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      The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level : Results From the Global Burden of Disease Study 2015

      research-article
      Global Burden of Disease Liver Cancer Collaboration , PhD 1 , MSc 2 , 3 , MBA 4 , MPH 5 , 6 , MPH 7 , BA 8 , PhD 9 , PhD 10 , FWACP 11 , PhD 12 , MS 13 , PhD 14 , PhD 15 , PhD 16 , PhD 17 , 18 , MPH 19 , FETP 20 , PhD 21 , PhD 22 , PhD 8 , 23 , MD 8 , 23 , PhD 24 , BS 8 , Do, MSc 25 , PhD 26 , PhD 27 , PhD 28 , PhD 29 , 30 , 31 , MLS 8 , DSc 8 , PhD 32 , 33 , PhD 34 , PhD 35 , ScD 36 , PhD 37 , PhD 38 , BS 8 , PhD 39 , PhD 8 , 40   , PhD 41 , 42 , MD 43 , PhD 44 , PhD 45 , MD 46 , PhD 8 , MD 47 , 48 , PhD 49 , MD 50 , MPH 8 , MPH 51 , 52 , MD 53 , PhD 54 , PhD 55 , PhD 56 , MD 57 , PhD 58 , PhD 59 , MD 60 , 61 , PhD 62   , PhD 63 , 64 , PhD 65 , PhD 66 , BA 8 , MPH 67 , PhD 68 , MS 69 , PhD 70 , 71 , PhD 72 , 73 , MD 74 , MD 75 , DrPH 76 , 77 , PhD 8 , MS 78   , PhD 79 , 80 , 81 , PhD 82 , MPH 83 , DrPH 84 , 85 , PhD 86 , PhD 87 , 88 , PhD 89 , Dphil 8 , PhD 8 , MD 8 , 90 ,
      JAMA Oncology
      American Medical Association

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          Abstract

          Importance

          Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use.

          Objective

          To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes.

          Design, Settings, and Participants

          Mortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs.

          Main Outcomes and Measures

          Liver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year.

          Results

          There were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies.

          Conclusions and Relevance

          Liver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.

          Abstract

          This data analysis of the Global Burden of Disease 2015 study on primary liver cancer reports incidence, mortality, and disability-adjusted life-years for 195 countries or territories from 1990 to 2015, and presents global, regional, and national estimates on the burden of liver cancer.

          Key Points

          Question

          What is the burden of liver cancer globally, what are the major risk factors for liver cancer across countries, regions, and at the global level and how did these change between 1990 and 2015?

          Findings

          There were 854 000 incident liver cancer cases and 810 000 deaths globally in 2015, contributing to 20 578 000 disability-adjusted life-years. Hepatitis B virus infection accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), hepatitis C virus infection for 167 000 (21%), and other causes for 133 000 (16%) deaths.

          Meaning

          Most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use.

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          Most cited references40

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          Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.

          Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large "areas" of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths). © 2014 UICC.
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            Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. We estimated the global prevalence, incidence, progression, and outcomes of NAFLD and nonalcoholic steatohepatitis (NASH). PubMed/MEDLINE were searched from 1989 to 2015 for terms involving epidemiology and progression of NAFLD. Exclusions included selected groups (studies that exclusively enrolled morbidly obese or diabetics or pediatric) and no data on alcohol consumption or other liver diseases. Incidence of hepatocellular carcinoma (HCC), cirrhosis, overall mortality, and liver-related mortality were determined. NASH required histological diagnosis. All studies were reviewed by three independent investigators. Analysis was stratified by region, diagnostic technique, biopsy indication, and study population. We used random-effects models to provide point estimates (95% confidence interval [CI]) of prevalence, incidence, mortality and incidence rate ratios, and metaregression with subgroup analysis to account for heterogeneity. Of 729 studies, 86 were included with a sample size of 8,515,431 from 22 countries. Global prevalence of NAFLD is 25.24% (95% CI: 22.10-28.65) with highest prevalence in the Middle East and South America and lowest in Africa. Metabolic comorbidities associated with NAFLD included obesity (51.34%; 95% CI: 41.38-61.20), type 2 diabetes (22.51%; 95% CI: 17.92-27.89), hyperlipidemia (69.16%; 95% CI: 49.91-83.46%), hypertension (39.34%; 95% CI: 33.15-45.88), and metabolic syndrome (42.54%; 95% CI: 30.06-56.05). Fibrosis progression proportion, and mean annual rate of progression in NASH were 40.76% (95% CI: 34.69-47.13) and 0.09 (95% CI: 0.06-0.12). HCC incidence among NAFLD patients was 0.44 per 1,000 person-years (range, 0.29-0.66). Liver-specific mortality and overall mortality among NAFLD and NASH were 0.77 per 1,000 (range, 0.33-1.77) and 11.77 per 1,000 person-years (range, 7.10-19.53) and 15.44 per 1,000 (range, 11.72-20.34) and 25.56 per 1,000 person-years (range, 6.29-103.80). Incidence risk ratios for liver-specific and overall mortality for NAFLD were 1.94 (range, 1.28-2.92) and 1.05 (range, 0.70-1.56).
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              No effective systemic therapy exists for patients with advanced hepatocellular carcinoma. A preliminary study suggested that sorafenib, an oral multikinase inhibitor of the vascular endothelial growth factor receptor, the platelet-derived growth factor receptor, and Raf may be effective in hepatocellular carcinoma. In this multicenter, phase 3, double-blind, placebo-controlled trial, we randomly assigned 602 patients with advanced hepatocellular carcinoma who had not received previous systemic treatment to receive either sorafenib (at a dose of 400 mg twice daily) or placebo. Primary outcomes were overall survival and the time to symptomatic progression. Secondary outcomes included the time to radiologic progression and safety. At the second planned interim analysis, 321 deaths had occurred, and the study was stopped. Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; 95% confidence interval, 0.55 to 0.87; P<0.001). There was no significant difference between the two groups in the median time to symptomatic progression (4.1 months vs. 4.9 months, respectively, P=0.77). The median time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo group (P<0.001). Seven patients in the sorafenib group (2%) and two patients in the placebo group (1%) had a partial response; no patients had a complete response. Diarrhea, weight loss, hand-foot skin reaction, and hypophosphatemia were more frequent in the sorafenib group. In patients with advanced hepatocellular carcinoma, median survival and the time to radiologic progression were nearly 3 months longer for patients treated with sorafenib than for those given placebo. (ClinicalTrials.gov number, NCT00105443.) 2008 Massachusetts Medical Society
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                Author and article information

