Global burden of primary liver cancer and its association with underlying aetiologies, sociodemographic status, and sex differences, 1990-2019: a DALYs-based analysis of the Global Burden of Disease 2019 study

Background and aims: Global distribution of dominant liver cancer aetiologies has changed greatly over the past decades with the development of potent antivirals, change in screening and immunization policies. This study aimed to analyse the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019. Methods The Global Burden of Disease 2019 report was used for statistical analysis. Also, we performed stratification analysis to five quintiles by sociodemographic index and 21 regions based on geography. Results The crude number of liver cancer disease-adjusted life years (DALYs) and deaths increased significantly during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the age-standardised DALYs and mortality rates declined. HBV remains the leading cause of liver cancer DALYs and mortality, followed by HCV, alcohol consumption, and NASH/ NAFLD. While age-standardised DALYs and mortality rates of liver cancer due to HBV and HCV have decreased, those due to alcohol consumption and NASH/NAFLD have increased. In 2019, the East Asia region had the highest age-standardised DALYs and mortality rates, followed by high-income Asia Pacific and Central Asia. While East Asia and high-income Asia Pacific regions displayed a decrease during the study period, Central Asia’s age-standardised DALYs rates increased. High-income North America and Australasia also showed a dramatic increase. Conclusions Liver cancer remains an ongoing global threat. The burden of liver cancer related to alcohol consumption and NASH/NAFLD is rising at worrying levels and is projected to continue to increase dramatically