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Journal of Preventive Medicine and Hygiene logoLink to Journal of Preventive Medicine and Hygiene
. 2020 Jul 4;61(2):E259–E289. doi: 10.15167/2421-4248/jpmh2020.61.2.1244

International epidemiology of liver cancer: geographical distribution, secular trends and predicting the future

M MOHAMMADIAN 1, K ALLAH BAKESHEI 2, A MOHAMMADIAN-HAFSHEJANI 3,4,✉
PMCID: PMC7419131  PMID: 32803012

Summary

Background

Liver cancer (LC) is ranked seventh common cancer in terms of the incidence; and the fourth in terms of the mortality of cancer in the world. The aim of this study was to investigate the international distribution of the incidence and mortality of LC in 2018 based on various socio-economic and political divisions in the world.

Material and methods

This study was conducted through the use of the incidence and mortality cancer data from GLOBOCAN Project in 2018. The Age-Standardized Incidence Rate (ASIR) and Age Standardized Mortality Rate (ASMR) of LC were expressed per 100,000 people. In the current report, we used Pearson correlation method to assess the correlation between ASIR and ASMR. Statistical significance was considered to be P < 0.05.

Results

The highest ASIR and ASMR of LC occurred in Asia (ASIR = 11.4 and ASMR = 10.5), and Western Pacific Region of the World Health Organization (ASIR = 17.4 and ASMR = 15.8), and those regions with income level equal to upper middle income (ASIR = 13.4 and ASMR = 6.6). Furthermore, the lowest ASIR and ASMR of LC occurred in in Latin America and Caribbean (ASIR = 5) and Europe (ASMR = 4.4), the South-East Asia region (ASIR = 4.5 and ASMR = 4.3), and regions with Low middle income (ASIR = 5.7) and regions with high income (ASMR = 2.7).

Conclusions

LC is one of the most important cancer forms in the world in terms of incidence and mortality. It is important to prevent exposure to known risk factors for LC by increasing the level of knowledge and attitudes of the community and prevent of morbidity and mortality of the population with early diagnosis and treatment of patients.

Keywords: Incidence, Mortality, Trend, Liver Cancer, The world

Introduction

Despite the advances in preventing and controlling non-infectious diseases in recent decades, the incidence and prevalence of these diseases have increased dramatically [1]. Cancer is the second cause of death in most countries after cardiovascular diseases [2-6]. There were 24.5 million new cancer cases and 9.6 million cancer deaths worldwide in 2017, and led to 233.5 million Disability-Adjusted Life Year (DALYs), of which 3% came from Years lived with disability (YLDs) and 97% came from Years of Life Lost (YLLs). Globally, the odds of developing cancer in lifetime were 33% for men and 25% for women. Between 2007 and 2017, the Age-Standardized Incidence Rate (ASIR) for all cancers has increasing trend, but Age-Standardized Mortality Rate(ASMR) has decreasing trend [7]. Liver is an important body organ that plays an key role in the detoxification, excretion of waste, and the metabolism of glucose and fats [8]. Liver cancer (LC) is ranked seventh among cancers in terms of the incidence; and since most cases of LC are diagnosed at advanced stages of disease, its fatality is high, so that this cancer is ranked fourth among other types of cancers in terms of the mortality [9]. Globally, there were 953000 new cases and 819 000 deaths of LC in 2017. LC led to 20,800,000 DALYs in 2017, which 1% coming from YLDs and 99% coming from YLLs. Generally, LC was more common in men, so lifetime odds of developing LC for men were 1 in 42 and for women 1 in 118. Population growth and population aging were the main causes of the increase of LC from 705000 cases in 2007 to 953000 cases in 2017 [7]. The most important risk factors associated with the incidence of LC are diagnosed, and most of them can be prevented and altered at the individual and social levels. Therefore, the incidence of LC and ultimately the rate of its mortality can be reduced in societies by taking appropriate measures [10].

LC can be categorized into three main forms with different risk factors associated with each of them. Hepatocellular carcinoma (HCC) is the most important LC form which is caused by the following cases: chronic infection with hepatitis B and C viruses; food contamination with aflatoxins; alcoholic cirrhosis; smoking, diabetes, overweight and obesity. Cholangiocarcinoma is the second most important LC form which is mainly caused by the following factors: infestation with liver flukes, Opistorchis viverrini and Clonorchis sinensis. Angiosarcoma is a very rare type of LC occurring in exposure to Vinyl chloride [11].

In the world, the ASIR of LC is 16 per 100,000 men and 6 per 100,000 women. The ASIR of LC in less developed countries is higher than developed countries (12 versus 5.4 per 100,000) [12]. Since the LC is a very high prevalent cancer and has high mortality due to the late diagnosis, it is considered to be a major health problem which imposes a large burden in term DALYs (YLL and YLD) on countries. Due to the high importance of this cancer, various studies have been conducted on estimating its burden on developed countries [11, 13]. Nevertheless, there are a few studies on distribution of LC at the international level [14]. Since obtaining the appropriate information to properly understand distribution of any disease in terms of person, place, and time is the first and most important necessity for appropriate measures and interventions to reduce the incidence and mortality of any disease, the present study was conducted with the aim to investigate the international distribution of the incidence and mortality of LC in 2018 based on various socio-economic and political divisions in the world. In addition, present study predicts the trends of incidence and mortality of LC during 2018 to 2040 in worldwide.

Materials and methods

In the present study, we extracted data on the incidence and mortality rate of LC in 184 countries from the International Agency for Research on Cancer (IARC) (Project GLOBOCAN, 2018). GLOBOCAN is a database of various types of cancers created by World Health Organization (WHO) [15, 16]. It covers information on the number, raw rates, and age standardization of cancer incidence, and mortality for different regions and countries. Currently, the available data in GLOBOCAN is known as one of the newest international databases on the cancer. Based on the data of GLOBOCAN project, it is possible to investigate and compare the incidence and mortality of cancer based on the type of cancer, age and gender groups for different regions of the world.

The present study categorized and presented the information on the Age-Standardized Incidence Rate (ASIR) and Age Standardized Mortality Rate (ASMR) of LC based on the continents (Africa, Latin America and Caribbean, Northern America, Europe, Oceania, Asia), income levels(high income, upper middle income, low middle income, and low income),human development index(HDI) (very high, high, medium, low, China and India),WHO regions (Africa region (AFRO), Americas region (PAHO), East Mediterranean region (EMRO), Europe region (EURO), South-East Asia region (SEARO) and Western Pacific region (WPRO)), and World regions(Australia and New Zealand, Caribbean, central America, central and eastern Europe, eastern Africa, eastern Asia, Melanesia, Micronesia, middle Africa, north America, northern Africa, northern Europe, Polynesia, south America, south-central Asia, south-eastern Asia, southern Africa, southern Europe, western Africa, western Asia, and western Europe).

HUMAN DEVELOPMENT INDEX (HDI)

Human Development Index (HDI) is a summary measure of average achievement in key dimensions of human development: life expectancy, education, and per capita income. The HDI is the geometric mean of normalized indices for each of the three dimensions with rang from 0 to 1 [17].

STATISTICAL ANALYSIS

We provided the information about the incidence and mortality of LC based on the number, raw rates and the Age-Standardized rates in 2018. We also expressed raw and standardized rates of incidence and mortality per 100,000 people. Geographical distribution map was prepared for the incidence and mortality of this disease based on the Age-Standardized rates. In GLOBOCAN project, predicting the number of incidence and mortality of LC in 2020, 2025, 2030, 2035 and 2040 is calculated by multiplying the age-specific incidence rates estimated for 2018, by the corresponding anticipated population for 2020, 2025, 2030, 2035 and 2040 [9]. Detailed descriptions of applied methods are presented in previous reports [11-14]. In the current report; we used Pearson correlation method in order to assess the correlation between ASIR and ASMR of LC. Statistical significance was considered as P < 0.05. All P-values reported in this study are two-sided. Also, statistical analyses were performed using SPSS (Version 16.0, SPSS Inc.).

Results

THE ASIR AND ASMR OF LC IN THE WORLD

In 2018, 841,080 new cases of LC were diagnosed worldwide. Of them 596,574 (70.92%) cases occurred in men and 244506 (29.08%) in women. In general, the ASIR of LC was equal to 9.3 (13.9 in men and 4.9 in women). The sex ratio (men to women ratio) of the newly diagnosed LC was equal to 2.43 (Fig. 1).

Fig. 1.

Fig. 1.

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Distribution of new LC cases worldwide in 2018.

There were also 781,631 deaths from LC during this year. Of them, 548,375 (70.15%) cases occurred in men and 233,256 (29.85%) in women. In general, the ASMR of LC was equal to 8.5 (12.7 in men and 4.6 in women). The sex ratio of the mortality of LC was equal to 2.35 (Fig. 2).

Fig. 2.

Fig. 2.

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Distribution of LC mortality worldwide in 2018.

THE ASIR AND ASMR OF LC BASED ON THE CONTINENTS

The ASIR of LC was equal to 6.6 (10.1 in men, and 3.4 in women) in North America, 5.1 (8 in men, and 2.7 in women) in Europe, 6.9 (10.1 in men and 3.7 in women) in Oceania, 11.4 (17.1 in men and 5.9 in women) in Asia, 5 (6.1 in men and 4.1 in women) in Latin America and Caribbean, and 8.4 (12 in men and 5.3 in women) in Africa. Of the total number of this disease in the world, the highest proportion occurred in Asia and the lowest proportion in Oceania, so that 72.47% of cases occurred in Asia, 9.8% in Europe, 4.97% in North America, 4.56% in Latin America and Caribbean, 7.73% in Africa and 0.47% in Oceania (Tab. I, Figs. 1-4). In addition, numbers, crude rate and ASIR of LC in worldwide countries are visible in the Supplementary data (Tab. SI).

Tab. I.

The age-standardized incidence rate of liver cancer in different regions of the world in 2018.

Population All Men Women
Numbers Crude
rate		 ASR
(W)		 Numbers Crude
rate		 ASR
(W)		 Numbers Crude
rate		 ASR
(W)
World 841,080 11 9.3 596,574 15.5 13.9 244,506 6.5 4.9
WHO regions WHO Africa region (AFRO) 37,036 3.4 6 23,719 4.4 8.1 13,317 2.5 4.1
WHO Americas region (PAHO) 80,251 7.9 5.6 50,684 10.1 7.8 29,567 5.8 3.7
WHO East Mediterranean region (EMRO) 39,415 5.7 7.9 26,936 7.5 10.7 12,479 3.7 5
WHO Europe region (EURO) 91,988 10 5.1 61,546 13.7 7.9 30,442 6.4 2.8
WHO South-East Asia region (SEARO) 84,733 4.3 4.5 59,783 5.9 6.5 24,950 2.6 2.6
WHO Western Pacific region (WPRO) 507,501 26.2 17.4 373,794 37.9 26.4 133,707 14.1 8.5
Continents Africa 64,779 5 8.4 43,530 6.8 12 21,249 3.3 5.3
Asia 609,596 13.4 11.4 443,744 19.1 17.1 165,852 7.5 5.9
Europe 82,466 11.1 5.1 55,825 15.5 8 26,641 6.9 2.7
Latin America and the Caribbean 38,400 5.9 5 20,784 6.5 6.1 17,616 5.3 4.1
North America 41,851 11.5 6.6 29,900 16.6 10.1 11,951 6.5 3.4
Oceania 3,988 9.7 6.9 2,791 13.5 10.1 1 197 5.8 3.7
Human Development Index (HDI) China 392,868 27.6 18.3 292,898 40 27.6 99,970 14.5 9
High HDI 76,109 19.1 13.8 46,301 27.2 20.8 29,808 10.7 7.2
India 27,670 2 2.2 18,807 2.7 3.1 8,863 1.4 1.4
Low HDI 33,447 3.3 6 21,138 4.1 7.9 12,309 2.4 4.3
Medium HDI 115,604 5.2 5.9 82,796 7.2 8.6 32,808 3.1 3.3
Very high HDI 195,092 14.1 6.9 134,426 19.6 10.6 60,666 8.6 3.5
Income levels High income 167,606 13.8 6.6 116,876 19.3 10.2 50,730 8.3 3.3
Low income 29,774 4 6.9 19,080 5.1 9.4 10,694 2.8 4.6
Low middle income 148,420 4.9 5.7 104,493 6.8 8.2 43,927 3 3.2
Upper middle income 480,356 18.3 13.4 345,927 26.1 20.2 134,429 10.3 7
World regions Australia and New Zealand 2,921 9.9 5.7 2,115 14.4 8.8 806 5.4 2.7
Caribbean 2,923 6.6 5 1,706 7.8 6.3 1,217 5.5 3.8
Central America 11,229 6.3 6.3 5,513 6.2 6.7 5,716 6.3 6
Central and Eastern Europe 22,784 7.8 4 13,737 10 6.2 9,047 5.9 2.5
Eastern Africa 11,550 2.7 4.8 7,011 3.3 6.2 4,539 2.1 3.6
Eastern Asia 467,327 28.3 17.7 343,523 40.6 26.8 123,804 15.3 8.7
Melanesia 915 8.7 11.4 557 10.4 14.2 358 6.9 8.9
Micronesia 85 16 15.2 69 25.7 25.6 16 6.1 5.4
Middle Africa 6,010 3.6 6.5 4,137 4.9 9.4 1,873 2.2 3.9
North America 41,851 11.5 6.6 29,900 16.6 10.1 11,951 6.5 3.4
Northern Africa 27,935 11.7 14.1 19,912 16.7 20.8 8,023 6.8 7.8
Northern Europe 10,997 10.5 4.7 7,086 13.7 6.6 3,911 7.4 2.9
Polynesia 67 9.7 9.2 50 14.2 14.4 17 5 4.1
South America 24,248 5.7 4.6 13,565 6.4 5.8 10,683 4.9 3.5
South-Central Asia 44,010 2.2 2.5 29,027 2.9 3.4 14,983 1.6 1.7
South-Eastern Asia 89,010 13.6 13.3 65,407 20 21 23,603 7.2 6.6
Southern Africa 2,710 4.1 4.9 1,692 5.2 7.4 1,018 3 3.2
Southern Europe 25,026 16.4 6.8 17,702 23.7 10.9 7,324 9.4 3.1
Western Africa 16,574 4.3 8.3 10,778 5.6 11.1 5,796 3.1 5.7
Western Asia 9,249 3.4 4 5,787 4.1 5.4 3,462 2.7 2.8
Western Europe 23,659 12.2 5.3 17,300 18.1 8.4 6,359 6.5 2.5
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Fig. 3.

