Burden of alcohol-related cirrhosis and liver cancer in India: Analysis of Global Burden of Disease Study 2023

Background: Alcohol-related liver disease is a leading cause of chronic liver disease in India, yet comprehensive national data describing the long-term burden of alcohol-related cirrhosis and liver cancer are limited. We evaluated temporal trends and geographic variation in alcohol-related cirrhosis and liver cancer using the Global Burden of Disease (GBD) Study 2023. Methods: We performed a secondary analysis of GBD 2023 estimates for alcohol-related cirrhosis and alcohol-related liver cancer. Age-standardized incidence, prevalence, mortality, absolute case numbers, annualized percentage change (APC), sex-specific differences, state-level variation, and comparisons with global estimates were evaluated. Results: Between 1990 and 2023, age-standardized incidence, prevalence, and mortality of alcohol-related cirrhosis declined by 45.0%, 35.4%, and 39.3%, respectively, while absolute numbers of prevalent cases, incident cases, and deaths increased by 57.4%, 34.3%, and 49.8%, respectively. In contrast, alcohol-related liver cancer showed increases in age-standardized prevalence (59.0%), incidence (55.6%), and mortality (77.6%), accompanied by a 3- to 6-fold rise in absolute burden, although APCs were not statistically significant. India had higher age-standardized cirrhosis incidence, prevalence, and mortality than the global average in 2023, whereas alcohol-related liver cancer rates remained lower than global estimates. Men had 2- to 4-fold higher disease burden than women. Marked geographic heterogeneity was observed, with northeastern states carrying the highest burden. Conclusions: Although age-standardized alcohol-related cirrhosis rates have declined in India, the absolute burden of cirrhosis and alcohol-related liver cancer continues to rise. These findings highlight the need for strengthened alcohol-control policies, expanded liver disease surveillance, and targeted interventions in high-burden states.