Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4749
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 predicted to be the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide. Novel treatment strategies against liver cancer have been developed rapidly recent years. Given its high malignant potential, liver cancer burden is still a serious public health problem over the past decade.
Socioeconomic development is closely interconnected with public health. However, little is known about healthcare disparities in individuals suffering from liver cancer. Furthermore, the manner in which social development and medical advances influenced liver cancer patients in the past decade is waiting to be clarified.
To investigate the influence of national Human Development Index (HDI) on mortality-to-incidence ratio (MIR) and 5-year net survival of patients with existing liver cancer, and transition in liver cancer epidemiology from 2008 to 2018.
We explored the association of MIR and survival of liver cancer with corresponding HDI via correlation analysis and nonlinear regression. Specifically, nonlinear regression was based on a modified “dose-to-inhibition response” model. We further investigated cancer geographic variability across continents and countries, among which MIRs within the four-tier HDI groups were compared via one-way ANOVA followed by Tukey-Kramer post hoc tests. Then we focused on temporal heterogeneity over the past decade, and comparisons of the incidence, mortality, calculated MIR, and survival between 2008 and 2018 were based on Weighted Chi-square test. A P-value less than 0.05 was considered statistically significant.
Liver cancer MIRs were negatively correlated and showed good fit with a modified “dose-to-inhibition response” pattern with HDI (P < 0.0001). Cancer survival was positively associated with HDI (P < 0.01) and negatively associated with MIR (P < 0.05), solidly confirming the interrelation among liver cancer outcome indicators and socioeconomic factors. Also, liver cancer MIRs of 4-tier HDI subgroups differed from each other. Notably, in the past decade, as the levels of national HDI in most countries have increased, the corresponding liver cancer MIR was relatively lower (P < 0.0001) and survival has simultaneously improved (P < 0.001), with long-existing region- or country-specific disparities.
This study is the first to explore the exact relationship between the epidemiology of liver cancer and socioeconomic development in a long time scale. We showed the association between MIR and survival of liver cancer and area-specific HDI. Moreover, HDI values have increased along with improved liver cancer outcomes over the last decade, with significant disparities among countries. 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.
The great disparities in cancer health care should compel us to exert greater effort in improving socioeconomic conditions in less developed countries and territories. Even the clinical outcomes of liver cancer have improved in the past decade, it still lacks an ideal radical therapeutic regimen. Given the dismal prognosis of liver cancer, research on new and available approaches against liver cancer is urgently needed in the future.