Epidemiological trends of NASH-related liver cancer in young and middle-aged populations: A global disease burden analysis from 1990 to 2021.

Recent decades have seen an increase in the incidence and mortality rates of early-onset cancers in adolescents and adults aged 15 to 49 years. The incidence and mortality rates of liver cancer caused by NAFLD have been increasing on an annual basis; however, the most recent global data on liver cancer caused by NAFLD has not been reported. A detailed analysis of trends in early-onset hepatocellular carcinoma attributable to NASH (EO-NRLC) from 1990 to 2021 was conducted using data from the global burden of disease study for 204 countries, 21 regions, and 5 sociodemographic indices (SDI) regions, with separate analysis conducted for each category. Prevalence rates, mortality rates, YLLs, YLDs, and disability-adjusted life years (DALYs) were calculated based on vital registration data, adjusted for age and reporting per 1,00,000 population, with a UI of 95%. Subsequently, we performed SDI analysis, as well as trend analysis based on age groups. In addition to this, decomposition analysis, age-period-cohort analysis, and Bayesian age-period-cohort projection and frontier analysis were also conducted. The prevalence (0.61 [0.49, 0.73]), mortality (0.48 [0.39, 0.58]), rate of DALYs (11.50 [9.39, 13.84]), and morbidity (0.49 [0.40, 0.60]) of EO-NRLCs in 2021 compared with 1990 were increasing. The analysis indicates that age-standardized indicators, encompassing prevalence, morbidity, mortality, and DALYs, have exhibited an accelerated increase in regions characterized by higher SDIs and more economically developed economies, particularly in Australia, Europe, and North America. Conversely, numerous low SDI countries and less developed economies continue to exhibit comparatively elevated age-standardized rates for these 4 indicators. It is also noteworthy that all indicators are higher for men than for women as a whole. Subsequent Bayesian age-period-cohort projection analyses suggest that the indicators will remain high and increasing through 2040. The substantial increase in the incidence, prevalence, mortality, and DALYs of EO-NRLC across multiple regions from 1990 to 2021 is projected to impose a considerable socioeconomic burden on governments and health systems in the coming years. The findings of this study may inform policymakers in developing strategies to address EO-NRLC, with particular emphasis on strengthening professional training to mitigate the burden of this complex disease.