Global trends in incidence and mortality of liver cancer by etiology and sociodemographic index among adolescents and young adults, 1990–2023.

e22583 Background: Liver cancer in adolescents and young adults (AYA) is an emerging global challenge with evolving etiologic drivers and persistent disparities in prevention and treatment. Long-term, etiology-specific global data focused on AYAs remain limited. Using Global Burden of Disease (GBD) 2023 data, we assessed trends in liver cancer incidence and mortality by etiology and country-level sociodemographic index (SDI). Methods: We conducted a population-based observational analysis using GBD 2023 data. Age-standardized incidence (ASIR) and death rates (ASDR) for liver cancer among AYAs (15–39 years) were evaluated globally from 1990–2023, stratified by etiology (hepatitis B virus [HBV], hepatitis C virus [HCV], alcohol use, and nonalcoholic steatohepatitis [NASH]) and SDI. Percent change was calculated across predefined periods (1990–1999, 2000–2009, 2010–2019, and 2020–2023). Results: In 2023, an estimated 33,736 incident cases and 24,754 deaths from liver cancer occurred among AYAs globally. From 1990–2023, ASDR declined by 8.9% and ASIR by 3.8%, with a parallel reduction in disability-adjusted life-years (−5.5%). HBV remained the leading etiology yet demonstrated the largest long-term mortality decline (ASDR −18.3%), with pronounced reductions in high-middle SDI (−34.5%) and high SDI (−29.5%) regions. In contrast, mortality increased for NASH (+30.4% globally; +51.4% in middle SDI) and alcohol-related liver cancer (+35.9%). HBV-related mortality remained highest in low-SDI regions in 2023 (ASDR 0.777 per 100,000), while HCV mortality increased substantially in low-middle SDI regions (+45.9%), contrasting with continued declines in high-SDI settings (−16.6% to −18.7%). Mortality trends followed a biphasic pattern, with increases in 1990–1999 (ASDR +8.6%), declines in 2000–2009 (−17.9%) and 2010–2019 (−10.9%), and a concerning reversal in 2020–2023 (ASDR +17.5%; ASIR +17.6%) across etiologies. Conclusions: As the largest global analysis of AYA liver cancer, this study demonstrates a recent re-acceleration in incidence and mortality driven by metabolic, alcohol-related, and HCV etiologies, with widening SDI-based disparities. These findings highlight liver cancer as an emerging early-onset malignancy and underscore the need for AYA-focused prevention strategies addressing metabolic risk, alcohol use, and viral hepatitis, particularly in regions undergoing epidemiologic transition. Period-specific percent change in liver cancer mortality among adolescents and young adults by etiology, 1990–2023. Death Rate Change (%): 1990-1999 2000-2009 2010-2019 2020-2023 Liver cancer 8.6% -17.9% -10.9% 17.5% Liver cancer due to HBV 10.7% -20.8% -16.7% 16.1% Liver cancer due to alcohol 9.3% -5.1% 6.9% 19.3% Liver cancer due to HCV 1.6% -5.1% 4.9% 21.4% Liver cancer due to NASH 4.9% -7.0% 8.3% 22.2%