                Journal
                JAMA Oncol
                JAMA Oncol
                JAMA Oncology
                American Medical Association
                2374-2437
                2374-2445
                5 October 2017
                December 2017
                14 December 2017
                : 3
                : 12
                : 1683-1691
                Affiliations
                [1 ]School of Public Health, Birmingham, University of Alabama at Birmingham
                [2 ]Mekelle University, School of Public Health, College of Health Sciences, Mekelle, Tigray, Ethiopia
                [3 ]University of Hohenheim, Institute of Biological Chemistry and Nutrition, Stuttgart, Baden Württemberg, Germany
                [4 ]Jimma University Institute of Health, Department of Epidemiology, Jimma, Oromiya, Ethiopia
                [5 ]Department of Health, Queensland Government, Herston, QLD, Australia
                [6 ]University of Queensland, School of Public Health, Herston, QLD, Australia
                [7 ]Mekelle University Epidemiology, Mekelle, TNRS, Ethiopia
                [8 ]University of Washington, Institute for Health Metrics and Evaluation, Seattle
                [9 ]Ministry of Health Research Department, Jeddah, Saudi Arabia
                [10 ]Universidad de Cartagena, Grupo de Investigación en Economía de la Salud, Cartagena, Bolivar, Colombia
                [11 ]Komfo Anokye Teaching Hospital, Department of Medicine, Bantama, Ghana
                [12 ]University of Manitoba, Community Health Sciences, Winnipeg, Manitoba, Canada
                [13 ]University of Gondar, Epidemiology and Biostatistics, Gondar, Ethiopia
                [14 ]Clinical Center of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia
                [15 ]Hospital Universitário, University of São Paulo Division of Internal Medicine, São Paulo, São Paulo, Brazil
                [16 ]Debre Berhan University, College of Health Sciences, Debre Berhan, Amhara, Ethiopia
                [17 ]Aga Khan University, Centre of Excellence in Women & Child, Karachi, Sindh, Pakistan
                [18 ]The Hospital for Sick Children, Centre for Global Child Health, Toronto, Ontario, Canada
                [19 ]Caja Costarricense de Seguro Social, Dirección Actuarial y Economica, San Jose, San Jose, Costa Rica
                [20 ]Iraq MOH FETP, MOH, Baghdad, Iraq
                [21 ]Seoul National University, College of Medicine Medical Library, Seoul, South Korea
                [22 ]Doherty Institute, WHO Collaborating Centre for Viral Hepatitis, Melbourne, Victoria, Australia
                [23 ]Public Health Foundation of India, Research, Gurgaon, NCR, India
                [24 ]Indian Institute of Public Health-Delhi, Environmental and Occupational Health, Gurgaon, Haryana, India
                [25 ]Duy Tan University, Institute for Global Health Innovations, Da Nang, Vietnam
                [26 ]Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
                [27 ]Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt
                [28 ]Bielefeld University, School of Public Health, Bielefeld, Germany
                [29 ]Swiss Tropical and Public Health Institute, Epidemiology and Public Health, Basel, Switzerland
                [30 ]University of Basel, Switzerland
                [31 ]Imperial College London, School of Public Health, London, England
                [32 ]Baylor College of Medicine, National School of Tropical Medicine, Houston, Texas
                [33 ]Sabin Vaccine Institute & Texas Children's Hospital Center for Vaccine Development, Houston
                [34 ]Graduate School of Public Health, Yonsei University, Epidemiology and Health Promotion, Seoul, South Korea
                [35 ]Tehran University of Medical Sciences, Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran, Tehran, Iran
                [36 ]Jordan University of Science and Technology, Public Health, Irbid, Irbid, Jordan
                [37 ]Seoul National University College of Medicine, Institute of Health Policy and Management, Seoul, Seoul Metropolitan City, South Korea
