Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4749-4763
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4749
Impact of national Human Development Index on liver cancer outcomes: Transition from 2008 to 2018
Shi-Yi Shao, Qi-Da Hu, Meng Wang, Xin-Yu Zhao, Wang-Teng Wu, Jun-Ming Huang, Ting-Bo Liang
Shi-Yi Shao, Qi-Da Hu, Meng Wang, Xin-Yu Zhao, Wang-Teng Wu, Jun-Ming Huang, Ting-Bo Liang, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Ting-Bo Liang, Zhejiang Innovation Center for the Study of Pancreatic Diseases (ICSPD-ZJ), Hangzhou 310003, Zhejiang Province, China
Author contributions: Shao SY and Hu QD contribute equally to this work; Shao SY, Hu QD, and Liang TB conceived and designed the study; Shao SY collected the data; Shao SY, Hu QD, and Wang M participated in analysis and interpretation of the data; Shao SY and Hu QD drafted the initial manuscript and prepared the figures; Wang M, Zhao XY, Wu WT, and Huang JM revised the manuscript critically for important intellectual contents; Liang TB finalized the manuscript, and took responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81972207, No. 81830089 and No. 81502026; Zhejiang Provincial Natural Science Foundation, No. LQ16H180002 and No. LY18H160026.
Institutional review board statement: The study did not involve any human or animal subjects. We have conducted this secondary analysis based on existing public data. Our major data resources are (1) GLOBOCAN database 2018 and 2008; (2) HDI: UNDP database; and (3) The CONCORD-3 report. Approval file of Institutional Review Board is not applicable.
Informed consent statement: Informed consent statement is not applicable.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The guidelines of the STROBE Statement have been adopted for this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ting-Bo Liang, FACS, MD, PhD, Attending Doctor, Chairman, Chief Doctor, Doctor, Full Professor, Professor, Research Fellow, Surgeon, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. liangtingbo@zju.edu.cn
Telephone: +86-571-87236688 Fax: +86-571-87072577
Received: May 5, 2019
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.