Global burden of liver cancer and cirrhosis among children, adolescents, and young adults

Liver diseases, including liver cancer, cirrhosis, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), impose a heavy disease burden worldwide [ 1 Liu Z. Jiang Y. Yuan H. Fang Q. Cai N. Suo C. et al. 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 Hepatol. 2019; 70: 674-683 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar , 2 Younossi Z. Tacke F. Arrese M. Chander Sharma B. Mostafa I. Bugianesi E. et al. Global perspectives on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Hepatology. 2019; 69: 2672-2682 Crossref PubMed Scopus (505) Google Scholar ]. Liver cancer and cirrhosis may derive from any chronic liver disease, such as hepatitis B/C virus (HBV/HCV) infections, alcoholic liver disease, NAFLD, haemochromatosis, and autoimmune hepatitis [ [3] Beste L.A. Leipertz S.L. Green P.K. Dominitz J.A. Ross D. Ioannou G.N. Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001–2013. Gastroenterology. 2015; 149 (e1475; quiz e1417–78): 1471-1482 Abstract Full Text Full Text PDF PubMed Scopus (254) Google Scholar ]. Over the last four decades, the prevalence of overweight has increased over fourfold in children, and there has been a great relative increase in obesity prevalence with no signs of slowing [ [4] NCD Risk Factor Collaboration (NCD-RisC) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017; 390: 2627-2642 Abstract Full Text Full Text PDF PubMed Scopus (2991) Google Scholar ]. For HBV/HCV infections, little attention has been given to testing and treatment strategies for chronic hepatitis among children and adolescents compared to adults [ 5 Indolfi G. Easterbrook P. Dusheiko G. El-Sayed M.H. Jonas M.M. Thorne C. et al. Hepatitis C virus infection in children and adolescents. Lancet Gastroenterol Hepatol. 2019; 4: 477-487 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar , 6 Indolfi G. Easterbrook P. Dusheiko G. Siberry G. Chang M.H. Thorne C. et al. Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol Hepatol. 2019; 4: 466-476 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar ], presenting obstacles for global prevention and control of liver cancer and cirrhosis in this population. In the current study, we aim to describe the epidemiology of liver cancer and cirrhosis among children, adolescents, and young adults at the global, regional, and national levels. We collected the incidence and mortality data of liver cancer and cirrhosis from the online Global Health Data Exchange (GHDx) query tool (http://ghdx.healthdata.org/gbd-results-tool) [ [7] Global Burden of Disease Collaborative Network Global Burden of Disease Study 2017 (GBD 2017) results. Institute for Health Metrics and Evaluation (IHME), Seattle, United States2018 Google Scholar ]. Data from a total of 195 countries and territories were available. These countries and territories were then categorised into 5 regions in terms of socio-demographic index (SDI), including low, low-middle, middle, high-middle, and high, and 21 global burden of disease (GBD) regions in terms of geography. We retrieved the data of people aged 0–39 years. People aged 0–19 years and 20–39 years were defined as children and adolescents (CADs) and young adults (YADs), respectively. The estimated annual percentage change (EAPC) was used to quantify the trends in the incidence, mortality, and prevalence of liver disease, stratified by sex, region, nation, and age, from 1990 to 2017 [ [1] Liu Z. Jiang Y. Yuan H. Fang Q. Cai N. Suo C. et al. 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 Hepatol. 2019; 70: 674-683 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar ].