Evolution, driving factors, and future incidence trends of the global burden of female liver cancer, 1990-2021

Abstract:

Background and Aims The disease burden of liver cancer in women has evolved substantially with demographic transitions and changes in etiological patterns worldwide. However, comprehensive evidence regarding its long-term epidemiological trends, driving factors, socioeconomic inequalities, and future incidence remains limited. This study aimed to characterize the global burden of female liver cancer from 1990 to 2021, quantify its major drivers and health inequalities, and project future incidence trends based on the Global Burden of Disease (GBD) 2021 database.Methods Data on incident cases and disability-adjusted life years (DALYs) of female liver cancer from 204 countries and territories were extracted from the GBD 2021 database. Temporal trends were assessed using the age-standardized rate (ASR). Decomposition analysis was performed to quantify the contributions of population growth, population aging, and epidemiological changes to variations in incident cases. Socioeconomic inequalities in DALY burden were evaluated using the slope index of inequality (SII) and the concentration index. A Bayesian age-period-cohort (BAPC) model was constructed to project global incidence trends from 2021 to 2050.Results Between 1990 and 2021, the global ASR of female liver cancer declined from 3.80 to 3.36 per 100 000, whereas the number of incident cases increased from 83 362 to 153 802. Decomposition analysis showed that population growth (61.48%) and epidemiological changes (54.46%) were the major contributors to the increase in incident cases, while population aging exerted a negative contribution (-15.94%), with substantial heterogeneity across socio-demographic index (SDI) regions. Age-specific analyses demonstrated that ASR increased markedly after 45-54 years of age, whereas the highest number of incident cases occurred among women aged 70-74 years. During the study period, the SII decreased from 112.11 to 88.19, and the concentration index declined from 0.140 to 0.037, indicating improvements in both absolute and relative socioeconomic inequalities, although a slight pro-rich inequality persisted. The BAPC model projected continued declines in both the global ASR and the expected number of incident cases under a standardized age structure by 2050.Conclusion Although the ASR of female liver cancer has declined globally over the past three decades, population growth has offset these gains, resulting in a sustained increase in the absolute disease burden. The drivers of disease burden differ substantially across socioeconomic settings, and despite improvements in health inequalities, the burden associated with metabolic risk factors in high-SDI regions remains a major concern. Region-specific prevention strategies and enhanced early screening for middle-aged and older women at high risk are warranted to further reduce the global burden of female liver cancer.