The Global Burden of Primary Liver Cancer and Underlying Etiologies from 1990 to 2021.

10573 Background: Liver cancer is a leading cause of global health burden, and was the seventh leading cause of cancer death in 2021. The most common type of liver cancer in adults is hepatocellular carcinoma, which can be due to alcohol, hepatitis B, hepatitis C, non-alcoholic steatohepatitis (NASH), or other causes. In children the most common type of liver cancer is hepatoblastoma. Comprehensive and comparative estimation of liver cancer burden can inform policy decisions and public health interventions to reduce incidence, morbidity, and mortality. This study provides updated liver cancer estimates from 1990 to 2021, and for the first time includes hepatoblastoma. Methods: Using estimation methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) we comprehensively estimated total liver cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability adjusted life-years (DALYs). Etiologic proportions from meta-analyses of literature review data were applied to the total. Liver cancers under age 10 were attributed to hepatoblastoma. YLLs were calculated using life expectancy estimates. Prevalence and YLDs were calculated from expected survival, disease sequelae, and disability weights. DALYs were the sum of YLLs and YLDs. Results are presented with 95% Uncertainty Intervals (95% UI). Results: Globally, there were an estimated 529,000 (95% UI 480,000 – 594,000) liver cancer cases and 484,000 (437,000 – 538,000) deaths in 2021, contributing to 12,900,000 (11,600,000 – 14,400,000) DALYs. Since 1990, these represented increases of 114.3% (87.0 – 145.3%) in cases, 102.5% (76.4 – 132.0%) in deaths, and 70.6% (48.7 – 96.8%) in DALYs. For liver cancer etiologies (excluding hepatoblastoma), 37.4% (32.6 – 42.6%) of deaths were due to hepatitis B, 30.3% (26.3 – 34.8%) hepatitis C, 19.1% (15.8 – 22.8%) alcohol, 8.5% (6.9 – 10.3%) NASH, and 4.3% (3.6 – 5.1%) other causes in 2021. Conclusions: These GBD 2021 estimates provide comprehensive estimates of the substantial health burden of liver cancer, highlighting a continued need for public health efforts targeting prevention, vaccination, treatment, or behavioral change.[Table: see text]