Disease Burden of Liver Cancer and Its Underlying Etiologies Globally and in China From 1990 to 2021: Results From the Global Burden of Disease Study 2021

ABSTRACT Aims As the sixth most common cancer globally, liver cancer exhibits dynamic shifts in its etiological spectrum, temporal and age distribution. The etiological spectrum, time, and age distribution of liver cancer are constantly changing. This study aimed to update the disease burden of liver cancer between 1990 and 2021 across 21 regions worldwide, especially in China, on the basis of the Global Burden of Disease (GBD) 2021 study. Methods Data from the GBD 2021 study were downloaded and used to describe the incidence, prevalence, mortality, and disability‐adjusted life years of liver cancer in 21 regions worldwide, especially in China. The disease burden of liver cancer was stratified by age, sex, and etiology. A joinpoint regression model and an age–period–cohort model were implemented in this study. Results The global age‐standardized incidence rate and prevalence rate of liver cancer increased by 4.2% and 11.9%, respectively, from 1990 to 2021. Countries with higher socio‐demographic index (SDI), such as Australasia and high‐income North America, experienced a greater increase (change of age‐standardized prevalence rate from 1990 to 2021: 257.9% for Australasia and 167.0% for high‐income North America) in liver cancer burden since 1990. China experienced a remarkable reduction (change of age‐standardized prevalence rate from 1990 to 2021: −1.7%) in the liver cancer burden from 1990 to 2021, especially between 2000 and 2005. The burden of hepatitis B virus (HBV)‐related liver cancer is declining, whereas that of nonalcoholic steatohepatitis (NASH)‐related liver cancer and alcohol‐related liver cancer is increasing. Conclusion The disease burden of liver cancer decreased in China and many other regions worldwide, but increased in high SDI countries like Australasia and high‐income North America from 1990 to 2021. In China, although HBV infection is still the leading cause of liver cancer, the incidence of HBV‐related liver cancer is declining, whereas that of NASH‐related liver cancer and alcohol‐related liver cancer is increasing.