Abstract
BACKGROUND: The global burden of liver cancer among adolescents and young adults (AYAs, 15-39 years) is an emerging concern. This study analyzes epidemiological trends from 1990 to 2021 and projects future burden to 2030 to inform prevention strategies. METHODS: Using data from the Global Burden of Disease Study 2021, we calculated age-standardized incidence (ASIR) and mortality (ASMR) rates and disability-adjusted life years (DALYs). Joinpoint regression analyzed temporal trends, and a Bayesian age-period-cohort model projected future burden. RESULTS: From 1990 to 2021, the absolute number of AYA liver cancer cases and deaths increased. However, ASIR peaked in the early 2000s before declining to 0.82 per 100,000 in 2021, with ASMR falling to 0.65 per 100,000. A sharp decline occurred around 2001-2005. The disease burden exhibited significant disparities: males had over double the incidence of females (ASIR 1.22 vs. 0.42). High-burden regions included East Asia and West Africa (e.g., Mongolia, Gambia), while middle-SDI regions carried the highest absolute burden. Projections indicate a continued rise in absolute incident cases (to 45,352) and deaths (to 31,448) by 2030, despite a narrowing of health inequalities. CONCLUSION: Although age-standardized rates have declined, the rising absolute burden of AYA liver cancer and persistent disparities highlight a critical need for targeted, equitable prevention and control measures globally.