Global epidemiology of liver cancer burden due to hepatitis B virus: A comprehensive estimate based on Global Burden of Disease Study 2021

BACKGROUND: Liver cancer remains a significant global health concern, with hepatitis B virus (HBV) as the leading cause. This study aims to systematically evaluate the global epidemiological burden, risk factors, and long-term trends of HBV-related liver cancer. METHODS: Data from the Global Burden of Disease (GBD) study 2021 were used to analyze incidence, deaths, and prevalence rates of HBV-related liver cancer across 204 countries and territories. Age-period-cohort (APC) models were applied to assess age-specific trends, period effects, and cohort impacts on age-standardized disease burden. Pearson correlation analyses examined the relationship between liver cancer burden, the socio-demographic index (SDI), and the universal health coverage (UHC) index. We also evaluated the influence of other concomitant risk factors on HBV-related liver cancer deaths. Projections for future death trends were generated using Bayesian APC models. RESULTS: In 2021, there were 206,365.7 new cases of HBV-related liver cancer and 181,194.3 deaths worldwide. Between 1990 and 2021, both the global age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) showed an upward trend. The age-standardized death rate (ASDR) declined, particularly in middle SDI countries, where the ASDR dropped by 21.7%. Incidence rates decreased among individuals under 70 years old, while death rates dropped for those under 75 years. Period trends revealed an increase in incidence and deaths from 1995 to 2000, followed by a sharp decline from 2000 to 2010, with death reductions being more pronounced. The downward trend was most notable among birth cohorts from the 1970s onward. A negative correlation was found between the SDI, the UHC, and liver cancer burden. The number of deaths attributable to risk factors increased by 97.8% from 1990 to 2021. Projections indicate a 30.2% reduction in HBV-related liver cancer deaths globally by 2040. CONCLUSIONS: The global burden of HBV-related liver cancer showed significant regional disparities and presented ongoing global health challenges. Socioeconomic factors and healthcare access are closely associated with disease burden. Effective, region-specific interventions are essential to mitigate future HBV-related liver cancer burdens.