Epidemiological trends and burden of liver cancer mortality due to hepatitis B in Sub-Saharan Africa: A retrospective analysis from 1990 to 2023 with advanced machine learning forecasting to 2050.

e16233 Background: Liver cancer due to hepatitis B virus (HBV) remains a major cause of cancer mortality in sub-Saharan Africa, where high chronic HBV prevalence, limited vaccination coverage, and late diagnosis drive substantial burden. Methods: This study utilized age-standardized mortality rates (ASMR per 100,000) for HBV-related liver cancer from the IHME Global Burden of Disease 2023 database for sub-Saharan Africa, stratified by sex (Both, Female, Male), covering 1990–2023. Historical trends were quantified using estimated annual percentage change (EAPC) derived from log-linear regression of ASMR. Future mortality projections to 2050 were generated using autoregressive integrated moving average (ARIMA) time-series models. ARIMA parameters (p, d, q) were selected via auto.arima algorithm based on minimizing AIC, with non-seasonal differencing applied as needed to achieve stationarity. Models were fitted to the full historical series, producing point forecasts and 95% prediction intervals (PI) assuming Gaussian errors. Results: In sub-Saharan Africa, age-standardized mortality rates (ASMR per 100,000) for HBV-related liver cancer declined substantially from 1990 to 2023. For Both sexes, ASMR fell from 5.88 in 1990 to 3.93 in 2023, with an estimated annual percentage change (EAPC) of -1.75% (95% CI -1.89 to -1.61). Males showed a steeper absolute and relative decline, dropping from 10.00 (1990) to 6.71 (2023) (EAPC -1.75%, 95% CI -1.90 to -1.60), while females declined more modestly from 1.90 to 1.47 (EAPC -1.25%, 95% CI -1.40 to -1.11). The male decline was consistent through the early decades but showed a clear plateau and recent upturn after 2019 (ASMR 5.87 in 2019 → 6.71 in 2023). ARIMA projections indicate reversal of the long-term trend, with male ASMR forecasted to rise from 7.15 (95% PI 6.95–7.35) in 2024 to 10.57 (95% PI 3.36–17.78) by 2050. Females followed a similar but less pronounced trajectory, with ASMR remaining relatively low and stable until a modest recent increase (1.25 in 2019 → 1.47 in 2023). Projections forecast female ASMR increasing from 1.59 (95% PI 1.54–1.65) in 2024 to 4.91 (95% PI 0.43–9.38) by 2050. Overall (Both sexes), the historical decline reversed in forecasts, with ASMR projected to rise from 4.24 (95% PI 4.14–4.35) in 2024 to 5.66 (95% PI 1.50–9.82) by 2050, largely driven by the male resurgence. Conclusions: HBV-related liver cancer mortality in sub-Saharan Africa declined substantially from 1990–2023 (EAPC -1.75%), with greater reductions in males (from 10.00 to 6.71) than females (1.90 to 1.47). However, ARIMA projections forecast a reversal, with ASMR rising to 5.66 (Both) by 2050, males reaching 10.57 and females 4.91. Intensified HBV vaccination, antiviral therapy scale-up, screening, and linkage to care are urgently needed to prevent projected resurgence.