Abstract:Background and Aims Liver cancer and cirrhosis/chronic liver diseases are major contributors to the global burden of liver disease. Their burden and etiologic profiles are influenced by multiple factors, including viral hepatitis, metabolic disorders, alcohol exposure, and population aging, with substantial geographic and population-level differences. As liver disease prevention and control measures continue to advance and risk-factor profiles evolve, the burden and etiologic composition of liver cancer and cirrhosis/chronic liver diseases may also change. This study aimed to systematically assess the burden, temporal trends, and etiologic profiles of liver cancer and cirrhosis/chronic liver diseases globally and in China from 1990 to 2023 using data from the Global Burden of Disease Study 2023 (GBD 2023), and to compare disease burden across socio-demographic index (SDI) strata and age- and sex-specific subgroups in China.Methods Data on incident cases, deaths, age-standardized incidence rates (ASIR), and age-standardized mortality rates (ASMR) for liver cancer and cirrhosis/chronic liver diseases and their major etiologies from 1990 to 2023 were obtained from the GBD Results Tool for the global population, China, and five SDI strata. Estimated annual percentage changes (EAPC) and their 95% confidence intervals (CI) were calculated to assess long-term trends in age-standardized rates. Etiologic proportions and mortality-to-incidence ratios (MIR) were calculated, and EAPC were compared across SDI strata and etiologies. Sex- and age-specific disease burden in China was further assessed for 2023. Etiologic proportions were calculated using the sum of the point estimates for the five included etiologies as the denominator.Results From 1990 to 2023, incident cases of liver cancer in China increased from 100 088 to 165 113, and deaths increased from 92 325 to 143 638. The ASIR decreased from 10.68 to 7.52 per 100 000 (EAPC=-1.386, 95% CI=-1.538--1.233), and the ASMR decreased from 10.13 to 6.44 per 100 000 (EAPC=-1.645, 95% CI=-1.814--1.474). During the same period, incident cases of cirrhosis/chronic liver diseases in China increased from 11 307 703 to 11 449 246, whereas deaths decreased from 164 354 to 120 865; the EAPCs for ASIR and ASMR were -0.789 and -4.014, respectively. The declines in age-standardized rates for both conditions in China were generally greater than those globally and in the corresponding SDI strata. The proportion of HBV-related liver cancer incidence in China decreased from 68.18% to 62.94%, while HBV-related disease accounted for 75.11% of cirrhosis/chronic liver disease deaths in 2023. The proportion of NAFLD-related cirrhosis/chronic liver disease incidence increased from 54.77% to 81.80%, accompanied by an increasing ASIR (EAPC=0.752, 95% CI=0.594-0.910). Globally, the ASIRs of alcohol-related and NASH-related liver cancer increased, with EAPCs of 0.264 and 0.539, respectively. In China, ASIRs for all liver cancer etiologies decreased, although the declines for NASH-related and alcohol-related liver cancer were relatively slower. In 2023, the male-to-female ratios of liver cancer ASIR and ASMR were 3.20 and 3.04, respectively, and the ratio of cirrhosis/chronic liver disease ASMR was 2.88. Individuals aged ≥70 years accounted for 29.96% of liver cancer incident cases, 35.39% of liver cancer deaths, and 38.03% of cirrhosis/chronic liver disease deaths.Conclusion From 1990 to 2023, the age-standardized burden of liver cancer and cirrhosis/chronic liver diseases generally declined globally and in China, although the absolute burden remained substantial. China continued to experience a high HBV-related burden, accompanied by increasing contributions from metabolic and alcohol-related etiologies and a disproportionate burden among males and older adults. Future prevention and control strategies should continue to prioritize viral hepatitis while strengthening the management of metabolic risk factors and alcoholic liver disease and implementing targeted interventions for high-risk populations, particularly males and older adults.