The liver cancer due to non-alcoholic steatohepatitis attributable to metabolic risk factors in 204 countries and territories, 1990–2021: an age–period–cohort analysis from the global burden of disease study

Background: Non-alcoholic steatohepatitis (NASH)-related liver cancer (LC), attributable to metabolic risk factors, is a significant global health challenge. This study investigates its burden from 1990-2021, focusing on temporal trends, geographic disparities, and demographic patterns, with projections to 2050. Methods: We analyzed data from the GBD 2021. Disability-adjusted life years (DALYs) and deaths were quantified by sex, age, and sociodemographic index (SDI) quintiles. Decomposition, age-period-cohort, and Bayesian modeling were employed to evaluate drivers and project trends. Results: From 1990-2021, global DALYs and deaths due to NASH-related LC attributable to metabolic risk factors nearly tripled, with the DALY age-standardized rate (ASR) rising by 81.2% (95% CI: 60.2–105.1%) and the death ASR by 90.9% (95% CI: 67.4–116.3%). High-SDI countries had the highest ASRs, but low/low-middle SDI regions saw the fastest growth, particularly among younger populations. Males bore a higher burden, though female rates increased faster in older groups. Epidemiological changes (41.8%), aging (29.5%), and population growth (28.7%) drove DALY increases. Projections suggest DALYs and deaths will nearly triple by 2050, shifting toward older ages. Conclusion: The global burden of NASH-related LC is increasing sharply, with significant temporal, geographic, and demographic disparities. These trends pose an escalating challenge for surgical systems, necessitating strategic investment in hepatobiliary surgical capacity, perioperative infrastructure, and preventive public health measures—particularly for aging, comorbid populations.