Time trends and geographic distribution of hepatocellular carcinoma in Brazil: An ecological study

Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing globally, and HCC is the fourth leading cause of cancer-related death. This ecological study aimed to investigate the time trends and geographic distribution of HCC in Brazil. Data from the Brazilian Health Public System were retrospectively collected from January 2005 to December 2018. Hospitalization and intrahospital lethality rates for HCC were stratified by age and sex. Hospitalization rates and associated lethality per 100,000 inhabitants in each municipality were included in a worksheet to build maps displaying the estimates and the geographic distribution of HCC. From 2005 to 2018, a total of 75,466 admissions for HCC were registered and the mean hospitalizations increased from 2.1 to 5.8/100,000 inhabitants (176%). The greatest increase occurred among patients older than 50, particularly in males above 70 years old. Prevalence rates increased throughout the country, with the highest levels detected in the South and Southeast. However, the increase was proportionally higher in the Northeast (377%), especially in municipalities not integrated into metropolitan regions. The HCC lethality rate remained relatively stable in both sexes, ranging from 21% to 25% (19%), but it was higher among older patients. The length of hospital stay did not differ between survivors and nonsurvivors throughout the study period. HCC hospitalizations are rising, particularly above 50 years of age and in rural areas, not paralleled by lethality rates. This suggests ongoing changes in environmental and socioeconomic factors in Brazil. Abbreviations: HCC = hepatocellular carcinoma, ICD-10 = International Classification of Diseases 10th Revision, MR = metropolitan region.

The Rise of Gastrointestinal Cancers as a Global Phenomenon: Unhealthy Behavior or Progress?

“…As obesity, diabetes, and the associated metabolic syndrome have become highly prevalent, nonalcoholic fatty liver disease is considered one of the most common causes of chronic liver diseases and a relevant cause of HCC [ 48 ]. Developing nations face a peculiar challenge, as the industrialization process influences the socioeconomic environment, and lifestyle changes are noticed, favoring a high-caloric Westernized diet and increasing the rates of obesity and diabetes [ 49 ]. The high male prevalence of HCC can be attributed to exposure to risk factors, such as viral hepatitis, alcohol abuse, cigarette smoking, and elevated iron storage [ 50 ].…”

Brazilian Landscape of Hepatocellular Carcinoma

“…5 Another study also showed that the southern region of Brazil has a proportionally higher incidence of HCC, probably because of the aging population, higher prevalence of HCV infection, and better diagnostic facilities. 6 Balbi et al 7 collected retrospective data from the Brazilian Health Public System from 2005 to 2018. HCC hospitalizations per 100,000 inhabitants were high in the South and Southeast.…”

“…On the other hand, the lethality rate was high in the North. 7 According to the National Institute of Cancer, there are 317 health units able to provide cancer care in Brazil; however, the geographic distribution is heterogeneous, as well as the availability of specific technologies between them, such as radiotherapy (RT), high-complexity surgeries, and image-guided procedures. For example, only 17 cancer units in the North region comprise approximately 8.5% of the Brazilian population.…”