Epidemiological Trends and Gender Differences in Hepatocellular Carcinoma: Analysis From the Global Burden of Disease Study 2019

Introduction: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally, with a persistently high burden worldwide. The etiological shift in the causes of cirrhosis, largely due to increased hepatitis screening, has been observed, however, paucity of data exists examining gender disparities in HCC incidence, death, and Disability-Adjusted Life Years (DALYs) globally. Methods: Using the Global Burden of Diseases Study 2019, we evaluated the 2009-2019 trend in Hepatocellular Carcinoma (HCC) incidence, mortality, and DALYs globally, stratified by gender, socio-demographic index (SDI), and HCC etiology. Results: In 2019, the overall burden of HCC was higher in male compared to female, with a total of 376,483 incident cases, 333,673 death 9,048,723 DALYs due to HCC in males, and 157,881 incident, 150,904 deaths, and 3,479,699 of DALYs in female. These numbers represent a 31.9% increase in male incident cases and a 25.8% increase in female cases from 2009. This also translated to increase of 28.3% mortality in males, and 24.6% increase in females. Male Age-Standardized Rates (ASR) of incidence increased by 3.85%, whereas female ASRs declined by 4.0%. Stratification by SDI revealed a decline in death ASRs in all regions except for males in middle SDI (+3.9%) and both sexes in lower-middle SDI (males: +5.5%, females: +0.45%). In the middle SDI group, Non-alcoholic steatohepatitis (NASH) had the highest increase in death ASR (18.8%), followed by alcohol use (11.8%) in males. In lower-middle SDI, the most substantial increase in death ASR was due to NASH (12.7%) in males and alcohol use (7.4%) and NASH (7.4%) in females. Globally, hepatitis B was the leading cause of HCC in males, and hepatitis C in females based on incident ASR. However, the most significant increase from 2009-2019 was seen with NASH in both males (12.9%) and females (4.95%). Conclusion: On a global scale, male has higher burden of HCC compared to female counterparts. The trend diverges in between male and female in incidence ASRs, while male saw an increased during this time, while female experiences in decrease in trend. When compared by SDI, we saw an decrease in death ASRs all region except for middle and low-middle SDI region, that is mainly driven by increase in NASH and followed by alcohol use. Given these disparities in burden between sexes, more target strategy is needed to reduce the burden of metabolic syndrome and thus NASH, as well as alcohol misuse.Figure 1.: A) Number of Deaths. B) Number of Incident cases. C) ASR.