Disparities and Trends in Liver Cancer Burden Due to Hepatitis B Across Five Asian Regions: Analysis from 1990 to 2023 with Projections to 2038

Objective To analyze the spatial distribution, temporal trends, and mechanisms of liver cancer attributable to hepatitis B (LCHB) across Asia from 1990 to 2023, evaluate health inequalities, and project future burden. Methods Epidemiological data on the LCHB were extracted from the Global Burden of Disease (GBD) 2023 database. The age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life- years (DALYs) rate (ASDR) were calculated. Joinpoint regression, Das Gupta decomposition, data envelopment analysis (DEA), slope index of inequality (SII), concentration index (CI), and a Bayesian age-period-cohort (BAPC) model were applied to assess the trends, drivers, inequality, efficiency, and future projections. Results In 2023, Asia had ~ 244,300 prevalent cases (ASPR 4.398/100,000), 166,700 new cases (ASIR 3.000/100,000), 142,500 deaths (ASMR 2.572/100,000), and 4.42 million DALYs (ASDR 79.433/100,000). East Asia has the highest prevalence (75.5%). From 1990 to 2023, the overall ASPR, ASIR, and ASMR decreased (estimated annual percentage changes(EAPCs) − 0.734% to − 1.477%), whereas South Asia increased (EAPCs 0.192–0.335%). Post-2020 rebound was notable. Inequalities persisted, with the SII worsening in East Asia and the burden concentrated in countries with lower SDI. The BAPC projected a 23% increase in ASPR and 68% increase in prevalence by 2038. Conclusions LCHB burden in Asia declined in the long term, but rebounded after 2020, with significant regional disparities and persistent inequalities. Targeted prevention, screening, infection control, and optimized resource allocation are essential for reducing the burden and improving health equity.