Trends in the incidence of cirrhosis in global from 1990 to 2019: A joinpoint and age-period-cohort analysis

Cirrhosis remains a major public health concern globally; the burden of cirrhosis should be further clarified worldwide and helped us to understand the current situation of cirrhosis. In the present study, we estimate DALYs and mortality rates attributable to several major cirrhosis risk factors and use joinpoint and age-period-cohort methods to determine the trends of cirrhosis incidence and deaths in the global population in the 1990-2019 period. Globally, from 1990 to 2019, the incidence of cirrhosis, deaths due to cirrhosis, and cirrhosis DALY cases increased from 1274 (10³ , 95% uncertainty interval [UI]: 1027.2-1548.5) to 2051.6 (10³ , 95% UI: 1661.4-2478.1), 1013 (10³ , 95% UI: 948.9-1073.9) to 1472 (10³ , 95% UI: 1374.6-1578.7), and 34727.7 (10³ , 95% UI: 32383.0-37132.8) to 46189.4 (10³ , 95% UI: 43027.1-49551.3), respectively. Hepatitis virus was the most important cirrhosis mortality risk factor. Globally, hepatitis virus infection (HBV+HCV) accounted for more than 45% of the incidence of cirrhosis cases and about 50% of cirrhosis deaths. Importantly, from 1990 to 2019, the proportion of cirrhosis incidence due to HBV decreased from 24.3% to 19.8%, whereas that due to alcohol use increased from 18.7% to 21.3%. Additionally, the proportion of NAFLD-induced cirrhosis incidence increased from 5.5% to 6.6% over the same period. Our findings on the global disease burden of cirrhosis provide a valuable resource for developing targeted prevention strategies.

Trends of Esophageal Cancer Incidence and Mortality and Its Influencing Factors in China

Purpose

To explore the esophageal cancer (EC) incidence and mortality trends and risk factors in China during 2005–2015.

Materials and Methods

The data were stratified by area (urban, rural), gender (male, female), and age groups (0 ~, 5 ~, …, 85 ~). The age-standardized incidence rate (ASIR) and mortality rate (ASMR), age-specific incidence and mortality were calculated to describe the trends, which were analyzed by Joinpoint software, negative binomial regression model, and age-period-cohort model.

Results

Trends in EC ASIR decreased markedly during 2010–2015 (APC=−6.14%, P<0.05), and the average annual percent change (AAPC) value was −8.07% (95% confidence interval (CI): −9.98~−6.12) for rural areas during 2005–2015. The ASMR was on a fast-downward trend after 2011 (APC=−6.67%, P<0.05), with AAPC values of −1.34% (95% CI: −2.56~−0.19) for males, −3.39% (95% CI: −5.65, −1.07) for females, and −9.67% (95% CI: −10.56~−8.77) for rural areas during 2005–2015. The age-specific incidence and mortality increased with age. The risk of EC for males was 3.1675 times higher than females (P<0.001), and for urban areas, it was 0.58 times larger than rural (P<0.001). The age and period effects presented an increasing trend, with a decreasing trend for the cohort effects in incidence and mortality risk. Later birth cohorts presented lower risks than previous birth cohorts.

Conclusion

ASIR and ASMR in China are higher in males than females, and higher in rural than urban areas, which have decreased during 2005–2015, especially in rural areas. The incidence increased with age up to the peak age group of 75. Area, gender, and age were independent risk factors for EC incidence.