title: Time trend analysis of primary liver cancer incidence in Sihui county of Guangdong Province, China (1987-2011).
abstract: Southern China is an endemic area for primary liver cancer (PLC), but it is unclear if rates have changed in recent decades. We evaluated PLC incidence and estimated the effects of age, period of diagnosis, and birth cohort in Sihui City, Guangdong Province, China.
  
  
  
  Age-standardized rates (ASRs) of PLC were examined for both males and females from 1987 to 2011. Joinpoint regression analysis was conducted to estimate the annual percent changes in PLC incidence. The age-period-cohort (APC) model was used to investigate the effects of age, diagnosis period, and birth cohort on the relative risk (RR) of PLC.
  
  
  
  A total of 2988 PLC cases were identified in this period, with average ASRs of 51.1/100,000 for males and 11.7/100,000 for females. Joinpoint regression analysis revealed increasing PLC incidence throughout the entire period in both males (average annual change of 1.65 %) and females (0.20 %). RRs increased gradually in both sexes from the youngest age group (30-34 years) to the oldest (80-84 years). In males, the RR decreased during diagnosis period from 1987-1991 to 1997-2001 and remained stable thereafter. In females, RRs fluctuated with diagnosis period throughout the entire period. Incidence tended to increase with birth cohort from 1905-1909 to 1975-1979 in both males and females; however, female incidence plateaued in the youngest cohorts born between 1955 and 1974, while incidence in males increased sharply in the cohorts born between 1965 and 1974. According to APC analysis, the full age-period-cohort (APC) model fit the data best, and the period-cohort (PC) model would be enough to explain variability of rates in females.
  
  
  
  The PLC incidence rate in males of Sihui City has increased more significantly than female over the last 25 years. Despite the age effect in male, this trend mainly reflects the effects of risk factors that are present in early life (birth cohort) and period change in both genders.
authors.affiliation: Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center Medicine, 21 Qingcaigang, Jianshe 6 road, Guangzhou, Guangdong, China.|School of Public Health, Sun Yat-sen University, 74 Zhongshan 2 road, Guangzhou, China.
authors.forename: Wenyi
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center Medicine, 21 Qingcaigang, Jianshe 6 road, Guangzhou, Guangdong, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Sihui Cancer Institute, Sihui, Guangdong, China.
authors.forename: Qihong
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Sihui Cancer Institute, Sihui, Guangdong, China.
authors.forename: Yuqiang
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center Medicine, 21 Qingcaigang, Jianshe 6 road, Guangzhou, Guangdong, China.
authors.forename: Shanghang
authors.initials: S
authors.lastname: Xie
authors.affiliation: School of Public Health, Sun Yat-sen University, 74 Zhongshan 2 road, Guangzhou, China. linaihua@mail.sysu.edu.cn.
authors.forename: Aihua
authors.initials: A
authors.lastname: Lin
authors.affiliation: Department of Cancer Prevention Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center Medicine, 21 Qingcaigang, Jianshe 6 road, Guangzhou, Guangdong, China. caosm@sysucc.org.cn.
authors.forename: Sumei
authors.initials: S
authors.lastname: Cao
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000266:history; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012042:Registries; D012306:Risk
keywords: Age-period-cohort model; Incidence trend; Joinpoint regression analysis; Primary liver cancer