Global epidemiology of early-onset liver cancer attributable to specific aetiologies and risk factors from 2010 to 2019.

Background: Considering its emergence as a public health concern worldwide, with potential spatial-temporal heterogeneities, we aimed to determine the global burden of early-onset liver cancer attributable to aetiologies and concomitant risk factors. Methods: We used data from the Global Burden of Diseases Study 2019 to determine age-standardised disability-adjusted life-year (DALY) rates for early-onset liver cancer by aetiologies and the population DALYs attributable to concomitant risk factors between 2010 and 2019. We also calculated estimated annual percentage changes (EAPCs) to measure temporal trends. Results: There were 2.9 million DALYs related to early-onset liver cancer globally in 2019. East Asia contributed over half of DALYs, which increased annually by 1.23% (95% confidence interval (CI) = 0.71, 1.76) between 2010 and 2019. Non-alcoholic steatohepatitis was the only growing aetiology. The proportion of DALYs attributed to metabolic risks increased by 22.50% (95% CI = 14.33, 38.13), while behavioral risks remained stable. Obesity surpassed smoking as the most prevalent nondeterministic aetiological risk factor from 2010 to 2019, while the population DALY attributable to hepatitis B combined with obesity increased by 29.93% (95% CI = 8.49, 60.77) in the same period, making it the principal joint contributor. Conclusions: Early-onset liver cancer poses considerable disability and continues to increase in many regions, especially in East Asia. Metabolic risk factors, particularly when hepatitis B and obesity coexist, are the fastest-growing contributors to this type of cancer. More targeted interventions are imperative to curb the growing burden of early-onset liver cancer due to metabolic risks.

Economic status, smoking, occupational exposure to rubber, and lung cancer: a case-cohort study.

Recent studies tend consistently to confirm the presence of a moderate excess risk of lung cancer in the rubber industry. However, the agent responsible for the excess of lung cancer is still obscure. Also, analyses without regard to the modifying effects of sex, economic status, and smoking habit are less than satisfactory. To explore these questions, we have conducted a case-cohort study using the data of 51 lung cancer deaths in 1973-1997 and a random sample (sub-cohort) of 188 from among 1598 subjects in a rubber factory in Shanghai, China. We computed the risks of lung cancer by economic status, smoking habit, coal fumes in home, and year of first employment. We assessed lung cancer risks for occupational exposures, unadjusted and adjusted for economic status and smoking. After confounding effects of smoking and economic status were controlled, we found that rate ratios were 1.43 (95% confidence interval (CI) 0.43-4.69), 1.79 (95% CI 0.64-5.03), and 3.76 (95% CI 1.44-9.86) for 1-14, 15-29, and 30-45 exposure-years in curing department, respectively. The data showed significant trends in increased risk of lung cancer with duration of exposure in tire-curing department (score test for trend:, P = 0.004). However, in front rubber processing (weighing and mixing, calendering, extruding, and milling), no significant excess risk of lung cancer was found. If it can be confirmed that nitrosamines are mainly generated in back rubber processing (curing and vulcanizing), it would be reasonable to conclude that excess risk of lung cancer in rubber industry is attributable, at least partially, to exposure to nitrosamines.