Fig. 3.

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Age standardized incidence rates of LC by sex in the worldwide in 2018.

Fig. 4.

Fig. 4.

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Age standardized incidence and mortality rates of LC in the worldwide in 2018.

Tab. S1.

The age-standardized incidence rate of LC in 185 countries of the world in 2018.

Countries All Male Female
Numbers Uncertainty interval Crude Rate ASR (W) Numbers Uncertainty interval Crude Rate ASR (W) Numbers Uncertainty interval Crude Rate ASR (W)
Afghanistan 642 [491.6-838.4] 1.8 3.9 391 [280.8-544.4] 2.1 4.9 251 [159.9-394.1] 1.4 3
Albania 435 [374.3-505.5] 14.8 7.8 265 [218.1-322.0] 17.9 10 170 [134.3-215.2] 11.7 5.7
Algeria 563 [455.6-695.7] 1.3 1.4 311 [231.8-417.3] 1.5 1.6 252 [185.8-341.8] 1.2 1.3
Angola 581 [368.5-915.9] 1.9 3.6 382 [225.1-648.2] 2.5 5.2 199 [81.3-486.8] 1.3 2.3
Argentina 2 343 [2028.2-2706.6] 5.2 3.6 1 364 [1134.2-1640.3] 6.2 5 979 [776.7-1234.0] 4.3 2.5
Armenia 474 [370.1-607.1] 16.2 9.7 263 [206.2-335.5] 19.1 13.5 211 [57.5-775.0] 13.6 6.9
Australia 2 438 [2235.6-2658.7] 9.8 5.7 1 729 [1572.3-1901.4] 14 8.6 709 [574.1-875.6] 5.7 2.9
Austria 1 121 [970.7-1294.6] 12.8 5.4 750 [629.9-893.0] 17.5 8.2 371 [287.6-478.7] 8.3 3
Azerbaijan 384 [338.4-435.7] 3.9 3.6 192 [161.9-227.8] 3.9 4.1 192 [159.1-231.7] 3.9 3.2
Bahamas 14 [7.2-27.2] 3.5 2.3 10 [4.1-24.4] 5.1 3.9 4 [1.5-10.8] 2 1.1
Bahrain 30 [19.1-47.2] 1.9 3.4 20 [11.1-36.0] 2 3.9 10 [4.9-20.4] 1.7 2.7
Bangladesh 3 128 [2395.3-4084.9] 1.9 2.2 2 352 [1689.1-3275.0] 2.8 3.3 776 [494.2-1218.5] 0.94 1.1
Barbados 14 [7.2-27.1] 4.9 2.4 7 [2.7-18.1] 5.1 3 7 [2.8-17.6] 4.7 1.9
Belarus 555 [471.5-653.3] 5.9 3.3 318 [262.1-385.8] 7.2 4.9 237 [174.9-321.2] 4.7 2.1
Belgium 1 006 [929.9-1088.3] 8.7 4.3 638 [585.3-695.4] 11.2 5.9 368 [292.9-462.3] 6.3 2.9
Belize 19 [11.0-32.7] 5 8.4 14 [6.8-28.7] 7.4 12.2 5 [2.2-11.5] 2.6 4.4
Benin 298 [196.8-451.3] 2.6 5.1 233 [129.9-417.8] 4.1 9.8 65 [36.0-117.3] 1.1 2.1
Bhutan 35 [30.8-39.7] 4.3 5.3 28 [23.9-32.8] 6.5 7.8 7 [5.7-8.6] 1.8 2.3
Bolivia, Plurinational State of 678 [585.7-7848] 6 6.1 303 [243.2-377.5] 5.4 5.6 375 [308.3-456.2] 6.7 6.7
Bosnia and Herzegovina 552 [454.5-670.4] 15.8 7.4 295 [228.3-381.2] 17.1 9.1 257 [190.8-346.2] 14.4 5.9
Botswana 62 [44.4-86.6] 2.7 3.9 40 [26.3-60.9] 3.5 6.4 22 [12.7-38.1] 1.9 2.3
Brazil 12 463 [11341.2-13695.8] 5.9 4.7 7317 [6491.1-8248.0] 7.1 6.3 5 146 [4415.6-5997.2] 4.8 3.4
Brunei 38 [23.0-62.8] 8.8 9.9 32 [17.7-57.9] 14.3 17 6 [2.4-15.3] 2.8 3.1
Bulgaria 559 [491.7-635.6] 7.9 3.6 377 [298.3-476.4] 11 5.7 182 [155.7-212.7] 5 1.8
Burkina Faso 1 296 [553.2-3036.0] 6.6 13.8 789 [319.9-1946.2] 8 19.2 507 [39.4-6517.7] 5.1 9.7
Burundi 400 [211.8-755.3] 3.6 6.3 270 [118.6-614.4] 4.9 9 130 [47.7-354.1] 2.3 3.9
Cabo Verde 44 [29.2-66.4] 8 10.7 24 [13.6-42.3] 8.7 11.3 20 [11.0-36.3] 7.2 9.3
Cambodia 2 546 [1376.1-4710.4] 15.7 21.8 1 691 [810.9-3526.2] 21.3 34.6 855 [275.1-2656.9] 10.3 12.7
Cameroon 955 [617.8-1476.4] 3.9 6.1 724 [436.5-1200.9] 5.9 9.3 231 [98.1-543.8] 1.9 3.1
Canada 3 889 [3592.5-4210.0] 10.5 5.3 2 608 [2364.3-2876.9] 14.2 7.6 1 281 [1119.5-1465.8] 6.9 3.2
Central African Republic 149 [94.5-234.9] 3.1 5.1 104 [61.3-176.5] 4.5 7.5 45 [18.4-110.1] 1.9 3.1
Chad 405 [256.9-638.5] 2.6 5.5 280 [165.0-475.1] 3.6 7.8 125 [51.1-305.8] 1.6 3.4
Chile 1 582 [1230.7-2033.6] 8.7 5.4 871 [618.9-1225.8] 9.7 6.9 711 [491.0-1029.7] 7.7 4.2
China 392 868 [386346.0-399500.0] 27.6 18.3 292 898 [287242.0-298665.0] 40 27.6 99 970 [96758.9-103288.0] 14.5 9
Colombia 2 279 [1874.9-2770.3] 4.6 3.9 1 195 [915.2-1560.3] 4.9 4.6 1 084 [814.0-1443.5] 4.3 3.3
Comoros 29 [15.4-54.8] 3.5 5.7 18 [7.9-41.0] 4.3 7.6 11 [4.0-30.0] 2.7 4.1
Congo, Democratic Republic of 3 613 [2291.8-5695.9] 4.3 8 2 431 [1432.6-4125.1] 5.8 11.5 1 182 [483.2-2891.5] 2.8 5
Congo, Republic of 207 [157.7-271.7] 3.8 5.9 146 [105.1-202.7] 5.4 8.6 61 [37.6-99.1] 2.3 3.4
Costa Rica 427 [297.4-613.1] 8.6 6.3 248 [142.8-430.6] 10 7.9 179 [110.9-289.0] 7.2 4.8
Croatia 639 [549.6-742.9] 15.3 6.3 410 [343.8-488.9] 20.4 9.9 229 [171.2-306.3] 10.6 3.4
Cuba 837 [730.9-958.4] 7.3 3.8 498 [419.4-591.3] 8.7 4.7 339 [271.9-422.6] 5.9 2.9
Cyprus 75 [55.3-101.8] 6.3 3.4 51 [35.1-74.1] 8.6 5 24 [14.1-40.9] 4 2
Czechia 1 063 [946.6-1193.7] 10 4.2 679 [592.7-777.8] 13 6.1 384 [307.4-479.7] 7.1 2.6
Côte d'lvoire 1 121 [932.5-1347.6] 4.5 8.4 703 [562.0-879.4] 5.6 9.7 418 [302.5-577.6] 3.4 6.9
Denmark 611 [537.3-694.8] 10.6 4.9 426 [364.9-497.4] 14.9 7.3 185 [146.9-233.0] 6.4 2.6
Djibouti 19 [10.1-35.9] 2 2.6 11 [4.8-25.0] 2.3 3.1 8 [2.9-21.8] 1.7 2.2
Dominican Republic 718 [587.6-877.3] 6.6 6.5 400 [304.1-526.2] 7.4 7.6 318 [237.0-426.6] 5.8 5.5
Ecuador 979 [846.0-1132.9] 5.8 5.3 483 [389.7-598.6] 5.7 5.7 496 [406.4-605.3] 5.9 4.9
Egypt 25 399 [23831.9-27069.1] 25.6 32.2 18 471 [17185.0-19853.3] 36.8 49 6 928 [6050.8-7932.4] 14.1 16.7
El Salvador 514 [417.9-632.1] 8 6.7 208 [156.0-277.3] 6.9 6.4 306 [227.1-412.3] 9 6.9
Equatorial Guinea 44 [27.9-69.4] 3.3 4.7 34 [20.0-57.7] 4.7 6 10 [4.1-24.5] 1.7 3
Eritrea 92 [48.7-173.7] 1.8 3.3 50 [22.0-113.8] 1.9 3.7 42 [15.4-114.4] 1.6 2.9
Estonia 103 [82.3-128.9] 7.9 3.2 61 [45.4-82.0] 10 5.1 42 [29.8-59.2] 6.1 2
Eswatini 37 [25.3-54.0] 2.7 3.9 20 [12.0-33.4] 3 5 17 [9.7-29.8] 2.4 3.2
Ethiopia 1 608 [1052.3-2457.1] 1.5 2.7 749 [409.9-1368.7] 1.4 2.6 859 [473.1-1559.6] 1.6 2.7
Fiji 76 [65.3-88.4] 8.3 8.3 53 [44.2-63.5] 11.5 12.3 23 [17.4-30.4] 5.1 4.9
Finland 550 [475.8-635.7] 9.9 3.6 347 [283.3-425.0] 12.7 5.2 203 [165.1-249.7] 7.2 2.3
France 10 624 [10156.6-11112.9] 16.3 7.8 8 382 [7967.5-8818.1] 26.1 13.3 2 242 [2033.8-2471.5] 6.8 2.7
France, Guadeloupe 34 [21.8-53.1] 7.6 3.7 22 [12.7-38.1] 10.6 6.2 12 [5.6-25.7] 5 1.7
France, La Réunion 85 [65.0-111.2] 9.6 6 58 [41.8-80.4] 13.6 9.1 27 [16.8-43.3] 5.9 3.3
France, Martinique 39 [26.8-56.8] 10.1 4.1 25 [15.6-40.0] 14.3 5.9 14 [7.5-26.3] 6.7 2.7
France, New Caledonia 38 [24.5-58.9] 13.6 10.4 25 [14.8-42.3] 17.7 14.3 13 [5.9-28.5] 9.4 6.9
French Guiana 21 [11.0-40.1] 7.2 8.5 18 [8.0-40.6] 12.4 15.5 3 [1.0-8.7] 2.1 2.3
French Polynesia 34 [22.3-51.9] 11.9 9.5 23 [11.7-45.3] 15.8 13.4 11 [6.4-19.0] 7.8 5.6
Gabon 55 [36.9-81.9] 2.7 3.3 35 [21.5-56.9] 3.3 3.9 20 [10.0-40.1] 2 2.6
Gaza Strip and West Bank 47 [24.1-91.8] 0.93 1.8 31 [14.5-66.4] 1.2 2.4 16 [3.9-65.3] 0.64 1.3
Georgia 380 [322.7-447.5] 9.7 5.4 235 [198.7-278.0] 12.6 8.3 145 [81.0-259.4] 7.1 3.1
Germany 8 883 [8277.0-9533.3] 10.8 4.2 6 191 [5716.5-6704.9] 15.3 6.4 2 692 [2311.4-3135.2] 6.4 2.3
Ghana 2 753 [2402.2-3155.0] 9.3 15.4 2016 [1717.8-2365.9] 13.7 24.4 737 [568.3-955.7] 5 7.6
Greece 1 642 [1486.9-1813.2] 14.7 5.7 1 121 [986.4-1274.0] 20.4 8.6 521 [445.3-609.6] 9.2 3.3
Guam 31 [25.3-37.9] 18.7 14.8 25 [20.0-31.2] 29.8 24.5 6 [3.7-9.8] 7.3 5.3
Guatemala 1 787 [1592.4-2005.4] 10.4 14.9 854 [723.0-1008.8] 10.1 15.8 933 [795.3-1094.6] 10.7 14.1
Guinea 1 582 [1242.4-2014.4] 12.1 21.8 969 [717.7-1308.3] 14.8 27.9 613 [408.0-921.0] 9.4 16.3
Guinea-Bissau 126 [53.8-295.2] 6.6 11.9 84 [34.1-207.2] 8.9 17.3 42 [3.3-539.9] 4.3 7.3
Guyana 20 [11.9-33.7] 2.6 2.7 10 [4.9-20.5] 2.5 2.7 10 [4.7-21.5] 2.6 2.7
Haiti 664 [543.7-810.9] 6 8.1 354 [288.2-434.8] 6.4 9.5 310 [132.7-724.1] 5.5 6.8
Honduras 403 [300.0-541.4] 4.3 5.7 302 [206.1-442.5] 6.4 9.2 101 [63.4-160.8] 2.1 2.7
Hungary 1 087 [959.0-1232.1] 11.2 5.4 770 [665.5-890.9] 16.7 9.2 317 [248.3-404.8] 6.2 2.4
Iceland 15 [9.0-25.0] 4.4 2.5 12 [6.2-23.4] 7.1 4.1 3 [1.4-6.6] 1.8 0.95
India 27 670 [26091.1-29344.5] 2 2.2 18 807 [17531.4-20175.5] 2.7 3.1 8 863 [7961.8-9866.2] 1.4 1.4
Indonesia 18 468 [16124.1-21152.6] 6.9 7.6 14 238 [12130.6-16711.6] 10.6 12.4 4 230 [3276.2-5461.5] 3.2 3.4
Iran, Islamic Republic of 3 492 [3303.2-3691.6] 4.3 4.7 1 999 [1860.1-2148.3] 4.8 5.3 1 493 [1368.0-1629.4] 3.7 4.1
Iraq 539 [478.6-607.0] 1.4 2.7 278 [236.4-326.9] 1.4 3.1 261 [219.2-310.8] 1.3 2.4
Ireland 363 [301.4-437.2] 7.6 4.3 275 [207.5-364.5] 11.5 6.8 88 [68.6-112.8] 3.6 2
Israel 336 [281.8-400.6] 4 2.6 200 [159.9-250.2] 4.8 3.5 136 [102.4-180.6] 3.2 1.7
Italy 12 325 [11947.7-12714.2] 20.8 7.9 8 742 [8418.2-9078.3] 30.2 12.8 3 583 [3391.8-3784.9] 11.8 3.5
Jamaica 106 [80.2-140.1] 3.7 2.9 55 [37.8-80.1] 3.8 3 51 [33.6-77.3] 3.5 2.8
Japan 35 535 [34730.5-36358.1] 27.9 7.6 23 448 [22796.6-24118.0] 37.8 12.3 12 087 [11621.1-12571.5] 18.6 3.5
Jordan 188 [148.6-237.8] 1.9 3.1 101 [74.4-137.2] 2 3.4 87 [60.3-125.6] 1.8 2.7
Kazakhstan 1 122 [1045.7-1203.9] 6.1 5.6 655 [597.0-718.6] 7.3 8.2 467 [419.0-520.5] 4.9 3.9
Kenya 1 346 [1050.6-1724.5] 2.6 5.3 761 [556.8-1040.0] 3 6.2 585 [389.4-878.9] 2.3 4.5
Korea, Democratic Republic of 5 718 [53545-6106.2] 22.3 16.5 3 831 [3524.8-4163.8] 30.6 25.4 1 887 [1695.9-2099.6] 14.4 9
Korea, Republic of 16510 [15880.0-17165.0] 32.3 17.3 12 180 [11648.7-12735.6] 47.6 27.7 4 330 [3998.8-4688.6] 16.9 8.2
Kuwait 121 [94.5-155.0] 2.9 5.2 88 [65.4-118.3] 3.7 6.2 33 [21.0-51.8] 1.8 3.7
Kyrgyzstan 456 [371.5-559.7] 7.4 9.5 267 [200.2-356.1] 8.8 13 189 [141.2-252.9] 6.1 6.9
