title: Effects of nucleoside analogue prescription for hepatitis B on the incidence of liver cancer in Hong Kong: a territory-wide ecological study.
abstract: The temporal relationship between nucleoside analogue therapy for chronic hepatitis B (CHB) and liver cancer development has not been evaluated at a population level.
  
  
  
  To investigate the impact of nucleoside analogue prescription on liver cancer incidence in a CHB-prevalent region.
  
  
  
  We obtained territory-wide nucleoside analogue prescription data from 1999, when nucleoside analogue was first available in Hong Kong, to 2012 and the population-based liver cancer incidence data from 1990 to 2012. We compared the liver cancer incidences from 1990 to 1998 and 1999 to 2012 with adjustment for local hepatitis B surface antigen seroprevalence.
  
  
  
  Nucleoside analogue prescription patient headcount increased from 2006 per year in 1999 to 26 411 in 2012. Prescription volume in 2012 was highest among 55-64 years (30.3%), higher than 65-74 years (13.0%) and ≥75 years (5.8%). Age-standardised liver cancer incidence 1999-2012 decreased by 1.88%/year (95% CI 3.34% to 0.42%/year). NA therapy was associated with decline in age-adjusted liver cancer incidence (2.7 per 100 000 persons, P < 0.001, 95% CI 1.4-4.0 per 100 000 persons). Fifty-five to sixty-four years age group had the most significant decline (men: 24.0 per 100 000 persons, P = 0.001, 95% CI 11.4-36.6 per 100 000 persons; women: 8.5 per 100 000 persons, P = 0.009, 95% CI 2.3-14.6 per 100 000 persons). No significant association was noted in age groups 65-74 years and ≥75 years (both P > 0.05).
  
  
  
  Nucleoside analogue prescription was associated with a reduction of overall liver cancer incidence in a CHB-prevalent region. The lack of association among individuals of ≥65 years was consistent with the low nucleoside analogue prescription volume in elderly patients, mitigating the impact of CHB treatment on liver cancer.
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: W-K
authors.identifier: 0000-0002-9012-313X
authors.initials: WK
authors.lastname: Seto
authors.affiliation: School of Public Health, The University of Hong Kong, Hong Kong.
authors.forename: E H Y
authors.initials: EH
authors.lastname: Lau
authors.affiliation: School of Public Health, The University of Hong Kong, Hong Kong.
authors.forename: J T K
authors.initials: JT
authors.lastname: Wu
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: I F N
authors.initials: IF
authors.lastname: Hung
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: W K
authors.initials: WK
authors.lastname: Leung
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: K-S
authors.initials: KS
authors.lastname: Cheung
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: C-L
authors.initials: CL
authors.lastname: Lai
authors.affiliation: Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.|State Key Laboratory for Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: M-F
authors.initials: MF
authors.lastname: Yuen
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D011307:Drug Prescriptions; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D019384:Nucleic Acid Synthesis Inhibitors / Q000627:therapeutic use; D016036:Seroepidemiologic Studies; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D019384:Nucleic Acid Synthesis Inhibitors