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Causes of increased mortality from hepatocellular carcinoma in high incidence country: Taiwan experience
Author(s) -
JAN CHYIFENG,
CHEN CHIENJEN,
CHEN HSIUHSI
Publication year - 2005
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2005.03602.x
Subject(s) - medicine , incidence (geometry) , poisson regression , demography , hepatocellular carcinoma , relative risk , confidence interval , case fatality rate , cohort , cohort study , epidemiology , rate ratio , mortality rate , proportional hazards model , population , environmental health , physics , sociology , optics
Background: Since 1991, a rapid rise in mortality from hepatocellular carcinoma (HCC) has been observed in Taiwan in subjects aged ≥20 years. The aim of the present study was to assess whether poor survival or excess incident cases pertaining to a cohort effect or a time‐period effect accounted for such a rise. Methods: A total of 41 150 deaths and 51 201 incident HCC patients (International Classification of Diseases = 155.0) aged 20–79 years between 1985 and 1998 were studied. Trends in HCC mortality rates were divided into two groups: annual case‐fatality rates and HCC incidence rates by age. Poisson regression was used to distinguish a cohort effect from a time‐period effect on the incidence of HCC. Results: Subjects aged >50 years after 1991 had the greatest risk of death (relative risk [RR] = 11.3; 95% confidence interval [CI]: 11.0–11.7). Annual case‐fatality rates declined from 1.6 in 1985 to 0.84 in 1998, whereas there was a remarkable increase in incidence, particularly from 1991 onward, in the >50‐year‐olds. It was found that subjects aged >50 years who were born before 1944 were the group most susceptible to HCC (RR = 9.3; 95%CI: 9.1–9.5). Conclusion: Increased incidence, particularly in individuals over 50, rather than poor survival, accounts for the rapid rise in mortality from HCC. © 2004 Blackwell Publishing Asia Pty Ltd