Global burden and trends of primary liver cancer are attributable to high BMI among hepatitis B patients: based on the 2021 global burden of disease study

Objective: To analyze the global, regional, and national epidemiological trends of liver cancer in hepatitis B patients attributable to high body mass index (BMI) from 1990 to 2021, with an emphasis on health inequalities. Methods: Using the Global Burden of Disease (GBD) 2021 study, we assessed the temporal trends in mortality and disability-adjusted life years (DALYs) for liver cancer attributable to high BMI among hepatitis B patients. We also analyzed how liver cancer mortality and DALYs varied by age, period, and birth cohort. The BAPC model was used to project trends from 2021 to 2050. Additionally, decomposition analysis was conducted to identify key drivers of changes, and health inequalities were evaluated. Finally, frontier analysis was performed in countries and regions worldwide. Results: From 1990 to 2021, the mortality and DALY rates for liver cancer attributable to high BMI in hepatitis B patients showed an upward trend globally, with EAPCs of 2.49 (95% CI: 2.39 to 2.59) and 3.01 (95% CI: 2.88 to 3.14), respectively. These trends were primarily driven by epidemiological changes and population growth. Projections indicate that the burden of liver cancer will continue to rise by 2050. Regions with higher Socio-demographic Index (SDI) exhibited significantly greater burdens. Age-effect analysis revealed that liver cancer mortality increased progressively with age. The disease burden was consistently higher in males than in females. Period-effect analysis showed an increasing burden of liver cancer attributable to high BMI among hepatitis B patients over time. For cohort effects, individuals born in later cohorts exhibited a higher overall risk compared to those born in earlier cohorts. Cross-national inequality analysis revealed significant disparities, with increasing inequalities in low SDI countries. In the frontier analysis, countries with the largest effective differences included Tonga, Mongolia, and Swaziland. Conclusion: The burden of liver cancer attributable to high BMI in hepatitis B patients has been increasing globally. Tailored preventive strategies targeting obesity should be implemented among hepatitis B patients.