Multilevel Determinants of Liver Cancer Screening Uptake in Community-Based High-Risk Populations in Chongqing, China: A Prospective Cohort Study
- 1Department of Oncology, Chongqing General Hospital, Chongqing University, Chongqing, People’s Republic of China
- 2Office of Cancer Prevention and Control, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
- 3Department of Urologic Oncology Surgery, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China
Abstract
Background: Evidence on the uptake and determinants of liver cancer screening in Southwest China remains limited. This study aimed to assess the participation rate, influencing factors, and screening outcomes among high-risk individuals in a population-based liver cancer screening program.
Methods: A community-based screening program was conducted across 18 districts or counties in Chongqing, China, from October 2013 to October 2022. High-risk individuals identified through a risk assessment system were invited to receive alpha-fetoprotein (AFP) testing and abdominal ultrasonography. A generalized linear mixed model (GLMM) was applied to identify individual-level and structural factors associated with screening uptake. Reasons for non-participation and liver cancer detection rates were also assessed.
Results: Among the 369,393 individuals who completed the risk assessment, 37,381 were identified as being at high-risk for liver cancer. After exclusions, 34,647 were included in the final analysis. Of these, 14,062 underwent screening, yielding an uptake rate of 40.59%. Screening participation was significantly associated with younger age, occupational exposures, alcohol consumption, lower levels of physical activity, hepatitis B infection, history of liver cirrhosis, comorbidities, and family history of liver cancer. At the structural level, developed status, use of multiple mobilization strategies, and receiving allowances were positively associated with uptake. Among 20,585 non-participants, the most frequently reported barriers included no symptoms (93.61%), fear of diagnosis (92.60%), and lack of knowledge about cancer prevention and treatment (89.30%). Liver cancer was detected in 14 of the screened individuals, corresponding to a detection rate of 0.10%.
Conclusion: Participation in liver cancer screening is shaped by a combination of individual and structural factors. Targeted interventions addressing key barriers (such as low risk perception, fear, and knowledge gaps) and structural factors (such as diversified mobilization and financial incentives) may help improve screening uptake among the high-risk populations.
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BibTeX
@article{li2026multilevel,
title = {{Multilevel Determinants of Liver Cancer Screening Uptake in Community-Based High-Risk Populations in Chongqing, China: A Prospective Cohort Study}},
author = {Bibo Li and Zhikai Yu and Yan Zhang and Qiucheng Li and Xiu Liu and Qing Guo and Hong Zhou and Jia Du and Mei He},
journal = {Journal of Hepatocellular Carcinoma},
year = {2026},
month = oct,
doi = {10.2147/jhc.s641810},
url = {https://doi.org/10.2147/jhc.s641810},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Multilevel Determinants of Liver Cancer Screening Uptake in Community-Based High-Risk Populations in Chongqing, China: A Prospective Cohort Study
AU - Bibo Li
AU - Zhikai Yu
AU - Yan Zhang
AU - Qiucheng Li
AU - Xiu Liu
AU - Qing Guo
AU - Hong Zhou
AU - Jia Du
AU - Mei He
PY - 2026
DA - 2026/10/26
JO - Journal of Hepatocellular Carcinoma
DO - 10.2147/jhc.s641810
UR - https://doi.org/10.2147/jhc.s641810
AB - Background: Evidence on the uptake and determinants of liver cancer screening in Southwest China remains limited. This study aimed to assess the participation rate, influencing factors, and screening outcomes among high-risk individuals in a population-based liver cancer screening program. Methods: A community-based screening program was conducted across 18 districts or counties in Chongqing, China, from October 2013 to October 2022. High-risk individuals identified through a risk assessment system were invited to receive alpha-fetoprotein (AFP) testing and abdominal ultrasonography. A generalized linear mixed model (GLMM) was applied to identify individual-level and structural factors associated with screening uptake. Reasons for non-participation and liver cancer detection rates were also assessed. Results: Among the 369,393 individuals who completed the risk assessment, 37,381 were identified as being at high-risk for liver cancer. After exclusions, 34,647 were included in the final analysis. Of these, 14,062 underwent screening, yielding an uptake rate of 40.59%. Screening participation was significantly associated with younger age, occupational exposures, alcohol consumption, lower levels of physical activity, hepatitis B infection, history of liver cirrhosis, comorbidities, and family history of liver cancer. At the structural level, developed status, use of multiple mobilization strategies, and receiving allowances were positively associated with uptake. Among 20,585 non-participants, the most frequently reported barriers included no symptoms (93.61%), fear of diagnosis (92.60%), and lack of knowledge about cancer prevention and treatment (89.30%). Liver cancer was detected in 14 of the screened individuals, corresponding to a detection rate of 0.10%. Conclusion: Participation in liver cancer screening is shaped by a combination of individual and structural factors. Targeted interventions addressing key barriers (such as low risk perception, fear, and knowledge gaps) and structural factors (such as diversified mobilization and financial incentives) may help improve screening uptake among the high-risk populations.
SN - 2253-5969
ER -