Burden of Virus-associated Liver Cancer in the Arab World, 1990-2010

  • Khan, Gulfaraz (Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University) ;
  • Hashim, M. Jawad (Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University)
  • Published : 2015.02.04


Hepatocellular carcinoma (HCC) is amongst the top three cancer causes of death worldwide with hepatitis B and C viruses (HBV/HCV) as the main etiological agents. An up-to-date descriptive epidemiology of the burden of HBV/HCV-associated HCC in the Arab world is lacking. We therefore determined the burden of HBV/HCV-associated HCC deaths in the Arab world using the Global Burden of Disease (GBD) 2010 dataset. GBD 2010 provides, for the first time, deaths specifically attributable to viral-associated HCC. We analyzed the data for the 22 Arab countries by age, sex and economic status from 1990 to 2010 and compared the findings to global trends. Our analysis revealed that in 2010, an estimated 752,101 deaths occurred from HCC worldwide. Of these 537,093 (71%) were from HBV/HCV-associated HCC. In the Arab world, 17,638 deaths occurred from HCC of which 13,558 (77%) were HBV/HCV-linked. From 1990 to 2010, the burden of HBV and HCV-associated HCC deaths in the Arab world increased by 137% and 216% respectively, compared to global increases of 62% and 73%. Age-standardized death rates also increased in most of the Arab countries, with the highest rates noted in Mauritania and Egypt. Male gender and low economic status correlated with higher rates. These findings indicate that the burden of HBV/HCV-associated HCC in the Arab world is rising at a much faster rate than rest of the world and urgent public health measures are necessary to abate this trend and diminish the impact on already stretched regional healthcare systems.


Supported by : NRF/UAEU, UAEU, CMHS-UAEU


  1. Altekruse SF, McGlynn KA, Reichman ME (2009). Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol, 27, 1485-91.
  2. Arab League (2013). Arab countries figures and indicators. at .
  3. Chang M-H, You S-L, Chen C-J, et al (2009). Decreased incidence of hepatocellular carcinoma in hepatitis B vaccinees: a 20-year follow-up study. J Natl Cancer Inst, 101, 1348-55.
  4. Colombo M, Kuo G, Choo QL, et al (1989). Prevalence of antibodies to hepatitis C virus in Italian patients with hepatocellular carcinoma. Lancet, 2, 1006-8.
  5. Daw MA, Dau AA (2012). Hepatitis C virus in Arab world: a state of concern. ScientificWorld J, 2012, 719494.
  6. Donato F, Tagger A, Gelatti U, et al (2002). Alcohol and hepatocellular carcinoma: the effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol, 55, 323-31.
  7. El-Serag HB, Rudolph KL (2007). Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology, 132, 2557-76.
  8. Frank C, Mohamed MK, Strickland GT, et al (2000). The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet, 355, 887-91.
  9. Gasim GI (2013). Hepatitis B virus in the Arab world: where do we stand? Arab J Gastroenterol, 14, 35-43.
  10. Gravitz L (2011). Introduction: a smouldering public-health crisis. Nature, 474, 2-4.
  11. Howell J, Lemoine M, Thursz M (2014). Prevention of maternofoetal transmission of hepatitis B in sub-Saharan Africa: the evidence, current practice and future challenges. J Viral Hepat, 21, 381-96.
  12. IHME (2013). Global burden of disease study 2010 (GBD 2010) Results by cause 1990-2010-country level. seattle, United States: institute for health metrics and evaluation (IHME).
  13. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. Cancer J Clin, 61, 69-90.
  14. Jemal A, Bray F, Forman D, et al (2012). Cancer burden in Africa and opportunities for prevention. Cancer, 118, 4372-84.
  15. Kew MC, Houghton M, Choo QL, Kuo G (1990). Hepatitis C virus antibodies in southern African blacks with hepatocellular carcinoma. Lancet, 335, 873-4.
  16. Liu J, Yang X-L, Li A, et al (2014). Epidemiological patterns of cancer incidence in southern China: based on 6 populationbased cancer registries. Asian Pac J Cancer Prev, 15, 1471-5.
  17. Lozano R, Naghavi M, Foreman K, et al (2012). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global burden of disease study 2010. Lancet, 380, 2095-128.
  18. Luo Z, Li L, Ruan B (2012). Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period. Int J Infect Dis, 16, 82-8.
  19. Mokdad AH, Jaber S, Aziz MIA, et al (2014). The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors. Lancet, 383, 309-20.
  20. Morgan TR, Mandayam S, Jamal MM (2004). Alcohol and hepatocellular carcinoma. Gastroenterology, 127, 87-96.
  21. Murray CJL, Ezzati M, Flaxman AD, et al (2012a). GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology. Lancet, 380, 2055-8.
  22. Murray CJL, Ezzati M, Flaxman AD, et al (2012b). GBD 2010: design, definitions, and metrics. Lancet, 380, 2063-6.
  23. Murray CJL, Vos T, Lozano R, et al (2012c). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380, 2197-223.
  24. Pileri P, Uematsu Y, Campagnoli S, et al (1998). Binding of hepatitis C virus to CD81. Science, 282, 938-41.
  25. Ploss A, Evans MJ, Gaysinskaya VA, et al (2009). Human occludin is a hepatitis C virus entry factor required for infection of mouse cells. Nature, 457, 882-6.
  26. Rahim HFA, Sibai A, Khader Y, et al (2014). Non-communicable diseases in the Arab world. Lancet, 383, 356-67.
  27. Ray S, Bailey J, Thomas D (2013). Hepatitis C Virus. In: Knipe DM, Howley PM, eds. Fields Virology, 1, 795-824.
  28. Razavi H, Waked I, Sarrazin C, et al (2014). The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm. J Viral Hepat, 21, 34-59.
  29. Salim EI, Moore MA, Al-Lawati JA, Al-Sayyad J, et al (2009). Cancer epidemiology and control in the Arab world - past, present and future. Asian Pac J Cancer Prev, 10, 3-16.
  30. Seeger C, Zoulim F, Mason W (2013). Hepadnaviruses. In: Knipe DM, Howley PM, eds. Fields Virology, 2, 2185-221.
  31. Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP (2006). Hepatitis B virus infection: epidemiology and vaccination. Epidemiol Rev, 28, 112-25.
  32. Wang H, Dwyer-Lindgren L, Lofgren KT, et al (2012). Agespecific and sex-specific mortality in 187 countries, 1970-2010: a systematic analysis for the global burden of disease study 2010. Lancet, 380, 2071-94.
  33. WHO (WHO: 2013). Global policy report on the prevention and control of viral hepatitis.
  34. Yeo Y, Gwack J, Kang S, et al (2013). Viral hepatitis and liver cancer in Korea: an epidemiological perspective. Asian Pac J Cancer Prev, 14, 6227-31.

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