Exploring burden of liver malignancies due to NASH: An analysis of GBD-2021.

Abstract

e16298 Background: The growing burden of obesity, type 2 diabetes, and metabolic risk factors has driven a rise in non-alcoholic steatohepatitis (NASH)-related liver cancer, surpassing HBV and HCV as major contributors. Despite advancements, the impact of NASH on cancer incidence and mortality, especially in the elderly, remains underexplored. Using the Global Burden of Diseases-2021 database, this study examines trends in DALYs, ASMRs, YLD, and YLL from 1990–2021 to address the rising global impact of NASH-related liver malignancies. Methods: Data from GBD 2021 were analyzed for 204 countries and territories from 1990 to 2021. Age-standardized mortality rates (ASMRs), disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Average annual percent changes (AAPC) were calculated by linear regression. Results: Globally, the ASMRs for liver malignancies due to NASH demonstrated a moderate overall increase, with an AAPC of +0.79 (95% CI: 0.71–0.87). Countries with the steepest increases included the United Kingdom (UK) (+4.42), Australia (+4.30), and Uruguay (+4.21). Conversely, regions such as the Republic of Korea (-2.58), Zambia (-2.76), and Bulgaria (-2.68) exhibited significant declines. The global DALYs and YLLs also showed an upward trend, with overall AAPCs of +0.53 (95% CI: 0.45–0.62) and +0.53 (95% CI: 0.44–0.61), respectively. The UK (DALY: +4.28, YLL: +4.26) and Poland (DALY: +4.25, YLL: +4.25) experienced the highest increases in both metrics, whereas Zambia (DALY: -3.21, YLL: -3.21) and the Republic of Korea (DALY: -3.00, YLL: -3.02) demonstrated significant reductions. In terms of YLD, a modest global increase was observed, with an AAPC of +1.09 (95% CI: 1.01–1.17). The sharpest increases were reported in the UK (+5.21) and Australia (+5.14), while Zambia (-2.89) and Bulgaria (-2.44) exhibited notable declines. Conclusions: While regions such as Zambia and the Republic of Korea showed consistent improvements across all metrics. The rising burden of NASH-related liver malignancies in the UK and Australia may stem from increasing obesity, sedentary lifestyles, high-fat diets, and aging populations. Healthcare disparities, delayed diagnoses, and urbanization could further drive these trends. Policies focusing on prevention, lifestyle changes, and equitable care are critical to mitigating this issue ASMRs, DALYs, YLLs and YLDs for global burden of liver malignancies due to NASH between 1990 and 2021. Outcome Global AAPC P-value Highest AAPC Lowest Burden Country AAPC (95% CI) Burden Country (95% CI) (95% CI) ASMRs 0.79 <0.001 UK 4.42 Zambia -2.76 (-0.71 to -0.87) (4.20 to 4.65) (-3.27 to -2.25) YLLs 0.52 <0.001 UK 4.26 Zambia -3.21 (0.44 to 0.61) (4.04 to 4.49) (-3.76 to -2.65) DALYs 0.53 <0.001 UK 4.27 Zambia -3.21 (0.45 to 0.61) (4.05-4.50) (-3.76 to -2.65) YLDs 1.09 <0.001 UK 5.21 Zambia -2.89 (1.01 to 1.17) (4.98 to 5.45) (-3.38 to -2.39)