Metabolic Cause of Cirrhosis Is the Emerging Etiology for Primary Liver Cancer in the Asia‐Oceania Region: Analysis of Global Burden of Disease (GBD) Study 2021

ABSTRACT Introduction Studies have shown a change in the etiological profile of liver cancer globally. We aimed to analyze the burden and changes in etiology of liver cancer in the Asia‐Oceania region. Methods The burden of liver cancer in Asia‐Oceania was estimated using data from the 2021 Global Burden of Disease (GBD) Study. The analysis included age‐standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability‐adjusted life years (DALY) per 100 000 population. Results The Asia‐Oceania region contributed 68.6%, 68.8%, and 67.3% of the global incidence, prevalence, and mortality of liver cancer in 2021. In 2021, Mongolia, Tonga, and South Korea had the highest ASIR, ASPR, and ASMR, whereas Australia, New Zealand, and Guam had the greatest increase in incidence and mortality rates. Viral hepatitis remained the most common etiology of liver cancer, with 47.7% and 26.1% of cases being related to hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. Around 14.5% and 7.1% of cases were related to alcohol and nonalcoholic steatohepatitis (NASH), respectively; however, the annual change in the ASIR was the highest for NASH. Alcohol, drug abuse, tobacco use, and metabolic syndrome, contributed to 15.2%, 11.7%, 11.5%, and 9.0% of liver cancer mortality in 2021; however, the change in death from 1990 to 2021 was the highest for metabolic syndrome. Conclusion Viral hepatitis remains the most common cause of liver cancer, with NASH having the highest annual rate of change in ASIR and liver cancer deaths in Asia‐Oceania.