S2506 From Male Dominance to Gender Convergence: Global and Regional Trends in Liver Cancer Burden Among Women (1990–2021)

Introduction: Liver cancer (LC), historically considered a man-dominant malignancy, has shown concerning trends among women over recent decades. While biological, hormonal, and environmental factors contribute to this shift, comprehensive sex-specific analyses remain limited. Methods: We analyzed age-, year-, and location-specific estimates of liver cancer burden in women, including mortality modeled by CODEm, non-fatal outcomes by DisMod-MR 2.1, and risk-attributable burden via population attributable fractions, as reported in the Global Burden of Disease Study 2021. Temporal trends in incidence, mortality, DALYs, and YLDs were evaluated using log-linear regression models to derive the annual percentage change (APC) and quantify global and regional shifts over time. Results: From 1990 to 2021, the total number of LC cases in women doubled, with incidence rising from 75,694 (67,486–85,264) to 164,847 (147,932–181,387), deaths from 76,126 (67,562–86,272) to 159,178 (142,936–175,020), and DALYs from 2.2 million (1.9–2.4) to 3.8 million (3.4–4.1). Regionally, the highest annualized increase in incidence was observed in the Region of the Americas (APC: 3.87%), followed by South-East Asia (3.33%) and the Eastern Mediterranean (2.71%), while Europe (1.95%) and Africa (2.09%) showed more modest trends. Based on World Bank classification, North America recorded the highest rise in DALYs (APC: 4.00%), followed by Latin America and the Caribbean (2.62%) and the Middle East and North Africa (2.32%), with smaller increases in East Asia and Pacific (1.28%) and Europe and Central Asia (1.39%). Age-wise, the burden was greatest among women aged 55+ (DALYs: 2.47%, deaths: 2.77%), moderate in the 20–54 group (DALYs: 1.04%, deaths: 1.15%), and declined in those under 20 (DALYs: –1.61%). Conclusion: Deaths due to LC in women accounted for 3.71% of all cancer related deaths in 2021. The LC burden in women is rising, masked by the overshadowing man predominance in earlier epidemiological reports. The shifting etiological landscape, particularly the rise in NASH and persistent hepatitis infections, demands gender-sensitive prevention, early detection, and treatment strategies. Policy efforts must prioritize equitable access to hepatitis vaccination, lifestyle interventions, and liver health surveillance tailored for women to mitigate this growing public health concern.