Research Square · Oct 21, 2026
Comparative Burden and Attributable Risk of Hepatocellular Carcinoma in China versus G20 Nations from 1990 to 2040: A Joinpoint Regression and Bayesian Age-Period-Cohort Modeling Study
By Luo Z, Hao Z, Tang M et al.
Hepatocellular carcinoma (HCC) is a principal contributor to cancer-related deaths globally, presenting significant public health and economic challenges. This investigation presents a detailed examination of the spatial and temporal progression, associated risk factors, and projected trajectories of HCC burden in China and G20 nations spanning the period from 1990 to 2040. Leveraging data from the Global Burden of Disease 2023 study, we applied descriptive statistical methods, Joinpoint regression analysis, Bayesian age-period-cohort (BAPC) modeling, ARIMA forecasting techniques, and risk factor decomposition. Findings revealed that while the absolute count of HCC cases rose, largely attributable to demographic aging, the age-standardized incidence and mortality rates (ASIR and ASMR) exhibited a downward trend from 1990 to 2023. This reduction was more pronounced in China compared to the G20 average, despite China’s rates continuing to exceed the group mean. Notable inequalities were identified, with higher burdens observed among males, older populations, and G20 countries with lower socioeconomic status. A transition in the etiological profile was evident: the proportion of cases attributable to hepatitis B virus (HBV) declined, whereas the fraction linked to metabolic dysfunction-associated fatty liver disease (MAFLD) rose significantly. Projections for 2040, generated through integrated BAPC-ARIMA models, anticipate a persistent decrease in age-standardized rates. Scenario modeling indicated that enhanced control of primary risk factors—including HBV, HCV, alcohol use, tobacco consumption, and MAFLD—could markedly hasten this decline. In summary, despite advancements, the HCC burden remains substantial, with a growing contribution from metabolic risks. These results highlight the necessity for precise, resource-adapted preventive measures, with particular emphasis on addressing MAFLD and existing inequalities, to effectively reduce the future impact of HCC.