Lao People's Democratic Republic 1 035 [559.4-1914.9] 14.9 22.4 712 [341.4-1484.7] 20.5 33.4 323 [103.9-1003.7] 9.3 13.1
Latvia 152 [112.4-205.5] 7.9 3.1 63 [43.0-92.3] 7.1 3.8 89 [54.4-145.7] 8.5 2.6
Lebanon 227 [185.8-277.3] 3.7 3.2 133 [102.4-172.8] 4.4 3.6 94 [68.9-128.2] 3.1 2.6
Lesotho 68 [39.0-118.4] 3 4.4 41 [20.3-82.7] 3.7 6.6 27 [10.9-66.8] 2.3 3
Liberia 412 [175.9-965.1] 8.5 15.2 247 [100.1-609.3] 10.1 18.9 165 [12.8-2121.1] 6.9 11.7
Libya 191 [125.0-291.8] 3 4.1 98 [55.9-171.9] 3 4.4 93 [48.8-177.3] 2.9 3.8
Lithuania 246 [206.6-292.9] 8.6 3.8 160 [121.7-210.3] 12.1 6.5 86 [68.4-108.1] 5.5 1.9
Luxembourg 70 [48.8-100.5] 11.9 6.5 48 [30.8-74.8] 16.2 9.1 22 [11.8-41.0] 7.5 4.2
Madagascar 898 [475.6-1695.7] 3.4 5.8 584 [256.6-1329.0] 4.5 8.3 314 [115.3-855.3] 2.4 3.6
Malawi 291 [162.5-521.2] 1.5 2.1 167 [78.6-354.9] 1.8 2.4 124 [49.5-310.7] 1.3 1.8
Malaysia 1 944 [1785.5-2116.6] 6.1 6.3 1 460 [1322.7-1611.5] 8.8 9.5 484 [409.4-572.1] 3.1 3.1
Maldives 27 [20.7-35.3] 6.1 8.3 22 [15.8-30.6] 8.7 12.3 5 [3.2-7.9] 2.6 3.7
Mali 598 [473.6-755.0] 3.1 6.3 438 [335.3-572.2] 4.6 10.2 160 [99.3-257.8] 1.7 2.9
Malta 22 [13.9-34.8] 5.1 2.2 15 [8.4-26.9] 6.9 3.5 7 [3.3-14.6] 3.3 0.94
Mauritania 320 [136.6-749.6] 7 11.3 221 [89.6-545.1] 9.7 16.8 99 [7.7-1272.7] 4.4 6.6
Mauritius 63 [46.6-85.1] 5 3.2 36 [24.3-53.3] 5.7 4 27 [16.9-43.2] 4.2 2.6
Mexico 7 265 [6896.2-7653.6] 5.6 5.4 3 450 [3220.8-3695.5] 5.3 5.5 3 815 [3522.2-4132.1] 5.8 5.4
Mongolia 2 241 [2129.2-2358.6] 71.8 93.7 1 299 [1214.3-1389.6] 84.2 117 942 [870.8-1019.0] 59.7 74.1
Montenegro 52 [34.8-77.6] 8.3 3.9 33 [19.8-55.0] 10.6 5.7 19 [10.0-36.2] 6 2.5
Morocco 428 [294.4-622.3] 1.2 1.1 243 [147.9-399.3] 1.4 1.4 185 [104.7-326.9] 1 0.95
Mozambique 1 200 [953.3-1510.5] 3.9 6.6 675 [499.9-911.4] 4.5 8.8 525 [366.9-751.1] 3.4 5
Myanmar 5 304 [2866.9-9812.9] 9.8 10.1 3 532 [1693.8-7365.1] 13.4 14.6 1 772 [570.2-5506.5] 6.4 6.2
Namibia 48 [30.2-76.2] 1.9 2.8 31 [17.3-55.7] 2.5 4.2 17 [8.0-36.2] 1.3 1.8
Nepal 282 [195.5-406.8] 0.95 1.1 175 [110.2-277.8] 1.2 1.5 107 [58.7-195.1] 0.7 0.82
New Zealand 483 [398.0-586.2] 10.2 5.8 386 [267.1-557.8] 16.5 10 97 [76.9-122.4] 4 2
Nicaragua 565 [470.3-678.7] 9 10.5 322 [256.8-403.7] 10.4 13.6 243 [177.6-332.4] 7.6 8
Niger 775 [505.4-1188.4] 3.5 7.3 587 [355.8-968.3] 5.2 11.5 188 [82.7-427.6] 1.7 3.3
Nigeria 5 129 [3969.6-6626.9] 2.6 5.1 3 087 [2271.3-4195.7] 3.1 5.9 2 042 [1281.7-3253.2] 2.1 4.3
Norway 334 [280.6-397.5] 6.2 3.4 248 [191.3-321.4] 9.2 5.3 86 [68.0-108.7] 3.2 1.5
Oman 117 [80.4-170.3] 2.4 4.4 90 [56.8-142.7] 2.8 5.8 27 [14.1-51.6] 1.7 2.7
Pakistan 4381 [3740.5-5131.2] 2.2 3.1 2 729 [2244.4-3318.3] 2.6 3.8 1 652 [1262.9-2160.9] 1.7 2.3
Panama 249 [195.8-316.7] 6 4.8 115 [82.3-160.7] 5.5 4.9 134 [94.8-189.4] 6.5 4.7
Papua New Guinea 732 [634.1-845.0] 8.7 11.9 425 [360.6-500.9] 9.9 14 307 [228.7-412.1] 7.4 10
Paraguay 181 [129.6-252.8] 2.6 2.8 115 [73.9-179.0] 3.3 3.7 66 [39.6-109.9] 1.9 2
Peru 2317 [2021.7-2655.4] 7.1 6.6 1 104 [914.3-1333.1] 6.8 6.8 1 213 [995.8-1477.6] 7.4 6.4
Philippines 9 628 [9132.7-10150.2] 9 11.5 6 848 [6430.4-7292.7] 12.8 17.8 2 780 [2522.5-3063.7] 5.3 6.2
Poland 2 569 [2346.3-2812.9] 6.7 3.2 1 541 [1364.3-1740.6] 8.4 4.7 1 028 [897.4-1177.6] 5.2 2.1
Portugal 1 386 [1234.7-1555.8] 13.5 5.4 983 [859.6-1124.1] 20.2 9.2 403 [321.0-506.0] 7.4 2.2
Puerto Rico 351 [310.6-396.7] 9.6 5.2 251 [219.6-286.9] 14.3 8.9 100 [68.7-145.5] 5.3 2.3
Qatar 42 [31.5-56.1] 1.6 4.1 37 [26.5-51.7] 1.8 5.7 5 [2.8-8.9] 0.74 1.8
Republic of Moldova 852 [708.4-1024.7] 21.1 13.8 539 [430.5-674.8] 27.8 20.9 313 [226.4-432.7] 14.9 8.4
Romania 3 451 [3253.3-3660.7] 17.6 8.4 2 229 [2065.1-2405.9] 23.5 12.7 1 222 [1113.6-1340.9] 12.1 4.9
Russian Federation 10 349 [10051.8-10655.0] 7.2 3.9 5 946 [5700.9-6201.6] 8.9 6 4 403 [4228.8-4584.4] 5.7 2.5
Rwanda 737 [498.4-1089.8] 5.9 10.1 483 [296.1-788.0] 7.9 14.7 254 [132.5-486.9] 4 6.6
Saint Lucia 4 [2.4-6.6] 2.2 1.5 3 [1.7-5.4] 3.4 2.2 1 [0.40-2.7] 1.1 0.83
Samoa 16 [10.0-25.7] 8.1 9.8 14 [6.6-29.9] 13.7 17.3 2 [1.1-3.7] 2.1 2.5
Sao Tome and Principe 8 [3.4-18.7] 3.8 8.3 7 [2.8-17.3] 6.7 14.8 1 [0.10-12.9] 0.95 2.6
Saudi Arabia 905 [764.2-1071.7] 2.7 4.5 676 [554.5-824.2] 3.5 6.2 229 [165.6-316.6] 1.6 2.5
Senegal 1 075 [458.9-2518.3] 6.6 12.6 673 [272.8-1660.1] 8.4 18 402 [31.3-5167.9] 4.9 8.4
Serbia 772 [671.3-887.8] 8.8 4.4 460 [383.8-551.3] 10.7 5.9 312 [250.4-388.8] 7 3.2
Sierra Leone 406 [370.8-4446] 5.3 10 248 [222.7-276.2] 6.5 12.6 158 [133.5-187.0] 4.1 7.5
Singapore 1 378 [1234.4-1538.3] 23.8 12.3 1 000 [882.0-1133.7] 34.9 19.5 378 [277.0-515.8] 12.9 5.9
Slovakia 512 [461.2-568.4] 9.4 5 335 [294.2-381.5] 12.6 7.7 177 [148.5-210.9] 6.3 2.9
Slovenia 292 [243.0-350.8] 14 5.8 216 [166.6-280.1] 20.9 9.7 76 [58.7-98.4] 7.3 2.3
Solomon Islands 41 [34.5-48.7] 6.6 10.3 32 [26.1-39.3] 10.1 15.5 9 [6.6-12.4] 2.9 5.1
Somalia 253 [134.0-477.7] 1.7 3.4 132 [58.0-300.4] 1.7 3.6 121 [44.4-329.6] 1.6 3.2
South Africa 2 495 [2258.3-2756.5] 4.3 5 1 560 [1372.5-1773.2] 5.5 7.6 935 [797.8-1095.8] 3.2 3.3
South Sudan 397 [210.2-749.6] 3.1 5.1 249 [109.4-566.7] 3.8 6.5 148 [54.3-403.1] 2.3 3.8
Spain 6 630 [6218.4-7068.8] 14.3 6.5 4 976 [4616.0-5364.1] 21.9 10.9 1 654 [1462.6-1870.4] 7 2.4
Sri Lanka 767 [644.7-912.5] 3.7 2.7 472 [387.5-574.9] 4.7 3.6 295 [204.3-426.0] 2.7 1.9
Sudan 942 [640.2-1386.1] 2.3 3.8 581 [360.6-936.1] 2.8 4.8 361 [186.9-697.3] 1.7 2.8
Suriname 34 [22.7-51.0] 6 5.6 25 [14.9-42.0] 8.8 9 9 [4.7-17.2] 3.2 2.6
Sweden 974 [880.1-1077.9] 9.8 4.5 641 [567.0-724.7] 12.8 6.5 333 [278.2-398.6] 6.7 2.6
Switzerland 946 [875.7-1021.9] 11.1 4.8 664 [607.6-725.7] 15.7 7.3 282 [241.3-329.6] 6.5 2.7
Syrian Arab Republic 380 [194.6-742.2] 2.1 3 200 [93.4-428.1] 2.2 3.4 180 [44.1-734.9] 2 2.6
Tajikistan 272 [219.9-336.5] 3 4.7 163 [124.4-213.6] 3.6 6 109 [77.2-153.9] 2.4 3.7
Tanzania, United Republic of 1 537 [1081.3-2184.8] 2.6 4.9 1 162 [757.1-1783.4] 4 8.1 375 [202.6-694.2] 1.3 2.2
Thailand 23 296 [22644.5-23966.2] 33.7 21 16 299 [15759.3-16857.2] 48.3 32.2 6 997 [6638.4-7375.0] 19.7 11.4
The former Yugoslav Republic of Macedonia 185 [122.7-278.9] 8.9 5 121 [71.5-204.9] 11.6 7.1 64 [33.2-123.2] 6.1 3.1
The Netherlands 1 001 [891.7-1123.7] 5.9 2.5 620 [527.1-729.2] 7.3 3.4 381 [323.1-449.3] 4.4 1.8
The Republic of the Gambia 319 [273.7-371.9] 14.7 23.9 245 [205.5-292.1] 22.9 36.5 74 [54.1-101.3] 6.8 12
Timor-Leste 38 [20.5-70.3] 2.9 5.3 27 [12.9-56.3] 4 7.3 11 [3.5-34.2] 1.7 3.2
Togo 312 [280.2-347.5] 3.9 6.9 207 [182.0-235.4] 5.2 9.7 105 [86.2-127.9] 2.6 4.4
Trinidad and Tobago 66 [45.7-95.4] 4.8 3.3 36 [21.7-59.7] 5.3 3.9 30 [17.5-51.3] 4.3 2.8
Tunisia 355 [254.1-496.0] 3 2.6 163 [105.7-251.5] 2.8 2.5 192 [113.5-324.7] 3.3 2.7
Turkey 4 362 [3969.3-4793.5] 5.3 4.5 2 779 [2484.7-3108.1] 6.9 6.6 1 583 [1328.5-1886.2] 3.8 2.8
Turkmenistan 281 [237.9-331.8] 4.8 6 175 [141.4-216.5] 6.1 8.4 106 [81.2-138.3] 3.6 4.1
Uganda 1 811 [1416.2-2315.9] 4.1 7.6 1 169 [847.3-1612.8] 5.3 10.1 642 [438.5-939.9] 2.9 5.4
Ukraine 1 787 [1660.4-1923.2] 4.1 2.2 1 003 [910.7-1104.6] 4.9 3.2 784 [700.0-878.1] 3.3 1.6
United Arab Emirates 97 [76.6-122.9] 1 4.2 62 [46.2-83.2] 0.9 4.3 35 [23.5-52.0] 1.3 4.3
United Kingdom 7618 [7346.6-7899.4] 11.4 5.1 4 832 [4625.2-5048.1] 14.7 7 2 786 [2611.0-2972.7] 8.3 3.3
United States of America 37 948 [37032.2-38886.5] 11.6 6.8 27 282 [26426.9-28164.8] 16.9 10.4 10 666 [10267.4-11080.1] 6.5 3.4
Uruguay 158 [123.5-202.2] 4.6 2.6 114 [78.7-165.1] 6.8 4.4 44 [31.5-61.4] 2.5 1.3
Uzbekistan 1 455 [1332.6-1588.7] 4.5 5.6 792 [705.3-889.4] 4.9 6.8 663 [579.4-758.7] 4.1 4.6
Vanuatu 28 [17.1-45.8] 9.9 13.1 22 [12.8-37.9] 15.4 20.2 6 [1.9-18.8] 4.3 6.2
Venezuela, Bolivarian Republic of 1 193 [1044.6-1362.5] 3.7 3.6 646 [523.7-796.8] 4 4.3 547 [460.8-649.4] 3.4 3
Viet Nam 25 335 [23627.6-27165.8] 26.3 23.2 19 568 [18064.2-21197.0] 41 39 5 767 [4999.5-6652.4] 11.8 9.5
Yemen 620 [511.0-752.3] 2.1 4.4 402 [315.1-512.9] 2.8 6.3 218 [158.6-299.7] 1.5 2.7
Zambia 194 [114.5-328.7] 1.1 2.2 108 [54.7-213.1] 1.2 2.8 86 [37.3-198.4] 0.97 1.8
Zimbabwe 577 [468.9-710.0] 3.4 6.9 321 [246.0-418.9] 3.9 8.7 256 [183.9-356.4] 3 5.6
World 841 080 [817635.0-865198.0] 11 9.3 596 574 [576976.0-616838.0] 15.5 13.9 244 506 [231861.0-257840.0] 6.5 4.9
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The ASMR of LC was equal to 4.8 (7.1 in men, and 2.8 in women) in North America, 4.4 (6.8 in men, and 2.4 in women) in Europe, 10.5 (15.8 in men and 5.5 in women) in Asia, 5.8 (8.3 in men and 3.4 in women) in Oceania, 4.8 (7.1 in men and 2.8 in women) in Latin America and Caribbean, and 8.3 (11.9 in men and 5.2 in women) in Africa. Of the total number of deaths of LC in the world, the highest proportion occurred in Asia and the lowest proportion in Oceania, so that 72.44% of cases occurred in Asia, 9.89% in Europe, 4.39% in North America, 4.66% in Latin America and Caribbean, 8.13% in Africa and 0.49% in Oceania (Tab. II, Figs. 1-4). In addition, numbers, crude rate and ASMR of LC in worldwide countries are visible in the Supplementary data (Tab. SII).

