Burden of cirrhosis and other chronic liver diseases and their progression to hepatocellular carcinoma in East Asia Pacific: 1990 to 2021

Background: Cirrhosis and other chronic liver diseases (CLD), along with liver cancer, present significant health challenges in the East Asia Pacific (EAP) region. This study evaluates the burden of CLD and its progression to hepatocellular carcinoma (HCC) from 1990 to 2021. Methods: Data from the Global Burden of Disease Study 2021 were analyzed to examine trends in CLD burden and annual transition rates to HCC across different etiologies and sociodemographic index (SDI) regions. The estimated annual percentage change (EAPC) was used to assess trends in age-standardized rates (ASR). Correlations between age-standardized DALY rates (ASDR), annual transition rates, and SDI were determined using Spearman’s rank correlation. Risk factors, such as high alcohol and drug use, were also evaluated. Findings: The prevalence of CLD in EAP increased significantly by 43.80% (95% UI: 38.23% to 48.77%) from 1990 to 2021, while the ASDR decreased (EAPC: -2.42% [95% CI: -2.48% to -2.36%]), notably in high and high-middle SDI regions. HBV and HCV remained the leading causes of CLD across all SDI regions, with alcohol use and NAFLD increasingly contributing, particularly in high SDI regions. A significant negative correlation was observed between ASDR and SDI in high (ρ=-0.20, p<0.01), middle (ρ=-0.49, p<0.001), and low-middle (ρ=-0.63, p<0.001) SDI regions. Despite this, high alcohol use and drug use contributed more to DALYs across all SDI regions, and the annual transition rate to HCC was rising (1.09% [0.89% to 1.28%]), with the highest rates in high SDI regions. The transition rate from CLD to HCC is rising in EAP, much exceeding the global rate. High SDI regions showed higher transition rates, particularly among those with chronic hepatitis B, C, and NAFLD including cirrhosis. A significant positive relationship was found between the transition rate from CLD to HCC and SDI in high (ρ=0.60, p<0.001) and low-middle (ρ=0.34, p<0.001) SDI regions. Interpretation: While the EAP region has made progress in reducing the burden of CLD, greater attention is needed for alcohol use and NAFLD. The progression from CLD to HCC warrants increased focus, especially in high SDI regions. Enhanced surveillance for HCC in patients with chronic hepatitis is crucial.