Global Burden of MASH-Related Liver Cancer Rising Sharply Among Older Adults

The worldwide burden of metabolic dysfunction–associated steatohepatitis (MASH)–related liver cancer among adults 65 years and older has more than doubled over the past 3 decades, according to a new analysis of Global Burden of Disease 2021 data.¹

Between 1990 and 2021, incident cases of MASH-related liver cancer in older adults rose 251.6%, deaths increased 231.1%, and disability-adjusted life years (DALYs) climbed 211%, according to researchers. Age-standardized incidence, mortality, and DALY rates also rose steadily during this period, particularly in lower–sociodemographic index regions, with men consistently carrying a higher disease burden than women. Findings were published in Discover Oncology.

“Our findings suggest the need for further in-depth studies to explore the underlying causes of this phenomenon and to develop appropriate strategies to address the growing disease burden associated with societal development,” the authors wrote. “This process will contribute to enhancing the effectiveness and targeting of public health policies, ultimately improving the health standards of the population.”

Regional and National Disparities

The analysis revealed striking geographic variation. East Asia (n = 6889.5), South Asia (n = 2785.4), and high-income North America (n = 2705.9) had the most cases of MASH-related liver cancer in 2021, while the lowest numbers were recorded in Oceania (n = 9.8), central Sub-Saharan Africa (n = 87.3), and the Caribbean (n = 72.6). Sub-Saharan Africa, including its East and West regions, recorded the highest age-standardized rates of incidence, mortality, and DALYs; the lowest were recorded in tropical Latin America and Eastern Europe.

At the national level, China bore the heaviest overall burden, with more than 6500 incident cases and 6600 deaths in 2021. India and the US followed closely behind, each with fewer than 2500 cases of MASH-associated liver cancer. China and India also ranked highest for mortality, with Thailand in third.

Mongolia, Mozambique, and The Gambia recorded the highest age-standardized mortality and DALY rates, with Mongolia also having the highest age-standardized incidence rate at 39.67. Australia, the United Kingdom, and Uruguay saw the sharpest increases in all 3 age-standardized rates between 1990 and 2021, while the East African country Mauritius had the largest decreases across the board.

“Low- and middle-income countries may be disproportionately affected by increasing metabolic risk factors and limited health care resources,” the authors said. “Increased MASH-[related liver cancer] burden in these regions may be associated with broader transitions such as urbanization, dietary changes, and unequal health care access, though these associations remain speculative.”

Demographic Trends

Older age was strongly associated with higher burden. Incidence peaked at ages 85 to 89 years for both sexes, while mortality peaked at 90 to 94 years. Men had significantly higher incidence and DALY rates across most age groups; among patients in their early 70s, men had 42,127.7 DALYs, nearly double the 21,205.8 DALYs observed among women. However, this gap narrowed and even reversed slightly past age 75.

Population aging was as a major driver, according to the authors. Between 1990 and 2021, the global population grew 43%, but the number of adults aged 65 and older more than doubled (114.6%). By 2050, this demographic is expected to double again, to 1.5 billion.² As a result, some experts project older adults will represent 60% of new cancer diagnoses by 2035.³

Policy and Practice Implications

MASH-related liver cancer often goes undetected until advanced stages, leaving older adults with fewer therapeutic options and poorer survival rates.⁴ The authors noted that some of the trends should be interpreted with caution, as what may seem like narrowing inequalities does not necessarily mean improved equity and access, but rather a rising liver cancer burden in previously low-burden areas.¹

“The convergence in inequality metrics underscores the need for broader, globally coordinated prevention efforts—not because the situation is improving, but because more countries are now affected,” the authors wrote. “In practical terms, this means that while the burden is becoming more evenly distributed across countries, it is doing so by increasing in places that were previously less affected.”

They noted that addressing the growing burden of MASH-associated liver cancer in low- and middle-income countries will require broad public health strategies, such as improving nutrition education, encouraging healthier diets, supporting sustainable urban development, and expanding access to health care. Although the study did not assess the effectiveness of specific interventions, the authors said such measures could help curb the rising impact of the disease.

References

1. Meng W, Hua J, Sun J, Liu H, Qian J, Gu Y. Global, regional, and national burden of metabolic dysfunction-associated steatohepatitis-related liver cancer in older adults: trends and cross-national inequality based on the global burden of disease study 2021. Discov Oncol. 2025;16(1):1547. doi:10.1007/s12672-025-03399-x
2. Liu C, Zhu S, Zhang J, et al. Global, regional, and national burden of liver cancer due to non-alcoholic steatohepatitis, 1990-2019: a decomposition and age-period-cohort analysis. J Gastroenterol. 2023;58(12):1222-1236. doi:10.1007/s00535-023-02040-4
3. Pilleron S, Sarfati D, Janssen-Heijnen M, et al. Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer. 2019;144(1):49-58. doi:10.1002/ijc.31664
4. Leyh C, Coombes JD, Schmidt HH, Canbay A, Manka PP, Best J. MASLD-related HCC—update on pathogenesis and current treatment options. J Pers Med. 2024;14(4):370. doi:10.3390/jpm14040370