Tab. II.

The age-standardized mortality rate of liver cancer in different regions of the world in 2018.

Population All Men Women
Numbers Crude
Rate		 ASR
(W)		 Numbers Crude
Rate		 ASR
(W)		 Numbers Crude
Rate		 ASR
(W)
World 781,631 10.2 8.5 548,375 14.2 12.7 233,256 6.2 4.6
WHO regions WHO Africa
region (AFRO)		 36,239 3.4 5.9 23,315 4.3 8 12,924 2.4 4
WHO Americas
region (PAHO)		 70,775 7 4.8 42,539 8.5 6.3 28,236 5.5 3.4
WHO East Mediterranean region (EMRO) 38,637 5.6 7.8 26,358 7.4 10.5 12,279 3.7 5
WHO Europe
region (EURO)		 86,407 9.4 4.4 55,850 12.5 6.8 30,557 6.4 2.5
WHO South-East Asia region (SEARO) 81,347 4.1 4.3 57,697 5.7 6.2 23,650 2.4 2.4
WHO Western Pacific region (WPRO) 468,065 24.2 15.8 342,501 34.7 24.1 125,564 13.3 7.8
Continents Africa 63,562 4.9 8.3 42,786 6.7 11.9 20,776 3.2 5.2
Asia 566,269 12.5 10.5 410,223 17.6 15.8 156,046 7 5.5
Europe 77,375 10.4 4.4 50,365 14 6.8 27,010 7 2.4
Latin America
and the Caribbean		 36,436 5.6 4.7 19,650 6.1 5.7 16,786 5.1 3.9
North America 34,339 9.4 4.8 22,889 12.7 7.1 11,450 6.2 2.8
Oceania 3,650 8.8 5.8 2,462 11.9 8.3 1,188 5.8 3.4
Human Development Index (HDI) China 368,960 25.9 17.1 273,014 37.3 25.6 95,946 13.9 8.6
High HDI 73,651 18 13 45,107 25.5 19.4 28,544 10.3 6.8
India 25,627 1.9 2 17,548 2.5 2.8 8,079 1.2 1.3
Low HDI 32,674 3.2 5.9 20,754 4.1 7.9 11,920 2.3 4.2
Medium HDI 113,443 5 5.7 81,390 7 8.3 32,053 3 3.2
Very high HDI 167,010 12 5.3 110,379 16.1 8.1 56,631 8.1 2.9
Income levels High income 47,477 7.8 2.7 47,477 7.8 2.7 47,477 7.8 2.7
Low income 10,295 2.7 4.5 10,295 2.7 4.5 10,295 2.7 4.5
Low middle income 42,245 2.9 3.1 42,245 2.9 3.1 42,245 2.9 3.1
Upper middle income 129,546 10 6.6 129,546 10 6.6 129,546 10 6.6
World regions Australia and New Zealand 2,709 9.2 4.7 1,881 12.8 7 828 5.6 2.5
Caribbean 2,791 6.3 4.7 1,588 7.3 5.8 1,203 5.4 3.7
Central America 10,672 5.9 5.9 5,324 6 6.4 5,348 5.9 5.5
Central
and Eastern Europe		 22,745 7.8 3.9 13,581 9.9 6.1 9,164 5.9 2.4
Eastern Africa 11,251 2.6 4.7 6,799 3.2 6.2 4,452 2 3.5
Eastern Asia 427,932 25.9 16 312,228 36.9 24.2 115,704 14.3 8
Melanesia 819 7.8 10.6 491 9.2 13.1 328 6.3 8.3
Micronesia 68 12.8 12 54 20.1 19.8 14 5.3 4.9
Middle Africa 5,853 3.5 6.5 4,056 4.8 9.5 1,797 2.1 3.9
North America 34,339 9.4 4.8 22,889 12.7 7.1 11,450 6.2 2.8
Northern Africa 27,505 11.6 13.9 19,570 16.4 20.4 7,935 6.7 7.7
Northern Europe 9,997 9.5 3.8 6,088 11.8 5.2 3,909 7.4 2.5
Polynesia 54 7.8 7.4 36 10.2 10.6 18 5.3 4.5
South America 22,973 5.4 4.3 12,738 6 5.5 10,235 4.7 3.4
South-Central Asia 40,812 2.1 2.3 27,060 2.7 3.2 13,752 1.4 1.5
South-Eastern Asia 88,429 13.5 13.2 65,238 19.9 20.9 23,191 7.1 6.5
Southern Africa 2,597 3.9 4.7 1,614 5 7.1 983 2.9 3.1
Southern Europe 21,996 14.4 5.3 14,800 19.8 8.3 7,196 9.2 2.6
Western Africa 16,356 4.3 8.2 10,747 5.6 11.1 5,609 3 5.6
Western Asia 9,096 3.4 4 5,697 4 5.4 3,399 2.6 2.8
Western Europe 22,637 11.7 4.5 15,896 16.6 7 6,741 6.9 2.2
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Tab. SII.