                [38 ]Public Health Foundation of India Research, Gurgaon (NCR), Haryana, India
                [39 ]Department Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
                [40 ]University of Melbourne, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
                [41 ]Aintree University Hospital NHS Foundation Trust, General Surgery Department, Liverpool, England
                [42 ]School of Medicine, University of Liverpool, Liverpool, England
                [43 ]Tehran University of Medical Sciences, Digestive Diseases Research Institute, Tehran, Tehran, Iran
                [44 ]University Hospitals Bristol, Department of Medicine, Bristol, England
                [45 ]Martin Luther University Halle-Wittenberg, Institute for Agricultural and Nutritional Sciences, Halle (Saale), Germany
                [46 ]UNFPA Peru Country Office, Lima, Peru
                [47 ]Iran University of Medical Sciences, Gastrointestinal and Liver Disease Research Center, Tehran, Tehran, Iran
                [48 ]Iran University of Medical Sciences, Preventive Medicine and Public Health Research Center, Tehran, Tehran, Iran
                [49 ]Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany
                [50 ]Duy Tan University, Institute for Global Health Innovations, Da Nang, Vietnam
                [51 ]Western Sydney University, Centre for Health Research, School of Medicine, Penrith, NSW, Australia
                [52 ]Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
                [53 ]University of Melbourne, Paediatrics, Melbourne, Victoria, Australia
                [54 ]REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
                [55 ]Department of Urology, University of British Columbia, Vancouver, British Columbia, Canada
                [56 ]Alborz University of Medical Sciences, Noncommunicable Diseases Research Center, Karaj, Alborz, Iran
                [57 ]A. T. Still University, College of Graduate Health Studies, Mesa, Arizona
                [58 ]Golestan University of Medical Sciences, Golestan Research Center of Gastroenterology and Hepatology, Gorgan, Iran
                [59 ]Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts
                [60 ]Marshall University School of Medicine, Surgery, Huntington, West Virginia
                [61 ]Case Western Reserve University, Nutrition and Preventive Medicine, Ohio
                [62 ]University of KwaZulu-Natal, Public Health Medicine, Durban, KwaZulu-Natal, South Africa
                [63 ]Utkal University, Centre for Advanced Study in Psychology, Bhubaneswar, Odisha, India
                [64 ]AIIMS New Delhi, JPN Apex Trauma Centre, New Delhi, Delhi, India
                [65 ]Marshall University Public Health, Huntington, West Virginia
                [66 ]Tehran University of Medical Sciences, Digestive Diseases Research Institute, Tehran, Tehran, Iran
                [67 ]Haramaya University School of Public Health, Harari, Harari, Ethiopia
                [68 ]Queensland University of Technology, School of Public Health and Social Work, Brisbane, Queensland, Australia
                [69 ]Mekelle University, Institute of Biomedical Sciences, Mekelle, Tigrai, Ethiopia
                [70 ]Faculty of Health Sciences Jagiellonian University Medical College, Institute of Public Health, Kraków, Poland
                [71 ]Faculty of Health Sciences Wroclaw Medical University, Wroclaw, Poland
                [72 ]Hanoi Medical University, Institute for Preventive Medicine and Public Health, Hanoi, Vietnam
                [73 ]Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
                [74 ]Federal Teaching Hospital, Department of Medicine, Abakaliki, Ebonyi State, Nigeria
                [75 ]Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia
                [76 ]Norwegian Institute of Public Health, Centre for Disease Burden, Bergen, Norway
                [77 ]University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
