Abstract
BACKGROUND: Primary liver cancer (PLC) is a major cause of cancer mortality worldwide, particularly among middle-aged and elderly populations. Given increasing life expectancy, understanding PLC burden in these groups is essential. METHODS: We obtained data about incidence, deaths, and disability-adjusted-life-years (DALYs) from 2000 to 2021 for PLC aged 55+ from Global Burden of Disease (GBD) 2021. Trends across sociodemographic index (SDI), etiology, age, and sex level were evaluated using age-standardized rates, estimated annual percentage change (EAPC), and percentage change. Bayesian-age-period-cohort (BAPC) model was applied to predict the global burden to 2050. RESULTS: Globally, the cases of PLC burden among middle-aged and elderly populations increased by 74% in incidence, 67% in deaths, and 59% in DALYs. Despite rising case counts, EAPC for incidence, deaths, and DALYs declined with -0.13, -0.32, and -0.55. Trends varied by region and SDI level, with reductions in HBV- and HCV-related PLC but increases in non-alcoholic steatohepatitis (NASH) and alcohol use related PLC, particularly in high-SDI regions. Burden was the highest and increasing among those aged 75+, especially for NASH-related PLC. Globally, the male-to-female burden ratio was 2.19, though gender differences varied regionally. Finally, projection indicated that the incidence case will persistently rise from 2021 to 2050, while incidence rate will decrease first and then increase. CONCLUSIONS: Our study analyzed the global epidemiology of PLC among middle-aged and elderly populations from etiology, age and gender, and conducted a prediction outlook for the next 30 years. These findings contribute to the development of efficient and targeted health strategies to mitigate PLC burden.