The age-standardized mortality rate of LC in 185 countries of the world in 2018.

Countries All Male Female
Numbers Uncertainty interval Crude Rate ASR (W) Numbers Uncertainty interval Crude Rate ASR (W) Numbers Uncertainty interval Crude Rate ASR (W)
Afghanistan 621 [487.6-790.9] 1.7 3.8 374 [277.1-504.9] 2 4.7 247 [1641-371.8] 1.4 2.9
Albania 430 [370.0-499.7] 14.7 7.6 259 [213.1-314.8] 17.5 9.6 171 [135.1-216.5] 11.8 5.7
Algeria 544 [424.3-697.5] 1.3 1.4 302 [213.8-426.6] 1.4 1.6 242 [169.2-346.1] 1.2 1.2
Angola 547 [355.7-841.3] 1.8 3.5 350 [212.3-577.1] 2.3 4.8 197 [84.5-459.0] 1.3 2.3
Argentina 2 113 [1963.0-22744] 4.7 3.2 1 206 [1095.1-1328.2] 5.5 4.4 907 [809.3-1016.4] 4 2.3
Armenia 455 [370.9-558.2] 15.5 9.4 262 [214.2-320.4] 19 13.5 193 [65.9-565.6] 12.4 6.3
Australia 2 356 [2200.3-2522.8] 9.5 4.8 1 617 [1485.9-1759.6] 13.1 7.2 739 [657.8-830.2] 5.9 2.6
Austria 947 [852.6-1051.8] 10.8 4.3 696 [618.1-783.7] 16.2 7.2 251 [200.5-314.2] 5.6 1.8
Azerbaijan 374 [320.8-436.0] 3.8 3.5 184 [149.5-226.4] 3.7 3.9 190 [151.2-238.7] 3.8 3.2
Bahamas 14 [7.9-24.8] 3.5 2.3 10 [46-21.5] 5.1 3.9 4 [1.7-9.4] 2 1.1
Bahrain 28 [16.2-48.3] 1.8 3.3 18 [9.0-36.1] 1.8 3.7 10 [4.2-23.9] 1.7 2.7
Bangladesh 2 841 [2230.6-3618.4] 1.7 2 2 117 [1568.3-2857.7] 2.5 3.1 724 [481.0-1089.7] 0.88 0.99
Barbados 14 [7.8-25.0] 4.9 2.4 7 [3.0-16.1] 5.1 3 7 [3.1-15.7] 4.7 1.9
Belarus 374 [311.0-449.8] 4 2.2 249 [195.9-316.5] 5.7 3.8 125 [93.7-166.8] 2.5 1.1
Belgium 1 004 [926.6-1087.9] 8.7 3.6 630 [576.2-688.9] 11.1 5.1 374 [305.7-457.6] 6.4 2.1
Belize 19 [11.9-30.4] 5 8.4 14 [7.5-26.0] 7.4 12.2 5 [2.4-10.2] 2.6 4.4
Benin 309 [193.6-493.1] 2.7 5.3 237 [122.8-457.4] 4.1 9.9 72 [37.0-139.9] 1.3 2.3
Bhutan 33 [28.8-37.8] 4 5.1 27 [22.8-32.0] 6.2 7.6 6 [4.8-7.5] 1.6 2
Bolivia, Plurinational State of 667 [580.7-766.1] 5.9 6 299 [242.8-368.2] 5.3 5.5 368 [305.7-443.1] 6.6 6.6
Bosnia and Herzegovina 524 [473.3-580.2] 15 6.4 276 [240.0-317.4] 16 7.9 248 [213.8-287.7] 13.9 5.2
Botswana 60 [40.7-88.4] 2.6 3.8 39 [23.9-63.6] 3.4 6.3 21 [11.1-39.7] 1.8 2.2
Brazil 11 797 [11462.0-12141.8] 5.6 4.4 6 906 [6660.3-7160.7] 6.7 5.9 4 891 [4664.0-5129.1] 4.6 3.2
Brunei 31 [20.2-47.6] 7.1 8.3 26 [14.1-48.0] 11.6 14 5 [2.7-9.1] 2.4 2.8
Bulgaria 585 [515.5-663.9] 8.3 3.6 378 [328.0-435.6] 11.1 5.4 207 [156.5-273.8] 5.7 2
Burkina Faso 1 269 [682.7-2358.8] 6.4 13.5 771 [399.5-1488.1] 7.8 18.7 498 [77.5-3198.4] 5 9.5
Burundi 409 [213.6-783.0] 3.6 6.6 288 [124.3-667.2] 5.2 9.7 121 [43.5-336.8] 2.1 3.8
Cabo Verde 47 [32.7-67.5] 8.5 11.2 26 [15.8-42.8] 9.4 11.8 21 [12.4-35.5] 7.6 9.7
Cambodia 2 546 [1408.7-4601.4] 15.7 21.9 1 695 [839.2-3423.4] 21.4 34.7 851 [284.2-2548.5] 10.2 12.7
Cameroon 895 [581.9-1376.5] 3.6 6 683 [414.2-1126.1] 5.5 9.2 212 [91.0-494.0] 1.7 2.9
Canada 3 845 [3578.4-4131.4] 10.4 4.5 2318 [2129.3-2523.5] 12.6 6 1 527 [1334.5-1747.3] 8.2 3.2
Central African Republic 133 [86.5-204.5] 2.8 4.8 91 [55.2-150.0] 3.9 6.9 42 [18.0-97.9] 1.7 2.9
Chad 372 [241.9-572.1] 2.4 5.3 254 [154.1-418.8] 3.3 7.5 118 [50.6-275.0] 1.5 3.3
Chile 1 448 [1336.6-1568.7] 8 4.9 781 [701.3-869.8] 8.7 6.1 667 [591.7-751.9] 7.3 3.9
China 368 960 [363309.0-374699.0] 25.9 17.1 273 014 [268132.0-277985.0] 37.3 25.6 95 946 [93128.5-98848.7] 13.9 8.6
Colombia 2216 [2048.6-2397.1] 4.5 3.8 1 156 [995.2-1342.7] 4.8 4.5 1 060 [966.6-1162.5] 4.2 3.2
Comoros 28 [146-53.6] 3.4 5.8 18 [7.8-41.7] 4.3 7.8 10 [3.6-27.8] 2.4 3.9
Congo, Democratic Republic of 3 624 [2356.4-5573.6] 4.3 8.1 2 479 [1503.5-4087.3] 5.9 11.9 1 145 [491.4-2668.1] 2.7 4.9
Congo, Republic of 186 [136.9-252.6] 3.4 5.4 131 [90.5-189.6] 4.8 8 55 [31.9-95.0] 2 3.2
Costa Rica 395 [331.3-470.9] 8 5.6 238 [188.7-300.2] 9.6 7.2 157 [120.0-205.4] 6.3 4.1
Croatia 547 [483.6-618.7] 13.1 5.2 364 [314.8-420.8] 18.1 8.4 183 [145.0-231.0] 8.5 2.6
Cuba 773 [691.1-864.6] 6.7 3.3 448 [388.7-516.3] 7.8 4.1 325 [270.9-390.0] 5.7 2.6
Cyprus 101 [77.6-131.5] 8.5 4.6 64 [46.1-88.9] 10.8 6.3 37 [23.8-57.5] 6.2 3
Czechia 874 [784.7-973.4] 8.2 3.2 565 [491.2-649.9] 10.8 4.8 309 [261.0-365.8] 5.7 2
Côte d'Ivoire 1 130 [914.3-1396.5] 4.5 8.4 712 [550.3-921.2] 5.6 9.8 418 [288.2-606.3] 3.4 6.9
Denmark 580 [501.2-671.2] 10.1 4.2 370 [304.9-449.1] 12.9 5.9 210 [168.1-262.3] 7.3 2.6
Djibouti 17 [8.9-32.5] 1.8 2.4 10 [43-23.2] 2.1 2.9 7 [2.5-19.5] 1.4 2
Dominican Republic 650 [548.9-769.8] 6 5.8 353 [280.1-444.9] 6.5 6.7 297 [231.8-380.6] 5.4 5
Ecuador 953 [860.4-1055.6] 5.7 5.1 471 [405.2-547.5] 5.6 5.5 482 [419.3-554.1] 5.7 4.7
Egypt 25 084 [23515.3-26757.3] 25.2 31.8 18 209 [16924.1-19591.5] 36.2 48.4 6 875 [5993.1-7886.7] 14 16.6
El Salvador 500 [416.7-599.9] 7.8 6.5 202 [156.8-260.2] 6.7 6.2 298 [229.2-387.4] 8.8 6.8
Equatorial Guinea 42 [27.3-64.6] 3.2 4.9 33 [20.0-54.4] 4.5 6.5 9 [3.9-21.0] 1.5 2.9
Eritrea 90 [47.0-172.3] 1.7 3.2 49 [21.2-113.5] 1.9 3.7 41 [14.7-114.1] 1.6 2.8
Estonia 95 [76.6-117.9] 7.3 2.9 57 [43.0-75.6] 9.3 4.8 38 [27.2-53.1] 5.5 1.6
Eswatini 35 [22.4-54.6] 2.5 3.9 19 [10.4-34.7] 2.8 5 16 [8.3-30.9] 2.2 3.2
Ethiopia 1 656 [1032.5-2655.9] 1.5 2.7 759 [387.7-1485.8] 1.4 2.7 897 [461.5-1743.3] 1.7 2.8
Fiji 75 [56.2-100.2] 8.2 8.2 53 [37.6-74.7] 11.5 12.2 22 [12.8-37.7] 4.9 4.6
Finland 579 [507.0-661.2] 10.4 3.6 377 [312.9-454.2] 13.8 5.5 202 [167.2-244.1] 7.2 2.1
France 10 063 [9742.7-10393.8] 15.4 6.3 7 376 [7117.9-7643.5] 23 10.4 2 687 [2487.4-2902.6] 8.1 2.6
France, Guadeloupe 30 [19.9-45.2] 6.7 2.6 20 [12.0-33.4] 9.6 4.2 10 [5.0-19.9] 4.1 1.3
France, La Réunion 89 [69.1-114.6] 10.1 6.1 60 [44.0-81.9] 14 9.3 29 [18.8-44.7] 6.4 3.3
France, Martinique 38 [26.1-55.4] 9.9 3.8 22 [13.4-36.2] 12.6 5.1 16 [9.0-28.4] 7.6 2.7
France, New Caledonia 26 [16.8-40.3] 9.3 6.8 19 [11.3-32.0] 13.5 10.6 7 [3.1-15.6] 5 3.4
French Guiana 12 [7.5-19.2] 4.1 4.9 11 [5.2-23.3] 7.6 9.5 1 [0.50-1.8] 0.69 0.7
French Polynesia 34 [22.3-51.8] 11.9 9.5 23 [12.2-43.3] 15.8 13.4 11 [6.2-19.4] 7.8 5.6
Gabon 52 [35.4-76.4] 2.5 3.3 33 [20.6-52.8] 3.1 3.9 19 [9.7-37.2] 1.9 2.6
Gaza Strip and West Bank 45 [24.8-81.7] 0.89 1.8 30 [15.3-58.9] 1.2 2.4 15 [4.3-52.9] 0.6 1.2
Georgia 370 [319.4-428.6] 9.5 5.2 227 [195.2-264.0] 12.2 8 143 [84.8-241.3] 7 3
Germany 8 643 [8358.0-8937.7] 10.5 3.8 5 936 [5685.9-6197.1] 14.6 5.7 2 707 [2566.0-2855.7] 6.5 2.1
Ghana 2 737 [2351.4-3185.8] 9.3 15.4 2 000 [1673.3-2390.5] 13.6 24.3 737 [551.7-984.5] 5 7.6
Greece 1 478 [1355.7-1611.4] 13.3 4.5 984 [880.2-1100.0] 17.9 6.7 494 [430.8-566.4] 8.7 2.7
Guam 25 [19.8-31.5] 15.1 11.9 20 [15.4-26.0] 23.8 19.2 5 [3.1-8.1] 6.1 4.9
Guatemala 1 741 [1578.0-1920.8] 10.1 14.5 832 [721.8-959.0] 9.8 15.4 909 [793.3-1041.6] 10.4 13.8
Guinea 1 413 [1098.3-1817.8] 10.8 19.5 866 [633.2-1184.3] 13.2 25 547 [357.8-836.2] 8.4 14.5
Guinea-Bissau 127 [68.3-236.1] 6.7 12 85 [44.0-164.1] 9.1 17.5 42 [6.5-269.7] 4.3 7.4
Guyana 20 [12.2-32.7] 2.6 2.8 10 [5.0-20.0] 2.5 2.8 10 [5.0-20.0] 2.6 2.7
Haiti 653 [539.3-790.6] 5.9 7.8 347 [285.0-422.5] 6.3 9.1 306 [135.9-689.2] 5.4 6.6
Honduras 378 [320.9-445.2] 4 5.4 275 [218.2-346.6] 5.9 8.2 103 [81.7-129.8] 2.2 2.9
Hungary 920 [829.5-1020.4] 9.5 4.4 628 [556.7-708.5] 13.6 7.3 292 [238.6-357.4] 5.8 2.1
Iceland 24 [16.9-34.1] 7.1 3.5 17 [9.9-29.3] 10 5.1 7 [4.4-11.1] 4.2 2
India 25 627 [24053.8-27303.2] 1.9 2 17 548 [16268.1-18928.7] 2.5 2.8 8 079 [7196.8-9069.3] 1.2 1.3
Indonesia 18 148 [15797.0-20848.8] 6.8 7.5 14 047 [11925.3-16546.2] 10.5 12.3 4 101 [3158.3-5325.1] 3.1 3.3
Iran, Islamic Republic of 3 439 [3311.2-3571.7] 4.2 4.7 1 977 [1881.3-2077.6] 4.8 5.2 1 462 [1378.8-1550.2] 3.6 4.1
Iraq 538 [472.1-613.1] 1.4 2.7 279 [233.5-333.4] 1.4 3.1 259 [213.7-313.9] 1.3 2.3
Ireland 380 [326.5-442.3] 7.9 4 245 [190.8-314.6] 10.3 5.7 135 [111.3-163.8] 5.6 2.5
Israel 397 [342.9-459.6] 4.7 3 234 [201.5-271.7] 5.6 4.1 163 [96.1-276.6] 3.8 2
Italy 10 535 [10214.5-10865.6] 17.8 5.7 7 127 [6846.9-7418.6] 24.6 9.2 3 408 [3246.8-3577.2] 11.2 2.7
Jamaica 103 [81.0-130.9] 3.6 2.7 54 [39.1-74.6] 3.7 2.9 49 [34.3-70.1] 3.4 2.6
Japan 28 986 [28306.8-29681.5] 22.8 5.4 18 539 [17987.1-19107.9] 29.9 8.6 10 447 [10055.0-10854.2] 16 2.7
Jordan 178 [135.6-233.6] 1.8 2.9 95 [66.8-135.1] 1.9 3.3 83 [54.2-127.2] 1.7 2.6
Kazakhstan 989 [920.0-1063.2] 5.4 5 605 [551.7-663.4] 6.8 7.6 384 [341.7-431.6] 4 3.3
Kenya 1 331 [10040-1764.6] 2.6 5.3 752 [527.0-1073.0] 3 6.2 579 [364.4-920.1] 2.3 4.4
Korea, Democratic Republic of 5 246 [4891.0-5626.7] 20.5 15 3 498 [3194.0-3830.9] 27.9 23.5 1 748 [1566.0-1951.2] 13.4 8
Korea, Republic of 12 122 [11758.6-12496.6] 23.7 11.8 8 819 [8516.9-9131.8] 34.5 19.5 3 303 [3102.9-3516.0] 12.9 5.2
