Global trends in early-onset liver cancer incidence and projections to 2050 based on the global burden of disease study 2021

Early-onset liver cancer (EOLC) affects individuals aged 15–49 and poses a major global health challenge. This study evaluates health inequalities in EOLC burden across regions and sexes to support effective, targeted interventions Using Global Burden of Disease (GBD) 2021 data, we analyzed global EOLC incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. Analyses included Joinpoint regression, decomposition, locally estimated scatterplot smoothing (LOESS), and frontier efficiency assessment. Trends to 2050 were projected via a gender-stratified Bayesian age-period-cohort (BAPC) model. Absolute EOLC burden increased globally, though age-standardized rates (ASRs) declined overall. Notably, age-standardized incidence rates (ASIRs) rose among women in high socio-demographic index (SDI) regions and among men in low-middle SDI regions. Hepatitis B virus (HBV) remained the leading cause, but alcohol, hepatitis C virus (HCV), and nonalcoholic steatohepatitis (NASH), especially in young women, showed increasing contributions. Population growth and aging drove increases in the absolute burden. Frontier analysis identified Mongolia as the lowest-performing country, while Somalia, Burundi, and Ethiopia achieved relatively efficient control. The BAPC model projects continued declines in ASR by 2050, yet female ASR is expected to rise modestly. In light of persistent gender and regional inequities and the rising impact of metabolic risks such as NASH, urgent and coordinated action is needed. Stakeholders must implement targeted etiology-specific strategies, prioritize early screening for high-risk groups—especially young women—and invest in stronger health systems in regions with the greatest need. These steps are critical to effectively reduce the global burden of EOLC.