Mortality analysis of primary liver cancer in the mainland of China from 2004 to 2018

Objective To determine the mortality and changing trend of primary liver cancer by using the death data of Chinese mainland from 2004 to 2018.

Methods The death certificate data was collected from China National Mortality Surveillance System from 2004 to 2018. The crude mortality rate（CMR）and age-standardized mortality rate（ASMR）of primary liver cancer in different ages， regions and living environments were calculated by Joinpoint regression model to analyze the basic situation and mortality trend.

Results From 2004 to 2018， there were 556 241 primary liver cancer deaths in China， with a CMR of 25.18/10⁵ and an ASMR of 17.98/10⁵. It suggested that the mortality of primary liver cancer was on a decreasing trend. During the 15 years， the ASMR of primary liver cancer was 15.56/10⁵ in urban areas and 19.29/10⁵in rural areas. In urban areas， CMR was 32.89/10⁵in males and 12.14/10⁵ in females， respectively； while in rural areas， CMR was 38.39/10⁵ in males and 14.02/10⁵ in females， respectively. The CMR in eastern， central and western urban regions was 22.25/10⁵， 22.66/10⁵ and 23.50/10⁵， respectively. The CMR in the rural areas of these three regions was 27.82/10⁵， 26.98/10⁵ and 23.85/10⁵， respectively. The patients were divided into four age groups： 0-19 years old， 20-39 years old， 40-59 years old， and more than 60 years old. The CMR of four groups in urban areas was 0.14/10⁵， 2.59/10⁵， 24.51/10⁵ and 91.80/10⁵. In rural areas， the CMR of four groups was 0.17/10⁵， 4.05/10⁵， 32.16/10⁵ and 103.02/10⁵.

Conclusion From 2004 to 2018， the mortality rate of liver cancer in China has a decreasing trend. However， the primary liver cancer death burden is still serious because of the large population base， severe aging population problem， and significant urban-rural and male-female disparities in China.