Nationwide Administrative Health Data for Liver Cancer Epidemiology in Kazakhstan

Abstract

Introduction Liver cancer, ranked as the fourth deadliest cancer globally, poses a significant threat, especially to the Asian population, which accounts for 70% of the incident liver cancer cases and related deaths. Despite this alarming statistic, the burden of liver cancer remains insufficiently explored across various Asian regions, including Central Asia. Kazakhstan, as a country in Central Asia with a high-middle Socio-Demographic Index (SDI) actively implementing liver disease control initiatives, is an intriguing case for study. This study aims to review the epidemiology of liver cancer in Kazakhstan by analyzing large-scale administrative data from the national registry. Methods The study cohort included 10,455 patients from 2014 to 2023 diagnosed with liver neoplasms coded as C22.0-C22.9 and D13.4 according to the International Classification of Diseases 10th Revision (ICD-10). Incidence and mortality rates per 100,000 population were calculated stratified by various demographic factors and etiologies. Age, sex, region, residence, and type of liver cancer-specific estimates were derived. Cox regression analysis was performed to estimate hazard ratios across different social-demographic and medical predictors of survival among liver cancer patients. Kaplan-Meier survival functions were calculated and graphically depicted to illustrate the survival over time since diagnosis. Results Over the decade, incidence rates increased, and were higher among males and elderly, ranging from 3.70 to 7.75 yearly cases per 100,000 population. Mortality showed a similar trend, ranging from 2.33 to 7.54 per 100,000. The patients were mostly diagnosed with stage III hepatocellular carcinoma. East and West Kazakhstan regions were the most burdened. Across different social-demographic factors, being male (aHR 1.18; 95% CI 1.13-1.23), over 75 years old (aHR 3.82; 95% CI 2.90-5.03), Russian (aHR 1.18; 95% CI 1.12-1.26) and a rural resident (aHR 1.09; 95% CI 1.05-1.14) was associated with a worse prognosis. Among comorbidities, liver cirrhosis (aHR 1.14; 95% CI 1.06-1.22) predicted worse survival, while in the presence of chronic hepatitis B (aHR 0.68; 95% CI 0.62-0.74), chronic hepatitis C (aHR 0.65; 95% CI 0.60-0.70) and primary hypertension (aHR 0.82; 95% CI 0.78-0.86), the prognosis improved. Conclusion The results of this study underscore the need for improvements in early detection of PLC and timely diagnosis of chronic conditions. These goals may be achieved through establishing functional national screening programs, targeting identified high-risk groups. Making diagnostics and treatment more available for rural areas is another target for interventions, alongside education campaigns aimed at improving the understanding of risk factors, prognoses, and options available for the population.