Kuwait 114 [84.2-154.3] 2.7 5 82 [57.5-116.9] 3.4 6 32 [18.2-56.2] 1.8 3.6
Kyrgyzstan 415 [351.0-490.7] 6.8 8.7 252 [199.1-319.0] 8.3 12.2 163 [128.4-206.9] 5.3 6
Lao People's Democratic Republic 1 032 [571.0-1865.1] 14.8 22.4 713 [353.0-1440.0] 20.5 33.4 319 [106.5-955.3] 9.1 13
Latvia 138 [113.6-167.6] 7.2 3.1 87 [69.5-108.9] 9.8 5.3 51 [34.1-76.2] 4.9 1.6
Lebanon 216 [172.5-270.5] 3.5 3 127 [94.6-170.5] 4.2 3.5 89 [62.8-126.1] 2.9 2.5
Lesotho 67 [39.2-114.6] 3 4.4 41 [20.8-80.9] 3.7 6.6 26 [10.8-62.5] 2.2 3
Liberia 422 [227.0-784.4] 8.7 15.4 254 [131.6-490.2] 10.4 19.2 168 [26.2-1079.0] 7 11.9
Libya 147 [93.6-230.8] 2.3 3.3 71 [39.0-129.1] 2.2 3.4 76 [38.2-151.0] 2.4 3.1
Lithuania 222 [181.4-271.7] 7.7 3.3 136 [104.8-176.5] 10.3 5.5 86 [62.5-118.4] 5.5 1.8
Luxembourg 53 [39.1-71.9] 9 4.4 36 [24.8-52.3] 12.1 6.5 17 [10.0-28.8] 5.8 2.5
Madagascar 908 [474.3-1738.4] 3.5 6 586 [252.9-1357.6] 4.5 8.5 322 [115.7-896.4] 2.4 3.8
Malawi 312 [163.0-597.3] 1.6 2.5 185 [79.9-428.6] 1.9 2.9 127 [45.6-353.5] 1.3 2
Malaysia 1 933 [1760.2-2122.7] 6 6.3 1 467 [1315.9-1635.5] 8.9 9.6 466 [387.6-560.3] 3 3
Maldives 26 [25.8-26.2] 5.9 8.2 21 [20.8-21.2] 8.3 12.1 5 [4.9-5.1] 2.6 3.7
Mali 545 [416.8-712.6] 2.9 5.9 402 [295.6-546.7] 4.2 9.7 143 [82.6-247.5] 1.5 2.7
Malta 24 [15.5-37.2] 5.6 2.4 16 [9.2-27.9] 7.4 3.6 8 [3.9-16.4] 3.7 1.1
Mauritania 326 [175.4-606.0] 7.2 11.5 224 [116.1-432.3] 9.8 16.9 102 [15.9-655.1] 4.5 6.7
Mauritius 53 [38.9-72.1] 4.2 2.7 27 [17.6-41.4] 4.3 2.9 26 [16.7-40.6] 4.1 2.4
Mexico 6 868 [6578.5-7170.2] 5.3 5.1 3 361 [3175.3-3557.5] 5.2 5.3 3 507 [3283.0-3746.3] 5.3 4.9
Mongolia 1 773 [1671.3-1880.9] 56.8 75.4 1 067 [988.2-1152.0] 69.1 98.4 706 [643.5-774.6] 44.7 56.8
Montenegro 52 [36.6-74.0] 8.3 3.9 33 [21.1-51.7] 10.6 5.7 19 [10.8-33.5] 6 2.5
Morocco 411 [270.9-623.6] 1.1 1.1 236 [135.7-410.4] 1.3 1.3 175 [92.8-330.0] 0.96 0.9
Mozambique 1 173 [905.2-1520.0] 3.8 6.7 700 [499.2-981.6] 4.7 9.4 473 [316.0-708.1] 3 4.7
Myanmar 5 360 [2965.8-9687.1] 10 10.1 3 571 [1768.1-7212.3] 13.6 14.7 1 789 [597.4-5357.6] 6.5 6.3
Namibia 47 [27.5-80.4] 1.8 2.9 31 [15.7-61.1] 2.5 4.2 16 [6.7-38.4] 1.2 1.8
Nepal 260 [181.6-372.2] 0.88 1 154 [97.9-242.2] 1.1 1.3 106 [58.8-191.0] 0.7 0.8
New Zealand 353 [292.6-425.9] 7.4 3.9 264 [192.7-361.7] 11.3 6.4 89 [70.2-112.9] 3.7 1.7
Nicaragua 533 [457.3-621.2] 8.5 9.9 290 [240.1-350.3] 9.4 12.3 243 [187.1-315.7] 7.6 8
Niger 759 [481.0-1197.7] 3.4 7.2 590 [345.9-1006.5] 5.3 11.5 169 [70.3-406.1] 1.5 3
Nigeria 5 154 [3920.8-6775.0] 2.6 5.1 3 192 [2300.6-4428.9] 3.2 6.1 1 962 [1193.5-3225.3] 2 4.2
Norway 328 [276.8-388.6] 6.1 2.9 220 [179.6-269.5] 8.1 4.2 108 [79.3-147.1] 4.1 1.7
Oman 111 [72.5-170.0] 2.3 4.3 86 [50.9-145.2] 2.7 5.6 25 [12.0-52.2] 1.5 2.6
Pakistan 4 222 [3585.2-4971.9] 2.1 3 2 608 [2130.5-3192.6] 2.5 3.6 1 614 [1222.5-2130.8] 1.7 2.2
Panama 238 [194.3-291.5] 5.7 4.6 112 [84.5-148.5] 5.4 4.7 126 [94.1-168.7] 6.1 4.5
Papua New Guinea 635 [373.9-1078.4] 7.5 10.9 354 [188.2-665.8] 8.3 12.5 281 [106.4-742.2] 6.8 9.4
Paraguay 182 [136.9-242.0] 2.6 2.9 114 [78.2-166.2] 3.3 3.7 68 [44.0-105.0] 2 2.1
Peru 2 239 [20743-2416.8] 6.9 6.3 1 057 [948.1-1178.4] 6.5 6.5 1 182 [1061.6-1316.1] 7.3 6.2
Philippines 9 485 [8937.5-10066.0] 8.9 11.4 6 776 [6312.7-7273.3] 12.6 17.7 2 709 [2428.3-3022.2] 5.1 6
Poland 2 230 [2092.9-2376.1] 5.9 2.7 1 305 [1194.3-1426.0] 7.1 3.9 925 [844.7-1013.0] 4.7 1.7
Portugal 1 372 [1217.2-1546.5] 13.3 5.2 980 [840.0-1143.3] 20.1 8.9 392 [324.1-474.1] 7.2 2.1
Puerto Rico 375 [327.9-428.9] 10.2 5.3 249 [207.0-299.5] 14.2 8.5 126 [103.7-153.2] 6.6 2.8
Qatar 40 [29.0-55.2] 1.5 4 35 [24.3-50.4] 1.7 5.6 5 [2.6-9.6] 0.74 1.8
Republic of Moldova 700 [601.9-814.1] 17.3 11.2 448 [372.8-538.4] 23.1 17.3 252 [193.4-328.4] 12 6.7
Romania 3 141 [2976.7-3314.4] 16 7.5 2 003 [1869.4-2146.1] 21.1 11.3 1 138 [1044.6-1239.8] 11.3 4.4
Russian Federation 11 192 [10886.5-11506.1] 7.8 4.1 6 432 [6187.1-6686.6] 9.6 6.4 4 760 [4575.8-4951.6] 6.2 2.6
Rwanda 704 [463.7-1068.9] 5.6 10.2 457 [271.0-770.7] 7.5 14.9 247 [123.3-494.8] 3.9 6.5
Saint Lucia 4 [2.6-6.2] 2.2 1.1 3 [1.8-5.0] 3.4 2 1 [0.40-2.4] 1.1 0.34
Samoa 7 [3.0-16.3] 3.5 4.8 5 [1.8-13.6] 4.9 7.1 2 [0.40-9.7] 2.1 2.6
Sao Tome and Principe 8 [3.8-16.8] 3.8 8.3 7 [3.2-15.4] 6.7 14.8 1 [0.10-9.2] 0.95 2.6
Saudi Arabia 852 [693.0-1047.5] 2.5 4.2 636 [499.2-810.3] 3.3 5.8 216 [145.4-320.9] 1.5 2.4
Senegal 1 083 [582.6-2013.1] 6.6 12.6 679 [351.8-1310.5] 8.5 18 404 [62.9-2594.7] 4.9 8.5
Serbia 892 [806.1-987.0] 10.2 4.7 515 [449.0-590.7] 12 6.3 377 [324.4-438.1] 8.4 3.5
Sierra Leone 374 [337.3-414.7] 4.8 9.5 225 [199.0-254.3] 5.9 11.9 149 [123.0-180.5] 3.8 7.2
Singapore 1 298 [1199.2-1405.0] 22.4 11.4 924 [840.8-1015.5] 32.3 17.7 374 [323.3-432.6] 12.8 5.7
Slovakia 473 [421.0-531.4] 8.7 4.3 302 [265.6-343.4] 11.4 6.7 171 [125.8-232.4] 6.1 2.5
Slovenia 268 [234.6-306.2] 12.9 5 175 [148.3-206.6] 16.9 7.6 93 [74.4-116.3] 8.9 2.6
Solomon Islands 55 [32.3-93.6] 8.8 13.7 43 [22.8-81.1] 13.6 20.7 12 [4.5-31.8] 3.9 6.7
Somalia 241 [125.9-461.4] 1.6 3.3 123 [53.1-285.0] 1.6 3.5 118 [42.4-328.5] 1.5 3.2
South Africa 2 388 [2231.2-2555.8] 4.2 4.8 1 484 [1362.9-1615.9] 5.3 7.2 904 [807.8-1011.6] 3.1 3.1
South Sudan 406 [212.1-777.3] 3.1 5.2 259 [111.8-600.0] 4 6.8 147 [52.8-409.2] 2.3 3.7
Spain 5 569 [5349.6-5797.4] 12 4.7 3 872 [3693.9-4058.7] 17 7.6 1 697 [1571.0-1833.0] 7.2 2
Sri Lanka 614 [497.3-758.2] 2.9 2.2 403 [317.2-512.0] 4 3.1 211 [135.1-329.6] 1.9 1.4
Sudan 906 [610.2-1345.2] 2.2 3.7 560 [343.7-912.4] 2.7 4.7 346 [176.4-678.6] 1.7 2.7
Suriname 43 [30.1-61.4] 7.6 7.1 26 [16.5-41.1] 9.1 9.7 17 [9.6-30.1] 6 4.9
Sweden 785 [709.2-868.9] 7.9 3.1 519 [456.4-590.2] 10.4 4.5 266 [225.5-313.8] 5.3 1.8
Switzerland 875 [764.9-1001.0] 10.2 4.1 567 [486.7-660.6] 13.4 5.8 308 [232.0-408.8] 7.1 2.6
Syrian Arab Republic 380 [208.6-692.2] 2.1 3 198 [100.1-391.5] 2.1 3.4 182 [51.6-641.8] 2 2.6
Tajikistan 253 [210.7-303.8] 2.8 4.4 153 [121.2-193.1] 3.3 5.5 100 [74.3-134.6] 2.2 3.4
Tanzania, United Republic of 1 516 [1028.7-22342] 2.6 5 1 146 [714.5-1838.0] 3.9 8.2 370 [187.6-729.7] 1.2 2.2
Thailand 23 154 [22448.8-23881.3] 33.5 20.9 16 284 [15696.9-16893.1] 48.3 32.3 6 870 [6486.9-7275.7] 19.4 11.1
The former Yugoslav Republic of Macedonia 187 [132.3-264.4] 9 5 122 [78.2-190.3] 11.7 7.1 65 [37.4-113.0] 6.2 3.1
The Netherlands 1 044 [966.3-1127.9] 6.1 2.5 648 [593.2-707.8] 7.6 3.3 396 [3346-468.7] 4.6 1.7
The Republic of the Gambia 343 [288.1-408.4] 15.9 26.2 267 [218.6-326.1] 24.9 41.1 76 [53.2-108.6] 7 12.4
Timor-Leste 38 [21.0-68.7] 2.9 5.3 27 [13.4-54.5] 4 7.4 11 [3.7-32.9] 1.7 3.2
Togo 310 [279.7-343.6] 3.9 6.9 210 [185.7-237.5] 5.3 9.8 100 [82.8-120.7] 2.5 4.2
Trinidad and Tobago 63 [46.0-86.2] 4.6 3.2 34 [22.1-52.3] 5 3.7 29 [18.4-45.8] 4.2 2.7
Tunisia 356 [246.3-514.5] 3.1 2.6 147 [91.2-237.0] 2.6 2.3 209 [117.2-372.7] 3.5 2.8
Turkey 4 307 [4119.8-4502.7] 5.3 4.4 2 747 [2626.6-2872.9] 6.8 6.5 1 560 [1110.5-2191.5] 3.8 2.7
Turkmenistan 262 [226.7-302.8] 4.5 5.6 161 [133.8-193.8] 5.6 7.6 101 [80.1-127.3] 3.4 3.9
Uganda 1 552 [1169.7-2059.3] 3.5 6.7 947 [654.0-1371.2] 4.3 8.8 605 [390.3-937.8] 2.7 5.1
Ukraine 2 256 [2102.7-2420.5] 5.1 2.7 1 271 [1159.5-1393.2] 6.2 3.9 985 [882.8-1099.1] 4.2 1.8
United Arab Emirates 96 [73.6-125.2] 1 4.2 61 [43.8-84.9] 0.89 4.2 35 [22.4-54.6] 1.3 4.2
United Kingdom 6 836 [6586.4-7095.1] 10.3 4 4 042 [3845.3-4248.8] 12.3 5.3 2 794 [2642.3-2954.4] 8.3 2.8
United States of America 30 485 [29839.9-31144.1] 9.3 4.9 20 564 [19973.4-21172.1] 12.7 7.2 9 921 [9613.4-10238.4] 6 2.8
Uruguay 131 [103.7-165.5] 3.8 2.1 80 [55.1-116.1] 4.8 3.1 51 [37.7-69.0] 2.8 1.3
Uzbekistan 1 210 [1066.3-1373.1] 3.7 4.7 660 [554.6-785.5] 4.1 5.5 550 [457.5-661.1] 3.4 4
Vanuatu 28 [16.5-47.5] 9.9 13.1 22 [11.7-41.4] 15.4 20.2 6 [2.3-15.8] 4.3 6.2
Venezuela, Bolivarian Republic of 1 152 [1031.0-1287.1] 3.6 3.5 621 [521.2-739.9] 3.9 4.2 531 [460.1-612.8] 3.3 2.9
Viet Nam 25 404 [23442.7-27529.3] 26.3 23.2 19 708 [17974.3-21608.9] 41.3 39.1 5 696 [4832.2-6714.2] 11.7 9.4
Yemen 595 [486.6-727.6] 2.1 4.3 396 [307.4-510.2] 2.7 6.2 199 [142.9-277.1] 1.4 2.6
Zambia 173 [95.5-313.4] 0.98 2.1 101 [47.0-217.2] 1.2 2.7 72 [28.1-184.6] 0.81 1.5
Zimbabwe 580 [455.7-738.1] 3.4 7 324 [237.8-441.5] 3.9 8.8 256 [174.3-376.1] 3 5.6
World 781 631 [737605.0-828285.0] 10.2 8.5 548 375 [511583.0-587813.0] 14.2 12.7 233 256 [209922.0-259184.0] 6.2 4.6
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THE ASIR AND ASMR OF LC ACCORDING TO THE WHO CLASSIFICATION

The ASIR of LC was equal to 17.4 (26.4 in men, and 8.5 in women) in WPRO, 5.1(7.9 in men, and 2.8 in women) in EURO, 5.6 (7.8 in men and 3.7 in women) in PAHO, 4.5 (6.5 in men and 2.6 in women) in SEARO, 7.9 (10.7 in men and 5 in women) in EMRO, and 6 (8.1 in men and 4.1 in women) in AFRO. Of the total incidence of this disease, 60.33% occurred in WPRO, 10.93% in EURO, 9.54% in PAHO, 10.07% in SEARO, 4.68% in EMRO, and 4.46% in AFRO (Tab. I).

The ASMR of LC was equal to 15.8(24.1 in men, and 7.8 in women) in WPRO, 4.4 (6.8 in men, and 2.5 in women) in EURO, 4.8 (6.3 in men and 3.4 in women) in PAHO, 4.3 (6.2 in men and 2.4 in women) in SEARO, 7.8 (10.5 in men and 5 in women) in EMRO, and 5.9 (8 in men and 4 in women) in AFRO. Of the total mortality of this disease, 59.88% occurred in WPRO, 11.05% in EURO, 9.05% in PAHO, 10.4% in SEARO, 4.94% in EMRO, and 4.68% in AFRO (Tab. II).

THE ASIR AND ASMR OF LC ACCORDING TO THE LEVELS OF HUMAN DEVELOPMENT INDEX (HDI)

The ASIR of LC was equal to 6.9 (10.6 in men, and 3.5 in women) in regions with very high HDI, 13.8 (20.8 in men, and 7.2 in women) in regions with high HDI, 5.9 (8.6 in men and 3.3 in women) in regions with medium HDI, 6 (7.9 in men and 4.3 in women) in regions with low HDI, 18.3 (27.6 in men and 9 in women) in China, and 2.2 (3.1 in men and 1.4 in women) in India. Of the total incidence of this disease, 23.19% occurred in regions with very high HDI, 9.04% in regions with high HDI, 13.74% in regions with medium HDI, 3.97% in regions with low HDI, 46.70% in China,and 3.28% in India (Tab. I)

The ASMR of LC was equal to 5.3 (8.1 in men, and 2.9 in women) in regions with very high HDI, 13 (19.4 in men, and 6.8 in women) in regions with high HDI, 5.7 (8.3 in men and 3.2 in women) in regions with medium HDI, and 5.9 (7.9 in men and 4.2 in women) in regions with low HDI. Of the total incidence of this disease, 21.36% occurred in regions with very high HDI, 9.42% in regions with high HDI, 14.51% in regions with medium HDI, and 4.18% in regions with low HDI, 47.20% in China,and 3.33% in India (Tab. II).

PREDICTING THE INCIDENCE AND MORTALITY OF LC FROM 2018 TO 2040

The number of new cases of LC is predicted to increase from 841,080 case in 2018 to 883,925 (+5.1%), 997,895 (+18.6%), 1,118,358 (+33.0%), 1,241,726 (+47.6%) and 1361836 (+61.9%) case in 2020, 2025, 2030, 2035 and 2040, respectively. In addition, the number of mortality from LC increases from 781631 case in 2018 to 821,727 (+5.1), 930,121 (+19.0%), 1,046,114 (+33.8%), 1,166,317 (+49.2%) and 1,284,252 (+64.3%) case in 2020, 2025, 2030, 2035 and 2040, respectively (Tab. III).

Tab. III.

Predicting the incidence and mortality cases of LC from 2018 to 2040.

Year 2018 2020 2025 2030 2035 2040
Event Sex Number Number Demographic change (APC 0%) Number Demographic change (APC 0%) Number Demographic change (APC 0%) Number Demographic change (APC 0%) Number Demographic change (APC 0%)
Incidence Males 596,574 626,767 30,193 (+5.1%) 706,015 109,441 (+18.3%) 788,519 191,945 (+32.2%) 872,035 275,461 (+46.2%) 952,887 356,313 (+59.7%)
Females 244,506 257,158 12,652 (+5.2%) 291,880 47,374 (+19.4%) 329,839 85,333 (+34.9%) 369,691 125,185 (+51.2%) 408,949 164,443 (+67.3%)
Both sexes 841,080 883,925 42,845 (+5.1%) 997,895 156,815 (+18.6%) 1,118,358 277,278 (+33.0%) 1,241,726 400,646 (+47.6%) 1,361,836 520,756 (+61.9%)
Mortality Males 548,375 576,354 27,979 (+5.1%) 650,956 102,581 (+18.7%) 729,536 181,161 (+33.0%) 809,877 261,502 (+47.7%) 888,195 339,820 (+62.0%)
Females 233,256 245,373 12,171 (+5.2%) 279,165 45,909 (+19.7%) 316,578 83,322 (+35.7%) 356,440 123,184 (+52.8%) 396,057 162,801 (+69.8%)
Both sexes 781,631 821,727 40,096 (+5.1%) 930,121 148,490 (+19.0%) 1,046,114 264,483 (+33.8%) 1,166,317 384,686 (+49.2%) 1,284,252 502,621 (+64.3%)
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RELATIONSHIP BETWEEN ASIR AND ASMR OF LC WORLDWIDE

There was a statistically significant correlation between ASIR and ASMR of LC worldwide at the level of 0.987 (P ≥ 0.001). This correlation was equal to 0.994 (P ≥ 0.001) in Asia, 0.848 (P ≥ 0.001) in Europe, 0.996 (P ≥ 0.001) in Africa, 0.964 (P ≥ 0.001) in the Latin America and the Caribbean and 0.764 (P = 0.010) in Oceania (Fig. 5).

Fig. 5.

Fig. 5.

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Correlation of ASIR and ASMR of LC.

Discussion

The present study was based on data from GLOBOCAN PROJECT that was internationally conducted by WHO in 2018. The study aimed to examine the geographical distribution of incidence and mortality of LC based on geographical, political and economic divisions at the international level. It also predicts the number of incidence and mortality cases of LC from 2018 to 2040.

Cancer is considered as an important health problem in developing countries, especially Asian countries, so that it is one of the most important causes of death in some Asian countries such as South Korea and Japan. It seems that if current management plans and strategies are not changed, the number of deaths from cancer will increase by more than 7000000 per year in these areas until 2020 [18, 19]. According to this, current study found that most cases of incidence and mortality of LC occurred in less developed regions of the world in 2018. According to a research by Chang et al., hepatocellular carcinoma (HCC) caused by the chronic infection with hepatitis B was more common in areas with a low and moderate HDI mostly in Asia and Africa [20]. On the other hand, the increased incidence of hepatocellular carcinoma in developed countries was due to the higher prevalence of alcohol consumption and hepatitis C infection [21].

