Asian Burden of Liver Cancer 1990-2021 and Predictions to 2040: An Analysis of the Global Burden of Disease Study 2021.

BackgroundLiver cancer (LivCa) is one of the most prevalent malignancies globally, and can result from viral hepatitis, non-alcoholic steatohepatitis (NASH), and alcohol use. LivCa is of increasing concern in Asia, but the burden of etiology-specific LivCa and future projections remain to be elucidated.MethodsWe extracted the incidence, mortality, and disability-adjusted life years (DALYs) of LivCa across Asia and in 34 Asian countries in 1990-2021 from the Global Burden of Disease Study 2021 (GBD 2021). We then calculated their estimated annual percentage change (EAPC) and percentage variation to quantify the changes in the burden of LivCa. The association of the level of social development with LivCa burden was explored using the sociodemographic index (SDI). Moreover, the trend of the epidemiology of LivCa burden in Asia from 2022 to 2040 was predicted using the Bayesian age-period-cohort (BAPC) model.ResultsOverall, the age-standardized incidence, mortality, and DALYs rates of LivCa in Asia showed a general declining trend, with EAPCs of -0.47, -0.73, and -1.14, respectively. Notably, hepatitis B virus remained the predominant cause. However, the burdens attributed to non-alcoholic steatohepatitis and alcohol use increased significantly, while that of hepatoblastoma decreased. Regarding demographic distribution, the highest disease burden was observed among males and the elderly population aged 85-94 years. Geographically, Nepal, Taiwan (Province of China), India, and Malaysia contributed most substantially to the increasing burden. In terms of risk factors, high BMI and alcohol use were prominent in Central Asia, whereas smoking was a key factor in East and Southeast Asia. Additionally, a positive correlation was observed between the SDI and the burden of LivCa. Finally, projections from the BAPC model indicated a persistent decline in the burden of LivCa from 2022 to 2040.ConclusionsDespite the overall decreasing trend, targeted strategies addressing etiology-specific risks and regional disparities are urgently needed to further reduce the future burden of LivCa in Asia.