                [78 ]Jimma University, Population and Family Health, Oromia, Ethiopia
                [79 ]Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
                [80 ]University of Tromsø, The Arctic University of Norway, Department of Community Medicine, Faculty of Health Sciences, Tromsø, Norway
                [81 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
                [82 ]Federal Institute for Population Research, Competence Center Mortality-Follow-Up of the National Cohort, Wiesbaden, Hesse, Germany
                [83 ]Kyoto University, School of Public Health Biostatistics, Sakyo, Kyoto, Japan
                [84 ]Jackson State University, Health Policy & Management, Jackson, Mississippi
                [85 ]Harvard Asia Aging Center, Harvard Medical School, Boston, Massachuetts
                [86 ]Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, Hubei Province, China
                [87 ]Department of Epidemiology, University Hospital of Setif, Setif, Algeria
                [88 ]University Ferhat Abbas, Faculty of Medicine, Setif, Algeria
                [89 ]Jiangsu Provincial Center for Disease Control and Prevention, Major Project Execution Office, Nanjing, Jiangsu, China
                [90 ]Division of Hematology, Department of Medicine, University of Washington, Seattle
                Author notes
                Article Information
                The Authors/Members of the Global Burden of Disease Liver Cancer Collaboration are listed at the end of this article.
                Corresponding Author: Christina Fitzmaurice, MD, MPH, Division of Hematology, Department of Medicine, Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave, Ste 600, Seattle, WA 98121 ( cf11@ 123456uw.edu ).
                Accepted for Publication: May 30, 2017.
                Correction: This article was corrected on December 14, 2017, to fix a typographical error in the key for Figure 1.
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2017 Global Burden of Disease Liver Cancer Collaboration. JAMA Oncology.
                Published Online: October 5, 2017. doi:10.1001/jamaoncol.2017.3055
                The Global Burden of Disease Liver Cancer Collaboration: Tomi Akinyemiju, PhD; Semaw Abera, MSc; Muktar Ahmed, MBA; Noore Alam, MPH; Mulubirhan Assefa Alemayohu, MPH; Christine Allen, BA; Rajaa Al-Raddadi, PhD; Nelson Alvis-Guzman, PhD; Yaw Amoako, FWACP; Al Artaman, PhD; Tadesse Awoke Ayele, MS; Aleksandra Barac, PhD; Isabela Bensenor, PhD; Adugnaw Berhane, PhD; Zulfiqar Bhutta, PhD; Jacqueline Castillo-Rivas, MPH; Abdulaal Chitheer, FETP; Jee-Young Choi, PhD; Benjamin Cowie, PhD; Lalit Dandona, PhD; Rakhi Dandona, MD; Subhojit Dey, PhD; Daniel Dicker, BS; Huyen Phuc, Do, MSc; Donatus U. Ekwueme, PhD; Maysaa El Sayed Zaki, PhD; Florian Fischer, PhD; Thomas Fürst, PhD; Jamie Hancock, MLS; Simon I. Hay, DSc; Peter Hotez, PhD; Sun Ha Jee, PhD; Amir Kasaeian, PhD; Yousef Khader, ScD; Young-Ho Khang, PhD; G Anil Kumar, PhD; Michael Kutz, BS; Heidi Larson, PhD; Alan Lopez, PhD; Raimundas Lunevicius, PhD; Reza Malekzadeh, MD; Colm McAlinden, PhD; Toni Meier, PhD; Walter Mendoza, MD; Ali Mokdad, PhD; Maziar Moradi-Lakeh, MD; Gabriele Nagel, PhD; Quyen Nguyen, MD; Grant Nguyen, MPH; Felix Ogbo, MPH; George Patton, MD; David M. Pereira, PhD; Farshad Pourmalek, PhD; Mostafa Qorbani, PhD; Amir Radfar, MD; Gholamreza Roshandel, PhD; Joshua A Salomon, PhD; Juan Sanabria, MD; Benn Sartorius, PhD; Maheswar Satpathy, PhD; Monika Sawhney, PhD; Sadaf Sepanlou, PhD; Katya Shackelford, BA; Hirbo Shore, MPH; Jiandong Sun, PhD; Desalegn Tadese Mengistu, MS; Roman Topór-Mądry, PhD; Bach Tran, PhD; Kingsley Nnanna Ukwaja, MD; Vasiliy Vlassov, MD; Stein Emil Vollset, DrPH; Theo Vos, PhD; Tolassa Wakayo, MS; Elisabete Weiderpass, PhD; Andrea Werdecker, PhD; Naohiro Yonemoto, MPH; Mustafa Younis, DrPH; Chuanhua Yu, PhD; Zoubida Zaidi, PhD; Liguo Zhu, PhD; Christopher J. L. Murray, Dphil; Mohsen Naghavi, PhD; Christina Fitzmaurice, MD.
