Global, Regional, and National Burden of Liver Cancer Due to Alcohol Use, 1990-2021: a Systematic Analysis for the Global Burden of Disease Study 2021

OBJECTIVE: To estimate the global, regional, and national burden of liver cancer attributable to alcohol use from 1990 to 2021, and to project trends to 2050. METHODS: Systematic analysis of GBD 2021 data covering 204 countries and territories, 21 regions, and 5 SDI quintiles. Numbers and age-standardised rates of deaths, DALYs, prevalence, and incidence were analysed. EAPC and AAPC quantified temporal trends; Spearman correlation, decomposition analysis, health inequality assessment, and efficiency frontier analysis were performed. ARIMA models projected trends to 2050. RESULTS: In 2021, alcohol use accounted for 92,228 deaths (95% UI 75,053-112,160) and 2.32 million DALYs (95% UI 1.89-2.85 million) globally, with age-standardised mortality and DALY rates of 1.17 and 29.35 per 100,000. From 1990 to 2021, the age-standardised mortality, DALY, incidence, and prevalence rates all increased. The highest rates were observed in Western Europe, Australasia, and High-income Asia Pacific. High SDI regions had the greatest burden and the steepest increases, whereas Low SDI regions showed modest declines. SDI was positively correlated with all burden metrics. Population growth and aging were the primary drivers of increasing death counts, and the SII for mortality widened from 1990 to 2021. Mongolia had the largest avoidable burden. CONCLUSION: The global burden of alcohol-attributable liver cancer has increased substantially over three decades, with marked geographical and socioeconomic disparities.