Global Trend of MASH-associated Liver Cancer: A Systematic Analysis From the Global Burden of Disease 2021

Background & Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are the leading causes of liver disease and are emerging as the main risk factors for primary liver cancer (PLC). However, updated global data on MASH remain scarce. Methods: This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from MASH-associated PLC, stratified by geographical region, sociodemographic index, age, and sex. Results: There were 42,290 incident cases, 40,920 deaths, and 995,470 DALYs from PLC globally. Global incidence (+98%), death (+93%), and DALYs (+76%) from MASH-associated PLC increased steeply over the study period. Among different etiologies, only MASH-associated PLC had increased mortality rates (annual percent change [APC], +0.46; 95% confidence interval [CI], 0.33%–0.59%). Africa and low sociodemographic index countries exhibited the highest age-standardized incidence, death, and DALYs from MASH-associated PLC. DALYs increased in females (APC, 0.24%; 95% CI, 0.06%–0.42%), whereas they remained stable in males. Americas experienced the highest percentage increase in age-standardized incidence rate (APC, 2.09%; 95% CI, 2.02%–2.16%), age-standardized death rate (APC, 1.96%; 95% CI, 1.69%–2.23%), and age-standardized DALYs (APC, 1.96%; 95% CI, 1.63%–2.30%) from MASH-associated PLC. Conclusions: Over the past 2 decades, the burden of MASH-associated PLC has risen, though there are sociodemographic and geographic disparities. This necessitates urgent strategies across the globe to mitigate the epidemic of MASH-associated PLC as well as its metabolic drivers.