Global, regional, and National burden of metabolic dysfunction-associated steatohepatitis-related liver cancer in older adults: trends and cross-national inequality based on the global burden of disease study 2021

Abstract

Background: Understanding the temporal trends of metabolic dysfunction-associated steatohepatitis-related liver cancer (MASH-LC) in older adults is crucial for raising public awareness and informing future policy decisions.

Methods: This is the first study to use Global Burden of Disease (GBD) data to analyze the burden of MASH-LC specifically in adults aged 65 years and older. Utilizing data from GBD 2021, we analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of MASH-LC among individuals aged 65 and older from 1990 to 2021. We also examined corresponding age-standardized rates and conducted stratified analyses based on region, sex, age, and temporal changes. To assess cross-national health inequality, we further applied the slope index of inequality (SII) and concentration index (CI), which have not been previously employed in studies of MASH-LC among older adults.

Results: Globally, age-standardized incidence, mortality, and DALYs rates (ASIR, ASMR, and ASDR) of MASH-LC in older adults exhibited a significant upward trend, with a higher burden observed in males. The absolute numbers of incidence, deaths, and DALYs increased by 251.59%, 231.08%, and 211.00%, respectively. While ASIR declined notably in high-sociodemographic index (SDI) regions, ASMR and ASDR were highest in low-SDI regions by 2021. China bore the heaviest burden globally, whereas Australia and the United Kingdom experienced the most substantial growth. Cross-national inequality analyses indicate that indicated that the burden of MASH-LC in older adults was more concentrated in low-SDI countries. Additionally, the disease burden escalated with age, with peak burden ages differing slightly between sexes.

Conclusion: The global burden of MASH-LC in older adults has risen markedly. Targeted preventive strategies are urgently needed to mitigate disease progression and reduce disparities across populations.

Keywords: Cross-national inequality; Liver cancer; Metabolic dysfunction-associated steatohepatitis; Older adults; Temporal trends.

Fig. 1

The global trends in number and AAPC of incidence (A, D), mortality (B, E), and DALYs (C, F) of MASH-LC in older adults from 1990 to 2021. AAPC, average annual percentage change; DALYs, disability-adjusted life years; LC, liver cancer; MASH, metabolic dysfunction-associated steatohepatitis

Fig. 2

The ASIR (A, D), ASMR (B, E), and ASDR (C, F) burden of MASH-LC in older adults, along with its AAPC by sex, globally, 5 SDI regions, and in 21 GBD regions. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years rate; AAPC, average annual percentage change; LC, liver cancer; MASH, metabolic dysfunction-associated steatohepatitis; SDI, sociodemographic index

Fig. 3

The ASIR (A, D), ASMR (B, E), and ASDR (C, F) burden of MASH-LC in older adults, along with its AAPC in 204 countries worldwide. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years rate; AAPC, average annual percentage change; LC, liver cancer; MASH, metabolic dysfunction-associated steatohepatitis

Fig. 4

The trends in rate of incidence (A), mortality (B), and DALYs (C) for MASH-LC in older adults across different sexes by age groups ranging from 65 years to 95 + years. Abbreviations: DALYs, disability-adjusted life years; LC, liver cancer; MASH, metabolic dysfunction-associated steatohepatitis

Fig. 5

SDI-related health inequality slope index (A) and concentration index (B) for DALYs of MASH-LC in older adults worldwide, 1990 and 2021. Abbreviations: DALYs, disability-adjusted life years; LC, liver cancer; MASH, metabolic dysfunction-associated steatohepatitis; SDI, sociodemographic index.