Aetiology-Specific Liver Cancer Burden in Sub-Saharan Africa, 1990–2023: A Global Burden of Disease 2023 Analysis
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healthcareRecord type:
paper
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MbaEsoNat
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Background: Liver cancer remains a leading cause of cancer mortality globally, with a disproportionate burden in low- and middle-income countries. In sub-Saharan Africa (SSA), the burden is heterogeneous across sub-regions and aetiologies, yet long-term analyses that are simultaneously aetiology-specific, sex-stratified, and sub-regionally resolved remain limited. This study assessed temporal trends and sub-regional heterogeneity in liver cancer burden across SSA from 1990 to 2023 using Global Burden of Disease (GBD) 2023 estimates.
Methods: We conducted a secondary analysis of GBD 2023 data for SSA and its four sub-regions: Central, Eastern, Southern, and Western SSA. We extracted aetiology-specific estimates of liver cancer deaths, incident cases, and disability-adjusted life years (DALYs) attributable to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, non-alcoholic steatohepatitis (NASH), and other causes. Analyses were stratified by sex, year, and sub-region, with selected country-level estimates examined for HBV-attributable mortality. Both absolute numbers and age-standardised rates per 100,000 population were assessed. Temporal trends were quantified using estimated annual percentage change (EAPC). Analyses and visualisations were performed in R version 4.5.2.
Results: Central SSA carried the highest age-standardised liver cancer mortality burden throughout the study period. Western SSA experienced the steepest decline in age-standardised mortality over time. In 2023, HCV accounted for the largest share of liver cancer mortality in Central SSA, whereas HBV was the dominant aetiology in Western SSA. Eastern SSA showed a more balanced HBV–HCV profile, while Southern SSA demonstrated a mixed pattern with appreciable contributions from viral, alcohol-related, and metabolic causes. Male populations generally had higher aetiology-specific mortality rates than females across most strata, although the magnitude of the sex gap varied by aetiology and sub-region. At country level, the highest HBV-attributable mortality was observed in a small cluster of Western and Central SSA countries, including Guinea, Liberia, Mauritania, Chad, Gambia, the Democratic Republic of Congo, Angola, and Gabon.
Conclusions: Liver cancer burden in SSA shows marked sub-regional and sex-specific heterogeneity. The predominance of HCV in Central SSA and HBV in Western SSA supports differentiated prevention strategies, including expanded access to HCV diagnosis and direct-acting antiviral therapy in Central SSA and strengthened HBV birth-dose vaccination in Western SSA. Additional attention to aflatoxin mitigation, HDV surveillance, alcohol control, and gender-responsive prevention strategies is warranted across the region.Keywords: Liver cancer; hepatocellular carcinoma; sub-Saharan Africa; hepatitis B virus; hepatitis C virus; Global Burden of Disease; age-standardised rates; sex disparities
Methods: We conducted a secondary analysis of GBD 2023 data for SSA and its four sub-regions: Central, Eastern, Southern, and Western SSA. We extracted aetiology-specific estimates of liver cancer deaths, incident cases, and disability-adjusted life years (DALYs) attributable to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, non-alcoholic steatohepatitis (NASH), and other causes. Analyses were stratified by sex, year, and sub-region, with selected country-level estimates examined for HBV-attributable mortality. Both absolute numbers and age-standardised rates per 100,000 population were assessed. Temporal trends were quantified using estimated annual percentage change (EAPC). Analyses and visualisations were performed in R version 4.5.2.
Results: Central SSA carried the highest age-standardised liver cancer mortality burden throughout the study period. Western SSA experienced the steepest decline in age-standardised mortality over time. In 2023, HCV accounted for the largest share of liver cancer mortality in Central SSA, whereas HBV was the dominant aetiology in Western SSA. Eastern SSA showed a more balanced HBV–HCV profile, while Southern SSA demonstrated a mixed pattern with appreciable contributions from viral, alcohol-related, and metabolic causes. Male populations generally had higher aetiology-specific mortality rates than females across most strata, although the magnitude of the sex gap varied by aetiology and sub-region. At country level, the highest HBV-attributable mortality was observed in a small cluster of Western and Central SSA countries, including Guinea, Liberia, Mauritania, Chad, Gambia, the Democratic Republic of Congo, Angola, and Gabon.
Conclusions: Liver cancer burden in SSA shows marked sub-regional and sex-specific heterogeneity. The predominance of HCV in Central SSA and HBV in Western SSA supports differentiated prevention strategies, including expanded access to HCV diagnosis and direct-acting antiviral therapy in Central SSA and strengthened HBV birth-dose vaccination in Western SSA. Additional attention to aflatoxin mitigation, HDV surveillance, alcohol control, and gender-responsive prevention strategies is warranted across the region.Keywords: Liver cancer; hepatocellular carcinoma; sub-Saharan Africa; hepatitis B virus; hepatitis C virus; Global Burden of Disease; age-standardised rates; sex disparities