S2364 Global Inequities in BMI-Attributable Liver Cancer: A Comprehensive Analysis Stratified by Age, Sex, and Sociodemographic Index (1990-2021)

Introduction: High body mass index (HBMI) is a growing global public health concern and a recognized modifiable risk factor for liver cancer (LC). As obesity rates rise, the associated burden of LC is expected to increase. However, global patterns of LC attributable to HBMI across age, sex, and socio-demographic index (SDI) strata remain poorly characterized. This knowledge gap limits the development of targeted public health interventions. This study aims to quantify and compare trends in disability-adjusted life years (DALYs), mortality, and years of life lost (YLL) due to high BMI–related LC across demographic and socio-economic groups using data from the 2021 Global Burden of Disease (GBD) Study. Methods: We extracted data from the 2021 GBD Study to evaluate LC burden attributable to HBMI from 1990 to 2021. Outcomes included age-standardized rates of DALYs, deaths, and YLLs per 100,000 population. Estimates were stratified by age, sex, and SDI quintiles. Joinpoint regression analysis was used to calculate Average Annual Percentage Change (AAPC), with 95% confidence intervals (CI). Trends with P-values < 0.05 were considered statistically significant. Results: Gender-stratified analysis revealed that men experienced nearly twice the number of DALYs compared to women (14.12 million vs 7.71 million). The increase in DALYs was also steeper in men (AAPC: 3.66%) than in women (AAPC: 3.08%). Similarly, men accounted for more deaths than women (483,266 vs 306,299), with a faster rise in mortality rates (AAPC: 3.89% vs 3.28%). In terms of YLLs, men bore a significantly higher burden (13.99 million vs 7.64 million), with a steeper upward trend (AAPC: 3.65% vs 3.08%). Age-stratified analysis showed that individuals aged 15–49 years experienced the fastest rise in DALYs, mortality, and YLLs (AAPC: 3.03% for all), followed by those aged 70+ years and 50–69 years. SDI analysis indicated that middle-SDI regions experienced the highest increase in DALYs (AAPC: 4.57%), mortality rates (AAPC: 4.91%), and YLLs (AAPC: 4.56%), followed by high-SDI and low-middle SDI regions. Conclusion: HBMI continues to drive a rising global burden of LC, with men, younger adults, and middle-SDI regions experiencing the steepest increases in DALYs, mortality, and YLLs. These findings underscore the urgent need for targeted obesity prevention and liver cancer control strategies across vulnerable populations.