Global trends, health inequalities, and long-term projections concerning liver cancer mortality attributable to nonalcoholic steatohepatitis between 1990 and 2050.

BACKGROUND AND AIMS: Nonalcoholic steatohepatitis is an important and increasing contributor to liver cancer. This study investigated mortality trends in liver cancer attributable to nonalcoholic steatohepatitis (LCN) over recent decades and projected to 2050. METHODS: Spatiotemporal trends in age-standardized mortality rates (ASMRs) for LCN were evaluated using a Bayesian model. The Bayesian Age-Period-Cohort model was used to predict the ASMR and mortality in 2022-2050. Temporal trends were analyzed by calculating the average annual percent change (AAPC) in ASMRs. Health inequalities, frontier analysis, and decomposition analysis were applied. RESULTS: Between 1990 and 2021, the ASMR for LCN trended upwards worldwide (AAPC 0.82). The Americas had the most rapid growth in ASMR for LCN (AAPC 2.03), whereas the African region had the highest ASMR for LCN. By 2050, India (ASMR 0.76) and Indonesia (ASMR 0.50) are predicted to be among the most populous countries facing the highest ASMR burden. Health inequalities associated with a lower sociodemographic index value have worsened over time: the concentration index was -0.24 in 2021, and the slope index of inequality is projected to decline sharply from -0.33 in 2021 to -0.82 by 2050. Decomposition analysis showed that the increase in LCN mortality was mainly attributable to changes in epidemiology and age structure. The mortality burden of smoking and high fasting plasma glucose-related LCN has continued to rise over the last three decades. CONCLUSION: Global LCN mortality is escalating, particularly in low-sociodemographic and low-income regions. The expanding mortality burden associated with smoking and high fasting plasma glucose underscores the importance of lifestyle and metabolic risk factors in shaping future trajectories and the need for targeted prevention strategies in high-burden regions.