Hepatocellular carcinoma: A 30-year trend analysis of global burden stratified by risk factors, and socio-demographic indexes.

529 Background: Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related morbidity and mortality worldwide, driven primarily by chronic infections with Hepatitis B, Hepatitis C, and alcohol consumption. This study systematically examines global trends of HCC from 1991 to 2021, focusing on age-standardized mortality rates (ASMR) and Disability-Adjusted Life Years (DALYs) according to risk factors across Socio-Demographic Index (SDI) regions. By highlighting these patterns, the study provides insights into the interplay of socio-economic disparities and healthcare advancements on HCC trends. Methods: We utilized data from the Global Burden of Disease database to extract ASMR, and age standardized DALYs for HCC between 1991 and 2021. The data was stratified by etiology (Hepatitis B, Hepatitis C, alcohol consumption) and stratified across five SDI regions: low, low-middle, middle, high-middle, and high SDI. Results: The global HCC ASMR decreased by 4% from 1991 to 2021, with the largest reduction (20.4%) in low SDI regions. Hepatitis B-related HCC ASMR dropped by 16.3%, with reductions across all SDI groups. ASMR of Hepatitis C-related HCC remained stable globally but fell by 15.1% in low SDI regions. Alcohol-related HCC ASMR increased by 10% globally, with the highest rise in high SDI regions (24.5%), and NASH-related HCC ASMR increased by 26.7% globally, with a 42% rise in high SDI regions. Hepatitis B-related HCC DALYs decreased by 22.2%, with the sharpest declines recorded in high (31.4%) and low SDI regions (29%). Hepatitis C-related HCC DALYs saw a 8.8% global reduction, which was consistent across all groups. Alcohol-related HCC DALYs rose by 4.6% globally, with increases of 14.4% in high SDI and 20.5% in low-middle SDI regions. NASH-related HCC DALYs increased by 18.7%, with a 34.7% rise in low-middle SDI regions. Conclusions: The study reveals substantial progress in reducing the global burden of Hepatitis B- and C-related HCC, particularly in low SDI regions. This progress likely reflects advances in vaccination, antiviral treatments, and screening programs. However, the rising mortality and disability associated with alcohol- and NASH-related HCC, especially in high SDI regions, emphasize the growing impact of lifestyle-related risk factors. These findings underscore the need for tailored public health strategies to mitigate the increasing effects of these preventable risk factors on global HCC outcomes.