Rapid Fire Session 2014 World Cancer Congress

Global mortality trends in hepatitis B induced liver cancer (#457)

Christina Fitzmaurice 1 , Benjamin O Anderson 2 , Mohsen Naghavi 1
  1. IHME, University of Washington, Seattle, WA, United States
  2. School of Medicine, University of Washington, Seattle, WA, United States

Background: Liver cancer due to chronic hepatitis B infection (LCHB) is a preventable disease. The hepatitis B vaccine has been used since 1982 and is highly effective in preventing hepatitis B infection. However, the vaccine only prevents new infections and the full effect of the vaccine on liver cancer mortality cannot be expected for some decades.


Aim: Global Burden of Disease (GBD) 2013 data was used to identify countries with the highest mortality rate for LCHB.

Methods: The analytical process to generate global mortality estimates starts with collecting and preparing incidence and mortality data from vital and cancer registries as well as verbal autopsy surveys. Mortality to incidence ratios are applied to the incidence to generate further mortality estimates. They are entered into the cause of death ensemble model to generate results for countries lacking data. The mortality estimates for a specific cause are rescaled to the total mortality envelope. A proportion model is used to allocate liver cancer deaths to the underlying causes (hepatitis B/C, alcohol, other).1

Results: The three countries with the highest mortality rate (age standardized rate per 100.000) secondary to LCHB in 1980 were Mongolia (male 35.9, female 14.1), China (male 15.05, female 6.97) and Mali (male 16.38, female 9.32). Since 1980 mortality has increased in Mongolia (2000: male 61.6, female 39.41; 2010: male 88.68, female 45.22). Mortality remained stable in Mali (2000: male 21.36, female 8.59; 2010: male 21.81, female 9.0) and in China (2000: male 18.01, female 6.38; 2010: male 14.69, female 5.22). In 2010 hepatitis B vaccine coverage was around 96% in Mongolia, 99% in China and 76% in Mali2.

Conclusions: Mortality secondary to HBLC is rising or remains stable in highly endemic areas. Implications for policy include optimizing vaccine coverage as well as allocation of resources for early detection and treatment.

  1. Lozano et al: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2095-128.
  2. WHO vaccine-preventable diseases: monitoring system 2013 global summary. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragebcg.html