Key result
Global NASH-related HCC incidence rises ~25% over three decades.
Why the study?
MASLD and NASH are leading causes of hepatocellular carcinoma, and the MASLD burden is increasing rapidly alongside rising global obesity and metabolic syndrome.
Observational
The global burden of NASH-related HCC is accelerating, particularly in high-SDI regions, highlighting the need for metabolic management and early screening.
Answers are grounded in this paper and cite their sources.
Rising NASH-related HCC incidence urges metabolic risk mitigation; leaves open optimal prevention strategies in high-SDI regions.
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), particularly its progressive form, nonalcoholic steatohepatitis (NASH), has emerged as a leading cause of hepatocellular carcinoma (HCC). The burden of MASLD is increasing rapidly in parallel with the rising global prevalence of obesity and metabolic syndrome, affecting approximately 30% of the world's population. Objective: This study aimed to quantify global trends in NASH-related liver cancer incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 and to project the future disease burden through 2035. Methods: Data from the Global Burden of Disease Study 2021, encompassing 204 countries, were utilized to evaluate age-standardized incidence (ASIR), mortality (ASMR), and DALY rates (ASDR) across 21 regions and five Socio-demographic Index (SDI) categories, with stratification by age, sex, and geographical location. Future trends were projected using statistical modeling approaches, while decomposition analysis was employed to identify the key drivers of changes in disease burden. Results: From 1990 to 2021, global ASIR of NASH-related HCC increased by 25% (0.4-0.5 per 100,000), with an EAPC of +3.5% (95% UI: 3.4-3.6). ASMR rose by 150% (0.2-0.5 per 100,000; EAPC + 3.2%), and ASDR increased by 20% (9.6-11.5 per 100,000; EAPC + 2.9%).Regional disparities: Australasia saw the steepest rise (ASIR + 200%, EAPC + 7.2%; ASMR + 150%, EAPC + 6.9%). High-income North America followed (ASIR + 160%, EAPC + 5.3%).Age/sex differences: Incidence peaked in ages 85-89 (6.31 per 100,000 men; 5.56 per 100,000 women). Men had higher burden, for example, 55-59 years: male ASIR 1.28 vs. female 0.87 per 100,000. but gender gaps narrowed after age 75.Risk drivers: Metabolic factors such as high fasting glucose accounted for 29.7% of deaths in ages 80-84; smoking contributed 11.1% in ages 55-59.Projections: By 2035, ASIR will rise to 0.74 per 100,000 (+7% from 2021), driven by aging, population growth, and epidemiological changes (52% of incidence increase globally). Conclusion: NASH-related HCC burden exhibits accelerating global growth, concentrated in high-SDI regions. Prioritizing metabolic management and early screening is critical to mitigate future burden.
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Cui et al. (2026) conducted an observational in NASH-related hepatocellular carcinoma (HCC). Time period (1990 to 2021) vs. 1990 baseline was evaluated on Global age-standardized incidence rate (ASIR) of NASH-related HCC per 100,000 (EAPC +3.5%, 95% CI 3.4-3.6). From 1990 to 2021, the global age-standardized incidence of NASH-related hepatocellular carcinoma increased by 25% (from 0.4 to 0.5 per 100,000), with an estimated annual percentage change of +3.5%.
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