                Affiliations of The Global Burden of Disease Liver Cancer Collaboration: School of Public Health, Birmingham, University of Alabama at Birmingham (Akinyemiju); Mekelle University, School of Public Health, College of Health Sciences, Mekelle, Tigray, Ethiopia (Abera); University of Hohenheim, Institute of Biological Chemistry and Nutrition, Stuttgart, Baden Württemberg, Germany (Abera); Jimma University Institute of Health, Department of Epidemiology, Jimma, Oromiya, Ethiopia (Ahmed); Department of Health, Queensland Government, Herston, QLD, Australia (Alam); University of Queensland, School of Public Health, Herston, QLD, Australia (Alam); Mekelle University Epidemiology, Mekelle, TNRS, Ethiopia (Alemayohu); University of Washington, Institute for Health Metrics and Evaluation, Seattle (Allen, L. Dandona, R. Dandona, Dicker, Hancock, Hay, Kutz, Lopez, Mokdad, G. Nguyen, Shackelford, Vos, Murray, Naghavi, Fitzmaurice); Ministry of Health Research Department, Jeddah, Saudi Arabia (Al-Raddadi); Universidad de Cartagena, Grupo de Investigación en Economía de la Salud, Cartagena, Bolivar, Colombia (Alvis-Guzman); Komfo Anokye Teaching Hospital, Department of Medicine, Bantama, Ghana (Amoako); University of Manitoba, Community Health Sciences, Winnipeg, Manitoba, Canada (Artaman); University of Gondar, Epidemiology and Biostatistics, Gondar, Ethiopia (Ayele); Clinical Center of Serbia, Clinic for Infectious and Tropic Diseases, Belgrade, Serbia (Barac); Hospital Universitário, University of São Paulo Division of Internal Medicine, São Paulo, São Paulo, Brazil (Bensenor); Debre Berhan University, College of Health Sciences, Debre Berhan, Amhara, Ethiopia (Berhane); Aga Khan University, Centre of Excellence in Women & Child, Karachi, Sindh, Pakistan (Bhutta); The Hospital for Sick Children, Centre for Global Child Health, Toronto, Ontario, Canada (Bhutta); Caja Costarricense de Seguro Social, Dirección Actuarial y Economica, San Jose, San Jose, Costa Rica (Castillo-Rivas); Iraq MOH FETP, MOH, Baghdad, Iraq (Chitheer); Seoul National University, College of Medicine Medical Library, Seoul, South Korea (Choi); Doherty Institute, WHO Collaborating Centre for Viral Hepatitis, Melbourne, Victoria, Australia (Cowie); Public Health Foundation of India, Research, Gurgaon, NCR, India (L. Dandona, R. Dandona); Indian Institute of Public Health-Delhi, Environmental and Occupational Health, Gurgaon, Haryana, India (Dey); Duy Tan University, Institute for Global Health Innovations, Da Nang, Vietnam (Phuc); Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Ekwueme); Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt (Zaki); Bielefeld University, School of Public Health, Bielefeld, Germany (Fischer); Swiss Tropical and Public Health Institute, Epidemiology and Public Health, Basel, Switzerland (Fürst); University of Basel, Switzerland (Fürst); Imperial College London, School of Public Health, London, England (Fürst); Baylor College of Medicine, National School of Tropical Medicine, Houston, Texas (Hotez); Sabin Vaccine Institute & Texas Children's Hospital Center for Vaccine Development, Houston (Hotez); Graduate School of Public Health, Yonsei University, Epidemiology and Health Promotion, Seoul, South Korea (Jee); Tehran University of Medical Sciences, Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran, Tehran, Iran (Kasaeian); Jordan University of Science and Technology, Public Health, Irbid, Irbid, Jordan (Khader); Seoul National University College of Medicine, Institute of Health Policy and Management, Seoul, Seoul Metropolitan City, South Korea (Khang); Public Health Foundation of India Research, Gurgaon (NCR), Haryana, India (Kumar); Department Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England (Larson); University of Melbourne, Melbourne School of Population and Global Health, Melbourne, VIC, Australia (Lopez); Aintree University Hospital NHS Foundation Trust, General Surgery Department, Liverpool, England (Lunevicius); School of Medicine, University of Liverpool, Liverpool, England (Lunevicius); Tehran University of Medical Sciences, Digestive Diseases Research Institute, Tehran, Tehran, Iran (Malekzadeh); University Hospitals Bristol, Department of Medicine, Bristol, England (McAlinden); Martin Luther University Halle-Wittenberg, Institute for Agricultural and Nutritional Sciences, Halle (Saale), Germany (Meier); UNFPA Peru Country Office, Lima, Peru (Mendoza); Iran University of Medical Sciences, Gastrointestinal and Liver Disease Research Center, Tehran, Tehran, Iran (Moradi-Lakeh); Iran University of Medical Sciences, Preventive Medicine and Public Health Research Center, Tehran, Tehran, Iran (Moradi-Lakeh); Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany (Nagel); Duy Tan University, Institute for Global Health Innovations, Da Nang, Vietnam (Q. Nguyen); Western Sydney University, Centre for Health Research, School of Medicine, Penrith, NSW, Australia (Ogbo); Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia (Ogbo); University of Melbourne, Paediatrics, Melbourne, Victoria, Australia (Patton); REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal (Pereira); Department of Urology, University of British Columbia, Vancouver, British Columbia, Canada (Pourmalek); Alborz University of Medical Sciences, Noncommunicable Diseases Research Center, Karaj, Alborz, Iran (Qorbani); A. T. Still University, College of Graduate Health Studies, Mesa, Arizona (Radfar); Golestan University of Medical Sciences, Golestan Research Center of Gastroenterology and Hepatology, Gorgan, Iran (Roshandel); Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts (Salomon); Marshall University School of Medicine, Surgery, Huntington, West Virginia (Sanabria); Case Western Reserve University, Nutrition and Preventive Medicine, Ohio (Sanabria); University of KwaZulu-Natal, Public Health Medicine, Durban, KwaZulu-Natal, South Africa (Sartorius); Utkal University, Centre for Advanced Study in Psychology, Bhubaneswar, Odisha, India (Satpathy); AIIMS New Delhi, JPN Apex Trauma Centre, New Delhi, Delhi, India (Satpathy); Marshall University Public Health, Huntington, West Virginia (Sawhney); Tehran University of Medical Sciences, Digestive Diseases Research Institute, Tehran, Tehran, Iran (Sepanlou); Haramaya University School of Public Health, Harari, Harari, Ethiopia (Shore); Queensland University of Technology, School of Public Health and Social Work, Brisbane, Queensland, Australia (Sun); Mekelle University, Institute of Biomedical Sciences, Mekelle, Tigrai, Ethiopia (Mengistu); Faculty of Health Sciences Jagiellonian University Medical College, Institute of Public Health, Kraków, Poland (Topór-Mądry); Faculty of Health Sciences Wroclaw Medical University, Wroclaw, Poland (Topór-Mądry); Hanoi Medical University, Institute for Preventive Medicine and Public Health, Hanoi, Vietnam (Tran); Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland (Tran); Federal Teaching Hospital, Department of Medicine, Abakaliki, Ebonyi State, Nigeria (Ukwaja); Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia (Vlassov); Norwegian Institute of Public Health, Centre for Disease Burden, Bergen, Norway (Vollset); University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway (Vollset); Jimma University, Population and Family Health, Oromia, Ethiopia (Wakayo); Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway (Weiderpass); University of Tromsø, The Arctic University of Norway, Department of Community Medicine, Faculty of Health Sciences, Tromsø, Norway (Weiderpass); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (Weiderpass); Federal Institute for Population Research, Competence Center Mortality-Follow-Up of the National Cohort, Wiesbaden, Hesse, Germany (Werdecker); Kyoto University, School of Public Health Biostatistics, Sakyo, Kyoto, Japan (Yonemoto); Jackson State University, Health Policy & Management, Jackson, Mississippi (Younis); Harvard Asia Aging Center, Harvard Medical School, Boston, Massachuetts (Younis); Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, Hubei Province, China (Yu); Department of Epidemiology, University Hospital of Setif, Setif, Algeria (Zaidi); University Ferhat Abbas, Faculty of Medicine, Setif, Algeria (Zaidi); Jiangsu Provincial Center for Disease Control and Prevention, Major Project Execution Office, Nanjing, Jiangsu, China (Zhu); Division of Hematology, Department of Medicine, University of Washington, Seattle (Fitzmaurice).
