Long-term effectiveness of population-wide multifaceted interventions for hepatocellular carcinoma in Taiwan

Taiwan has launched a series of population-wide interventions to prevent hepatocellular carcinoma (HCC) related to hepatitis B and C virus infection since 1984. We took this opportunity to investigate the impact of each intervention on the incidence and case-fatality rate of HCC, and assessed their...

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Published in:	Journal of hepatology Vol. 75; no. 1; pp. 132 - 141
Main Authors:	Liao, Sih-Han, Chen, Chi-Ling, Hsu, Chen-Yang, Chien, Kuo-Liong, Kao, Jia-Horng, Chen, Pei-Jer, Chen, Tony Hsiu-Hsi, Chen, Chien-Hung
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01.07.2021 Elsevier Science Ltd
Subjects:	Age Age groups Antiviral agents Antiviral Agents - therapeutic use Bayesian analysis Bayesian Poisson regression model Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - prevention & control Child Fatalities Hepatitis B Hepatitis B - complications Hepatitis B - epidemiology Hepatitis B - prevention & control Hepatitis C - complications Hepatitis C - epidemiology Hepatitis C - prevention & control Hepatocellular carcinoma Humans Immunization Immunization Programs - organization & administration Immunization Programs - trends Incidence Liver cancer Liver Neoplasms - mortality Liver Neoplasms - prevention & control Middle age Middle Aged Mortality Mortality rate decomposition method Population Preventive Health Services - methods Preventive Health Services - organization & administration Preventive Health Services - trends Preventive strategy Taiwan - epidemiology Universal Health Care Vaccination Taiwan Bayesian Poisson regression model Preventive strategy Mortality rate decomposition method
ISSN:	0168-8278, 1600-0641, 1600-0641
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Summary:	Taiwan has launched a series of population-wide interventions to prevent hepatocellular carcinoma (HCC) related to hepatitis B and C virus infection since 1984. We took this opportunity to investigate the impact of each intervention on the incidence and case-fatality rate of HCC, and assessed their relative contributions to the overall reduction in mortality during this period. Population-based registry data on HCC mortality and incidence from individuals aged 0 to 84 years between 1979 and 2016 were collected before (Period 1) and after universal hepatitis B vaccination from 1984 (Period 2), universal health care from 1995 (Period 3), and viral hepatitis therapy from 2003 (Period 4). A Bayesian Poisson regression model was used for mortality decomposition analysis to estimate the respective contributions of these interventions to the reduction in age-specific incidence and case-fatality rates. Mortality declined substantially in children, young- and middle-aged groups, but only slightly decreased in the elderly group. The declining trends in mortality were in part explained by incidence reduction and in part by a remarkable decline in case-fatality rate attributed to universal health care. Hepatitis B vaccination led to a 35.9% (26.8% to 44.4%) reduction in incidence for individuals aged 30 years or below, whereas antiviral therapy reduced the incidence of HCC by 14.9% (11.8% to 17.9%) and 15.4% (14.1% to 16.6%) for individuals aged 30–49 years and 50–69 years, respectively. Vaccination and antiviral therapy were effective in reducing HCC incidence and mortality for the young and middle-aged groups, while the case-fatality rate was improved by universal health care for all age groups. Since 1984, a series of population-wide interventions have been launched in Taiwan to prevent viral hepatitis-related hepatocellular carcinoma, including a universal hepatitis B vaccination program (from 1984), universal health care (from 1995), and a national viral hepatitis therapy program (from 2004). Vaccination and antiviral therapy were effective in reducing HCC incidence and mortality for the young and middle-aged groups, while the case-fatality rate was improved by universal health care for all age groups. [Display omitted] •We assessed the impact of serial population-wide prevention programs on HCC mortality (incidence and case-fatality rates).•Hepatitis B vaccination was associated with a 35.9% reduction in incidence in the young age group.•Antiviral therapy was associated with a ~15% decline in incidence in the middle-aged group.•Surveillance resulted in a remarkable decline in the case-fatality rate across the whole population.
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ISSN:	0168-8278 1600-0641 1600-0641
DOI:	10.1016/j.jhep.2021.02.029