Global, Regional, and National Burden of Liver Cancer from 1990 to 2021 and Projections to 2050: A Global Burden of Disease Study 2021

Background/Aims: This study assessed the burden of liver cancer (LC) and its major risk factors from 1990 to 2021, with projections to 2050. Methods: The global and regional LC burden from 1990 to 2021 was extracted from the Global Burden of Disease Study 2021, and stratified by age, sex, Sociodemographic Index (SDI), region, and etiological category. Trends for the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR) were evaluated using estimated annual percentage changes. Attributable risk factors, including alcohol use, drug use, a high body mass index, tobacco use, and high fasting plasma glucose levels, were examined. Projections of the LC burden to 2050 were modeled under baseline and hypothetical risk elimination scenarios. Results: The global ASMR of LC remained stable, from 5.86 per 100,000 population (95% uncertainty interval [UI], 5.38 to 6.46) in 1990 to 5.65 (95% UI, 5.13 to 6.30) in 2021. Regions with an initially high ASMR showed increases until the early 2000s, then decreased. The LC burden increased sharply with age and was consistently higher in males, particularly in high-SDI regions. Mortality varied by etiology, with hepatitis B virus as the leading cause, followed by hepatitis C virus and alcohol use. Major risk factors were alcohol and tobacco use among males and drug and alcohol use among females. By 2050, the ASMR and ASDR of LC are projected to reach 6.23 per 100,000 population (95% UI, 4.94 to 8.09) and 158.91 (95% UI, 125.34 to 210.28), respectively, but could decrease to 5.32 (95% UI, 4.21 to 6.95) and 135.33 (95% UI, 106.74 to 179.05) under improved metabolic and behavioral risk scenarios. Conclusions: Despite public health interventions, LC is estimated to maintain a significant global burden.