Distribution of cancer in different regions of the world varies according to the HDI. Different cancers are considered as the most common cancers in regions with low, medium, high and very high HDI. Lung, colorectal, prostate, and breast cancers are considered as the most common cancers in areas with high and very high HDI; and they account for more than 50% of all new cancer cases in these areas. Meanwhile, in areas with low and moderate HDI, the lung, breast, colorectal, stomach, liver and cervical cancers are also diagnosed as cancers with the highest incidence and severity. However, in areas with low HDI, cancers associated with infectious agents account for a high proportion of cancer incidence and mortality [21-23].

In 2018, the incidence of LC was 5.1 and 6.6 per 100,000 people in Europe and North America, respectively. While the incidence of this disease was 11.4 and 8.4 in Asia and Africa, respectively, indicating the high incidence of disease in less developed regions of the world. Top ten countries with the highest incidence of LC in 2018 were as follows: Mongolia with ASIR = 117, Egypt with ASIR = 49, Viet Nam with ASIR = 39, The Gambia with ASIR = 36.5, Lao People’s Democratic Republic with ASIR = 33.4, Thailand with ASIR = 32.2, Guinea with ASIR = 27.9, Republic of Korea with ASIR = 27.7, China with ASIR = 27.6,and Democratic Republic of Korea with ASIR = 25.4 [21]. Among 10 countries with the highest standardized LC incidence worldwide, 3 countries were located in Africa and 7 countries in Asia. Most of these countries with low or moderate HDI were located in less developed regions [6, 24-29].

In the present study, there was a significant statistical correlation between ASIR and ASMR of LC in the world, Europe, Asia, Africa, the Oceania, and the United States, in other words, an increase in the incidence of LC significantly enhanced its mortality rate. Therefore, appropriate and applied measures and programs should be adopted in areas with the highest incidence of LC, for primary and secondary prevention of disease with the aim to reduce the incidence and mortality of LC [30, 31]. Accordingly, it is suggested conducting case-control and cohort studies in countries and regions with the highest incidence of LC with the aim to diagnose the most important risk factors of this cancer and the risk attributable to each of these factors in order to perform appropriate regional planning to reduce the incidence of disease. Furthermore, patients need to be diagnosed and treated at early stages of disease by conducting appropriate screening programs in order to reduce the rate of disease mortality in these areas in the long term.

LIMITATIONS OF THE STUDY

The quality of the collected cancer data in the GLOBOCAN project is not similar in all countries, especially those with medium or low HDI, so that the estimates of some countries are based on the recorded cases of cancer in limited areas or based on estimates from neighboring countries [24]. Please, see the Supplementary data (Tabs. SIII, SIV). for more information.

Tab. SIII.

Cancer incidence and mortality data: sources and methods by country.

Incidence Method
1 National (or local with coverage greater than 50%) rates projected to 2018
2a Most recent rates from a single registry applied to 2018 population
2b Weighted/simple average of the most recent local rates applied to 2018 population
3a Estimated from national mortality estimates by modelling, using mortality: incidence ratios derived from country-specific cancer registry data
3b Estimated from national mortality estimates by modelling, using mortality: incidence ratios derived from cancer registry data in neighbouring countries
4 "All sites" estimates from neighbouring countries partitioned using frequency data
9 No data: the rates are those of neighbouring countries or registries in the same area
Mortality
1 National rates projected to 2018
2a Most recent rates from one source applied to 2018 population
2b Weighted/simple average of the most recent local rates applied to 2018 population
3 Estimated from national incidence estimates by modelling, using incidence: mortality ratios derived from cancer registry data in neighbouring countries
9 No data: the rates are those of neighbouring countries in the same area
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Tab. SIV.

The method used in each country to calculate the incidence and attenuation of cancer in Global Cancer Observatory in 2018.

Country Incidence Mortality
Source Method Source Method
Eastern Africa
Burundi No data 9 No data 3
Comoros No data 9 No data 3
Djibouti No data 9 No data 3
Eritrea No data 9 No data 3
Ethiopia Local 2a No data 3
France, Reunion National 2a National (WHO) 1
Kenya Local 2b No data 3
Madagascar No data 9 No data 3
Malawi Local 2a No data 3
Mauritius National 1 National (WHO) 1
Mozambique Local 2b No data 3
Rwanda Local 4 No data 3
Somalia No data 9 No data 3
South Sudan No data 9 No data 3
Tanzania Local 2b No data 3
Uganda Local 2b No data 3
Zambia Local 2a No data 3
Zimbabwe Local 2b No data 3
Middle Africa
Angola No data 9 No data 3
Cameroon Local 2a No data 3
Central African Republic No data 9 No data 3
Chad No data 9 No data 3
Congo Local 2a No data 3
Congo, Democratic Republic of No data 9 No data 3
Equatorial Guinea No data 9 No data 3
Gabon No data 4 No data 3
Northern Africa
Algeria Local 2b No data 3
Egypt Local 2b National (WHO) 3
Libya Local 2a No data 3
Morocco Local 2b National (WHO) 3
Sudan Local 2b No data 3
Tunisia Local 2b National (WHO) 3
Southern Africa
Botswana National 1 No data 3
Lesotho No data 9 No data 3
Namibia National 2a No data 3
South African Republic No data 3b National (WHO) 1
Swaziland National 2a No data 3
Western Africa
Cape Verde No data 3b National (WHO) 2a
Benin Local 2a No data 3
Burkina Faso Local 9 No data 3
Cote d'Ivoire Local 2a No data 3
Ghana Local 4 No data 3
Guinea Local 2a No data 3
Guinea-Bissau No data 9 No data 3
Liberia No data 9 No data 3
Mali Local 2a No data 3
Mauritania No data 9 No data 3
Niger Local 2a No data 3
Nigeria Local 2b No data 3
Sao Tome and Principe No data 3b National (WHO) 2a
Senegal No data 9 No data 3
Sierra Leone No data 4 No data 3
The Gambia National 1 No data 3
Togo Local 4 No data 3
Caribbean
Bahamas No data 3b National (WHO) 1
Barbados No data 3b National (WHO) 1
Cuba Local 3b National (WHO) 1
Dominican Republic No data 3b National (WHO) 1
France, Guadeloupe National 1 National (WHO) 1
France, Martinique National 1 National (WUO) 1
Haiti No data 3b National (WHO) 2a
Jamaica Local 3b National (WHO) 1
Puerto Rico National 1 National (WHO) 1
Saint Lucia No data 3b National (WHO) 1
Trinidad and Tobago No data 3b National (WHO) 1
Central America
Belize No data 3b National (WHO) 2a
Costa Rica National 1 National (WHO) 1
El Salvador No data 3b National (WHO) 1
Guatemala No data 3b National (WHO) 1
Honduras Local 2a National (WHO) 2a
Mexico No data 3b National (WHO) 1
Nicaragua No data 3b National (WHO) 1
Panama No data 3b National (WHO) 1
South America
Argentina Local 3a National (WHO) 1
Bolivia Local 3b National (WHO) 2a
Brazil Local 3a National (WHO) 1
Chile Local 3a National (WHO) 1
Colombia Local 3a National (WHO) 1
Ecuador Local 3a National (WHO) 1
French Guiana National 1 National (WHO) 1
Guyana No data 3b National (WHO) 1
Paraguay No data 3b National (WHO) 1
Peru Local 3a National (WHO) 1
Suriname No data 3b National (WHO) 1
Uruguay National 1 National (WHO) 1
Venezuela No data 3b National (WHO) 1
Northern America
Canada Local 1 National (WHO) 1
United States of America National 1 National (WHO) 1
Eastern Asia
China Local 2b Local 2b
Japan Local 3a National (WHO) 1
Korea, Democratic Republic of No data 9 No data 9
Korea, Republic of National 1 National (WHO) 1
Mongolia National 2a National 2a
South-Eastern Asia
Brunei Darussalam National 2a National (WHO) 2a
Cambodia No data 9 No data 3
Indonesia National 4 No data 3
Lao People's Democratic Republic No data 9 No data 3
Malaysia Local 2b National (WHO) 3
Myanmar No data 9 No data 3
Philippines Local 2b National (WHO) 3
Singapore National 1 National (WHO) 2a
Thailand Local 2b National (WHO) 3
Timor Leste No data 9 No data 3
Viet Nam Local 2b National (Survey) 3
South Central Asia
Afghanistan No data 9 No data 3
Bangladesh No data 9 No data 3
Bhutan National (pathology-based register) 2a No data 3
India Local 2b Regional 3
Iran, Islamic Republic of Local 2b National (WHO) 2a
Kazakhstan National 2a National (WHO) 2a
Kyrgyzstan Local 3b National (WHO) 1
Maldives No data 9 No data 9
Nepal Local 4 No data 3
Pakistan Local 2b No data 3
Sri Lanka National 1 National (WHO) 3
Tajikistan No data 3b National (WHO) (ICD-9 limitedsites). 2a
Turkmenistan No data 3b National (WHO) (ICD-10 limitedsites). 1
Uzbekistan National 2a National (WHO) 1
Western Asia
Azerbaijan National 2a National (WHO) 3
Armenia No data 3b National (WHO) 1
Bahrain National 1 National (WHO) 3
Georgia No data 3b National (WHO) 1
Iraq National 2a No data 3
Israel National 1 National (WHO) 1
Jordan National 1 National (WHO) 3
Kuwait National 1 National (WHO) 3
Lebanon National 2a No data 3
Oman National 1 National (WHO) 3
Palestine No data 9 National (WHO) 3
Qatar National 2a National (WHO) 3
Saudi Arabia National 1 National (WHO) 3
Syrian Arab Republic No data 9 No data 3
Turkey Local 2b National (WHO) 2a
United Arab Emirates National 2a No data 3
Yemen Local 2b No data 3
Eastern Europe
Belarus National 1 National (WHO) 1
Bulgaria National 1 National (WHO, ICD-10 limited sites). 2a
Czech Republic National 1 National (WHO) 1
Hungary No data 3b National (WHO) 1
Moldova No data 3b National (WHO) 1
Poland Local 3a National (WHO) 1
Romania Local 3b National (WHO) 1
Russian Federation National 1 National (WHO, ICD-10 limited sites) 1
Slovakia National 2a National (WHO) 1
Ukraine National 1 National (WHO, ICD-10 limited sites) 1
Northern Europe
Denmark National 1 National (WHO) 1
Estonia National 1 National (WHO) 1
Finland National 1 National (WHO) 1
Iceland National 1 National (WHO) 1
Ireland National 1 National (WHO) 1
Latvia National 1 National (WHO) 1
Lithuania National 1 National (WHO) 1
Norway National 1 National (WHO) 1
Sweden National 1 National (WHO) 1
United Kingdom National 1 National (WHO) 1
Southern Europe
Albania No data 3b National (WHO) 1
Bosnia Herzegovina Local 3a National (WHO) 2a
Croatia National 1 National (WHO) 1
Cyprus National 1 National (WHO) 1
FYR Macedonia No data 3b National (WHO) 1
Greece No data 3b National (WHO) 1
Italy Local 3a National (WHO) 1
Malta National 1 National (WHO) 1
Montenegro No data 3b National (WHO) 1
Portugal Local 3a National (WHO) 1
Serbia Local 3b National (WHO) 1
Slovenia National 1 National (WHO) 1
Spain Local 3a National (WHO) 1
Western Europe
Austria National 1 National (WHO) 1
Belgium National 1 National (WHO) 1
France Local 3a National (WHO) 1
Germany Local 1 National (WHO) 1
Luxembourg National (pathology-based register) 3b National (WHO) 1
The Netherlands National 1 National (WHO) 1
Switzerland Local 3a National (WHO) 1
Australia/New Zealand
Australia National 1 National (WHO) 1
New Zealand National 1 National (WHO) 1
Melanesia
Fiji No data 3b No data 3
France, New Caledonia National 2a National (WHO) 2a
Papua New Guinea Local 9 National 2a
Solomon Islands No data 9 No data 3
Vanuatu National 2a No data 3
Micronesia
Guam No data 9 National 2a
Polynesia
French Polynesia National 2a National 2a
Samoa No data 9 No data 9
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Conclusions

LC is one of the most important cancers in the world in terms of incidence and mortality. It is important to prevent exposure to known risk factors for LC by increasing the level of knowledge and attitudes of the community. In addition, it is necessary that health policy makers have appropriate planning for providing suitable diagnostic and medical service to prevent of morbidity and mortality of the population with early diagnosis and treatment of patients.

Figures and tables

Acknowledgements

Funding sources: this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Footnotes

Conflict of interest statement

The authors declare no conflict of interest.

Authors’ contributions

AMH conceived the idea of the study and approved the final draft of the manuscript. MM and KAB wrote the first draft of the manuscript and carried out the data analysis. All authors contributed to the revising and editing of the article and the final version of the article was approved by them.

Supplementary data

References

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