Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4749-4763
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4749
Impact of national Human Development Index on liver cancer outcomes: Transition from 2008 to 2018
Shi-Yi Shao, Qi-Da Hu, Meng Wang, Xin-Yu Zhao, Wang-Teng Wu, Jun-Ming Huang, Ting-Bo Liang
Shi-Yi Shao, Qi-Da Hu, Meng Wang, Xin-Yu Zhao, Wang-Teng Wu, Jun-Ming Huang, Ting-Bo Liang, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Ting-Bo Liang, Zhejiang Innovation Center for the Study of Pancreatic Diseases (ICSPD-ZJ), Hangzhou 310003, Zhejiang Province, China
Author contributions: Shao SY and Hu QD contribute equally to this work; Shao SY, Hu QD, and Liang TB conceived and designed the study; Shao SY collected the data; Shao SY, Hu QD, and Wang M participated in analysis and interpretation of the data; Shao SY and Hu QD drafted the initial manuscript and prepared the figures; Wang M, Zhao XY, Wu WT, and Huang JM revised the manuscript critically for important intellectual contents; Liang TB finalized the manuscript, and took responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81972207, No. 81830089 and No. 81502026; Zhejiang Provincial Natural Science Foundation, No. LQ16H180002 and No. LY18H160026.
Institutional review board statement: The study did not involve any human or animal subjects. We have conducted this secondary analysis based on existing public data. Our major data resources are (1) GLOBOCAN database 2018 and 2008; (2) HDI: UNDP database; and (3) The CONCORD-3 report. Approval file of Institutional Review Board is not applicable.
Informed consent statement: Informed consent statement is not applicable.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE Statement have been adopted for this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ting-Bo Liang, FACS, MD, PhD, Attending Doctor, Chairman, Chief Doctor, Doctor, Full Professor, Professor, Research Fellow, Surgeon, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. liangtingbo@zju.edu.cn
Telephone: +86-571-87236688 Fax: +86-571-87072577
Received: May 5, 2019
Peer-review started: May 6, 2019
First decision: June 16, 2019
Revised: July 10, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019

Liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide. Socioeconomic development, indicated by the Human Development Index (HDI), is closely interconnected with public health. But the manner in which social development and medical advances influenced liver cancer patients in the past decade is still unknown.


To investigate the influence of HDI on clinical outcomes for patients with existing liver cancer from 2008 to 2018.


The HDI values were obtained from the United Nations Development Programme, the age-standardized incidence and mortality rates of liver cancer were obtained from the GLOBOCAN database to calculate the mortality-to-incidence ratio, and the estimated 5-year net survival of patients with liver cancer was provided by the CONCORD-3 program. We then explored the association of mortality-to-incidence ratio and survival with HDI, with a focus on geographic variability across countries as well as temporal heterogeneity over the past decade.


From 2008 to 2018, the epidemiology of liver cancer had changed across countries. Liver cancer mortality-to-incidence ratios were negatively correlated and showed good fit with a modified “dose-to-inhibition response” pattern with HDI (r = -0.548, P < 0.0001 for 2018; r = -0.617, P < 0.0001 for 2008). Cancer survival was positively associated with HDI (r = 0.408, P < 0.01) and negatively associated with mortality-to-incidence ratio (r = -0.346, P < 0.05), solidly confirming the interrelation among liver cancer outcome indicators and socioeconomic factors. Notably, in the past decade, the HDI values in most countries have increased alongside a decreasing tendency of liver cancer mortality-to-incidence ratios (P < 0.0001), and survival outcomes have simultaneously improved (P < 0.001), with significant disparities across countries.


Socioeconomic factors have a significant influence on cancer outcomes. HDI values have increased along with improved cancer outcomes, with significant disparities among countries.

Keywords: Liver cancer, Human Development Index, Incidence, Mortality, Survival

Core tip: This study identified the interrelation of area-specific development and liver cancer outcomes. We verified that the Human Development Index (HDI) correlated negatively with mortality-to-incidence ratio and positively with survival rates of liver cancer in a “dose-to-inhibition response” pattern. Analyzing epidemiological data of liver cancer from 2008 to 2018, it was found that HDI in most countries has increased, and the liver cancer outcomes have improved. Our findings provide strong evidence of healthcare disparities related to socioeconomic factors, and we provide a substantial summary of the development of liver cancer health care in the last decade.