updated meta-analysis of prospective studies.Eur J Cancer2012;48:2137-45

[17]

Corrao G,Zambon A.A meta-analysis of alcohol consumption and the risk of 15 diseases.Prev Med2004;38:613-9

[18]

Kulik L.Epidemiology and management of hepatocellular carcinoma.Gastroenterology2019;156:477-91.e1 PMCID:PMC6340716

[19]

Peng J,Peng Y.Global incidence of primary liver cancer by etiology among children, adolescents, and young adults.J Hepatol2023;79:e92-4

[20]

Liu Z,Jin L,Chen X.Global burden of liver cancer and cirrhosis among children, adolescents, and young adults.Dig Liver Dis2020;52:240-3

[21]

Danpanichkul P,Sukphutanan B.Incidence of liver cancer in young adults according to the Global Burden of Disease database 2019.Hepatology2024;80:828-43

[22]

Indolfi G,Dusheiko G.Hepatitis B virus infection in children and adolescents.Lancet Gastroenterol Hepatol2019;4:466-76

[23]

Li W,Wang W.Global cancer statistics for adolescents and young adults: population based study.J Hematol Oncol2024;17:99 PMCID:PMC11492650

[24]

Lam CM,Ho P.Different presentation of hepatitis B-related hepatocellular carcinoma in a cohort of 1863 young and old patients - implications for screening.Aliment Pharmacol Ther2004;19:771-7

[25]

Ugai T,Lee HY.Is early-onset cancer an emerging global epidemic?.Nat Rev Clin Oncol2022;19:656-73 PMCID:PMC9509459

[26]

Wan DW,Smith JA.Risk factors for early-onset and late-onset hepatocellular carcinoma in Asian immigrants with hepatitis B in the United States.Am J Gastroenterol2011;106:1994-2000

[27]

Park CH,Yim HW.Family history influences the early onset of hepatocellular carcinoma.World J Gastroenterol2012;18:2661-7 PMCID:PMC3370003

[28]

Liu Z,Mao X.Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017.Cancer2020;126:2267-78

[29]

Doycheva I,Alkhouri N.Nonalcoholic fatty liver disease in adolescents and young adults: the next frontier in the epidemic.Hepatology2017;65:2100-9

[30]

Pierce JP.International comparisons of trends in cigarette smoking prevalence.Am J Public Health1989;79:152-7 PMCID:PMC1349924

[31]

Miller KD,Keegan TH,Jemal A.Cancer statistics for adolescents and young adults, 2020.CA Cancer J Clin2020;70:443-59

[32]

Turgeman I.Adolescents and young adults with cancer.JAMA Oncol2023;9:440

[33]

McGlynn KA,El-Serag HB.Epidemiology of hepatocellular carcinoma.Hepatology2021;73:4-13 PMCID:PMC7577946

[34]

CJL; GBD 2021 Collaborators. Findings from the Global Burden of Disease study 2021.Lancet2024;403:2259-62

[35]

2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.Lancet2024;403:2100-32 PMCID:PMC11126520

[36]

2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease study 2019.Lancet2020;396:1223-49 PMCID:PMC7566194

[37]

2019 Demographics Collaborators. 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.Lancet2020;396:1160-203 PMCID:PMC7566045

[38]

Wen J,Luo H,Li M.Global, regional, and national burden of liver cancer in adolescents and young adults from 1990 to 2021: an analysis of the global burden of disease study 2021 and forecast to 2040.Front Public Health2025;13:1547106 PMCID:PMC11931027

[39]

Peng J,Wang X.Global, regional, and national burden of gastrointestinal cancers among adolescents and young adults from 1990 to 2019, and burden prediction to 2040.BMC Public Health2024;24:3312 PMCID:PMC11603860

[40]

Ross RK,Yu MC.Urinary aflatoxin biomarkers and risk of hepatocellular carcinoma.Lancet1992;339:943-6

[41]

Khlangwiset P.Costs and efficacy of public health interventions to reduce aflatoxin-induced human disease.Food Addit Contam Part A Chem Anal Control Expo Risk Assess2010;27:998-1014 PMCID:PMC2885555

[42]

Sun Z,Gail MH.Increased risk of hepatocellular carcinoma in male hepatitis B surface antigen carriers with chronic hepatitis who have detectable urinary aflatoxin metabolite M1.Hepatology1999;30:379-83

[43]

Ming L,Gail MH.Dominant role of hepatitis B virus and cofactor role of aflatoxin in hepatocarcinogenesis in Qidong, China.Hepatology2002;36:1214-20

[44]

Chen JG,Zhu J.Profound primary prevention of liver cancer following a natural experiment in China: a 50-year perspective and public health implications.Int J Cancer2025;156:756-63 PMCID:PMC11661919

[45]

Chen JG,Ng D.Reduced aflatoxin exposure presages decline in liver cancer mortality in an endemic region of China.Cancer Prev Res2013;6:1038-45 PMCID:PMC3800239

[46]

Yang WS,Liu ZN.Diet and liver cancer risk: a narrative review of epidemiological evidence.Br J Nutr2020;124:330-40

[47]

Henry SH,Bowers JC.Aflatoxin, hepatitis and worldwide liver cancer risks.Adv Exp Med Biol2002;504:229-33

[48]

Hou CY,Lv P.Aristolochic acids-hijacked p53 promotes liver cancer cell growth by inhibiting ferroptosis.Acta Pharmacol Sin2025;46:208-21 PMCID:PMC11696298

[49]

Hu Y,Jiang W.Aristolochic acid I induced mitochondrial Ca2+ accumulation triggers the production of MitoROS and activates Src/FAK pathway in hepatocellular carcinoma cells.Chem Biol Interact2025;405:111269

[50]

Turati F,Rota M.Alcohol and liver cancer: a systematic review and meta-analysis of prospective studies.Ann Oncol2014;25:1526-35

[51]

Jinjuvadia R,Liangpunsakul S.The association between metabolic syndrome and hepatocellular carcinoma: systemic review and meta-analysis.J Clin Gastroenterol2014;48:172-7 PMCID:PMC3887366

[52]

Ohkuma T,Woodward M.Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events.Diabetologia2018;61:2140-54 PMCID:PMC6133170

[53]

Lauby-Secretan B,Loomis D,Bianchini F.International Agency for Research on Cancer Handbook Working GroupBody fatness and cancer--viewpoint of the IARC working group.N Engl J Med2016;375:794-8 PMCID:PMC6754861

[54]

Berentzen TL,Holst C,Baker JL.Body mass index in childhood and adult risk of primary liver cancer.J Hepatol2014;60:325-30

[55]

Hui Z,Fuzhen W.New progress in HBV control and the cascade of health care for people living with HBV in China: evidence from the fourth national serological survey, 2020.Lancet Reg Health West Pac2024;51:101193 PMCID:PMC11419793

[56]

Goldstein ST,Hadler SC,Mast EE.A mathematical model to estimate global hepatitis B disease burden and vaccination impact.Int J Epidemiol2005;34:1329-39

[57]

Cao M,Lu L.Long term outcome of prevention of liver cancer by hepatitis B vaccine: results from an RCT with 37 years.Cancer Lett2022;536:215652

[58]

Qu C,Fan C.Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study: a cluster randomized controlled trial.PLoS Med2014;11:e1001774 PMCID:PMC4280122

[59]

Lu FM,Liu S.Epidemiology and prevention of hepatitis B virus infection in China.J Viral Hepat2010;17:4-9

[60]

Shan S,Jia J.Comprehensive approach to controlling chronic hepatitis B in China.Clin Mol Hepatol2024;30:135-43 PMCID:PMC11016498

[61]

Sun J.Management of chronic hepatitis B: experience from China.J Viral Hepat2010;17:10-7

[62]

Yu L,Zhu D,Wangen KR.Hepatitis B-related knowledge and vaccination in association with discrimination against hepatitis B in rural China.Hum Vaccin Immunother2016;12:70-6 PMCID:PMC4962711

[63]

Gao S,Bray F.Declining rates of hepatocellular carcinoma in urban Shanghai: incidence trends in 1976-2005.Eur J Epidemiol2012;27:39-46 PMCID:PMC5477645

[64]

Bai L,Fang Q.The trends and projections in the incidence and mortality of liver cancer in urban Shanghai: a population-based study from 1973 to 2020.Clin Epidemiol2018;10:277-88 PMCID:PMC5849921

[65]

2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease study 2016.Lancet2017;390:1084-150 PMCID:PMC5605514

[66]

2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease study 2016.Lancet2017;390:1151-210 PMCID:PMC5605883

[67]

2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease study 2016.Lancet2017;390:1211-59 PMCID:PMC5605509

[68]

2016 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet2017;390:1260-344 PMCID:PMC5605707

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