Statewide Burden and Trends of Liver Cancer Mortality Attributable to High BMI in the US (1991–2021): Insights from the Global Burden of Disease study, 2021.

e22569 Background: Liver cancer remains a leading cause of cancer-related deaths in the United States and high BMI is a key risk factor, which contributes to the increasing incidence, prevalence, and mortality of liver cancer, emphasizing the need for targeted interventions and prevention strategies. Methods: Using the Global Burden of Disease (GBD) Study 2021 Results Tool, the age-standardized mortality rate (ASMR)and disability-adjusted life years (DALYs) rate were extracted, considering high BMI as a risk factor for liver cancer in the US from 1991 to 2021. Data was stratified by year, gender, and location. Mortality trends were analyzed using Joinpoint regression, and annual percentage change (APC) was calculated. Results: The Age-standardized mortality rate (ASMR) due to liver cancer attributable to high BMI showed a notable increase, rising from 0.29 per 100,000 population in 1991 (95% CI: 0.12 – 0.51) to 0.90 in 2021 (APC 7.01%, 95% CI: 0.39 – 1.47). Overall, liver cancer DALYs rose from 7.85 (95% CI: 3.18–13.61) in 1991 to 23.20 (APC 6.52%, 95% CI: 10.21–37.33) in 2021. The Joinpoint Trend Analysis reveals distinct patterns in ASMR - starting 1991-2001, APC was 5.85%, indicating a sharp rise, followed by slow growth in 2001-2007 with APC of 3.27%, followed by a resurgence to 4.58% from 2007- 2010. After 2010, the trend slowed further, with APCs of 2.57% (2010–2017) and 0.92% (2017–2021). Among males, ASMR increased from 0.39 (95% CI: 0.16–0.71) in 1991 to 1.32 (APC 7.95%, 95% CI: 0.57–2.14) in 2021, reflecting rise in the burden. For females, the ASMR increase was less pronounced, going from 0.21 (95% CI: 0.08–0.35) in 1991 to 0.53 (APC 5.08%, 95% CI: 0.23–0.86) in 2021. Analysis of ASMR for liver cancer attributable to high BMI from 1991 to 2021 reveals that all states demonstrated an upward trajectory in ASMR. The District of Columbia had the highest burden in 2021, with an ASMR of 1.21 (95% CI: 0.50–2.07), followed by Texas (ASMR: 1.166)and Alaska (ASMR: 1.162) while In 2021, Utah had the lowest burden with an ASMR of 0.66 (95% CI: 0.27–1.12), followed by New York (ASMR: 0.692) and New Jersey (ASMR: 0.735). However from 1991-2021, the District of Columbia is identified as having the lowest APC of 3.279% in ASMR. Conversely, Oklahoma shows the highest APC at 13%. Conclusions: In conclusion, liver cancer mortality and DALYs attributable to high BMI have significantly increased in the U.S. from 1991 to 2021, with notable state-level variations. These findings underscore the need for targeted interventions to address obesity and reduce its impact on liver cancer outcomes.