Global, regional, and national health inequalities in hepatitis B virus-related liver cancer in 204 countries, 1990-2021

Background Hepatitis B virus-related liver cancer (HBV-LC) is a significant public health challenge, particularly in low- and middle-income countries. Despite advancements in vaccination and antiviral therapies, global disparities persist. Objective This study provides a comprehensive analysis of the global, regional, and national burden of HBV-LC from 1990 to 2021 and projects future trends to 2036, using data from the Global Burden of Disease (GBD) 2021 study. Methods Data on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) were extracted from GBD 2021. Joinpoint regression was used to analyze trends, and Bayesian age-period-cohort (BAPC) models were employed to forecast future burden. Results In 2021, an estimated 288,106 global cases of HBV-LC were reported, with an age-standardized prevalence rate (ASPR) of 3.32 per 100,000 people. The global incidence rate (ASIR) was 2.37 per 100,000, while the mortality rate (ASMR) was 2.09 per 100,000. From 1990 to 2021, the ASIR declined by 0.22%, and the DALYs decreased by 0.79 years per 100,000. The highest burden was observed in East Asia and the High-income Asia Pacific region, while the lower SDI regions experienced more significant mortality. Projections from the BAPC model indicate continued declines in both ASIR and ASMR through 2036, particularly among females. Conclusion This study highlights a global reduction in the HBV-LC burden over the past three decades, yet significant disparities remain between regions. Future efforts should focus on expanding access to vaccination and antiviral therapies in low-SDI areas to further mitigate the disease burden.