                Author Contributions: Dr Fitzmaurice had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
                Study concept and design: Akinyemiju, Jee, Khader, Satpathy, Vos, Weiderpass, Younis, Zaidi, Murray, Naghavi, Fitzmaurice.
                Acquisition, analysis, or interpretation of data: Akinyemiju, Abera, Ahmed, Alam, Alemayohu, Allen, Al-Raddadi, Alvis-Guzman, Amoako, Artaman, Awoke Ayele, Barac, Bensenor, Berhane, Bhutta, Castillo-Rivas, Chitheer, Choi, Cowie, L. Dandona, R. Dandona, Dey, Dicker, Do, Ekwueme, Zaki, Fischer, Fürst, Hancock, Hay, Hotez, Kasaeian, Khang, Kumar, Kutz, Larson, Lopez, Lunevicius, Malekzadeh, McAlinden, Meier, Mendoza, Mokdad, Moradi-Lakeh, Nagel, Q. Nguyen, G. Nguyen, Ogbo, Patton, Pereira, Pourmalek, Qorbani, Radfar, Roshandel, Salomon, Sanabria, Sartorius, Satpathy, Sawhney, Sepanlou, Shackelford, Shore, Sun, Mengistu, Topór-Mądry, Tran, Ukwaja, Vlassov, Vollset, Vos, Wakayo, Weiderpass, Werdecker, Yonemoto, Yu, Zaidi, Zaki, Zhu, Murray, Naghavi, Fitzmaurice.
                Drafting of the manuscript: Akinyemiju, Allen, Zaki, Hancock, Khader, Sanabria, Satpathy, Shackelford, Weiderpass, Zaidi, Zaki, Fitzmaurice.
                Critical revision of the manuscript for important intellectual content: Akinyemiju, Abera, Ahmed, Alam, Alemayohu, Al-Raddadi, Alvis-Guzman, Amoako, Artaman, Awoke Ayele, Barac, Bensenor, Berhane, Bhutta, Castillo-Rivas, Chitheer, Choi, Cowie, L. Dandona, R. Dandona, Dey, Dicker, Do, Ekwueme, Zaki, Fischer, Fürst, Hay, Hotez, Jee, Kasaeian, Khang, Kumar, Kutz, Larson, Lopez, Lunevicius, Malekzadeh, McAlinden, Meier, Mendoza, Mokdad, Moradi-Lakeh, Nagel, Q. Nguyen, G. Nguyen, Ogbo, Patton, Pereira, Pourmalek, Qorbani, Radfar, Roshandel, Salomon, Sartorius, Satpathy, Sawhney, Sepanlou, Shore, Sun, Mengistu, Topór-Mądry, Tran, Ukwaja, Vlassov, Vollset, Vos, Wakayo, Weiderpass, Werdecker, Yonemoto, Younis, Yu, Zaidi, Zaki, Zhu, Murray, Naghavi.
                Statistical analysis: Akinyemiju, Allen, Castillo-Rivas, Dey, Do, Hotez, Kasaeian, Kutz, Malekzadeh, McAlinden, Meier, Mokdad, Moradi-Lakeh, Q. Nguyen, G. Nguyen, Qorbani, Salomon, Satpathy, Tran, Ukwaja, Vos, Weiderpass, Younis, Yu, Zaidi, Zhu, Naghavi, Fitzmaurice.
                Obtained funding: Murray.
                Administrative, technical, or material support: Alam, Allen, Amoako, Bensenor, Berhane, Bhutta, L. Dandona, Dicker, Zaki, Hancock, Khader, Lopez, Pereira, Radfar, Satpathy, Sawhney, Shackelford, Tran, Ukwaja, Weiderpass, Younis, Zaidi, Zaki, Zhu, Murray.
                Study supervision: Akinyemiju, Barac, Jee, Ukwaja, Vos, Weiderpass, Murray, Naghavi.
                Conflict of Interest Disclosures: Prof Larson reports that her research group has received funding from GlaxoSmithKline (GSK) and Merck to convene research symposia, as well as funding from GSK for advising on vaccine hesitancy issues. Prof Larson also reports that she has served on the Merck Vaccines Strategic Advisory Board. Dr Mendoza reports that he is currently the Program Analyst at the United Nations Population Fund Country Office in Peru, an institution that does not necessarily endorse this study. No other disclosures are reported.
                Article
                coi170064
                10.1001/jamaoncol.2017.3055
                5824275
                28983565
                0707af3e-39e3-447c-ab58-4d61215979e2
                Copyright 2017 Global Burden of Disease Liver Cancer Collaboration. JAMA Oncology.

                This is an open access article distributed under the terms of the CC-BY License. ©2017 Global Burden of Disease Liver Cancer Collaboration. JAMA Oncology.

                History
                : 23 February 2017
                : 24 May 2017
                : 30 May 2017
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