Global, regional, and national liver cancer attributable to smoking and alcohol use burden, 1990–2021

Smoking and alcohol consumption are both risk factors for liver cancer. Researchers analysed data from the Global Burden of Disease (GBD) Study 2021 to identify the Global, regional, and national liver cancer burden attributable to smoking and alcohol use. The numbers and age-standardised rates of deaths and disability-adjusted life years (DALYs) were assessed globally and by subtypes.
From 1990 to 2021, the burden of liver cancer attributed to alcohol consumption increased significantly, whereas age-standardised rates (ASRs) remained relatively stable compared to those associated with smoking. In 2021, the number of deaths and disability-adjusted life years (DALYs) due to smoking-related liver cancer were 53,054 (95% uncertainty interval [UI]: 18,268–88,111) and 1,482,896 (95% UI: 505,000–2,478,906), respectively. The corresponding age-standardised rates (ASRs) were 0.61 per 100,000 population (95% UI: 0.21–1.01) for mortality and 16.9 per 100,000 (95% UI: 5.76–28.26) for DALYs. The estimated annual percentage changes (EAPCs) for these ASRs were − 0.84 (95% confidence interval [CI]: -0.96 to -0.73) for mortality and − 1.12 (95% CI: -1.24 to -1.01) for DALYs. Conversely, in 2021, deaths and DALYs attributable to alcohol-related liver cancer totalled 93,807 (95% UI: 77,476–113,542) and 2,385,090 (95% UI: 1,949,109–2,911,783), respectively. The corresponding ASRs were 1.08 per 100,000 (95% UI: 0.89–1.30) for mortality and 27.2 per 100,000 (95% UI: 22.25–33.1) for DALYs. The EAPCs were 0.26 (95% CI: 0.19–0.32) for mortality and 0.04 (95% CI: -0.03 to 0.10) for DALYs. Males, middle-aged, and older adults were high-risk populations, and middle socio-demographic index (SDI) regions were high-risk areas. For alcohol-related liver cancer, the Commonwealth High-Income region exhibited the highest age-standardised death rate, whereas Australasia had the highest age-standardised DALYs. Andean Latin America had the lowest ASRs for both smoking- and alcohol-related liver cancer. Notably, Mongolia had the highest ASRs for liver cancer attributed to both smoking and alcohol consumption, with values hundreds of times greater than those in the country with the lowest burden, Morocco.
The authors say that the overall disease burden associated with smoking and alcohol consumption remains significant, highlighting the urgent need for more effective risk factor control strategies. The establishment of accurate and efficient screening systems, as well as specialised cancer treatment centres, is imperative, particularly for high-risk populations, such as middle-aged and elderly men, and for high-risk regions classified as High and Middle SDI areas.
Source: Liu C, Shi T, Li S. et al. Global, regional, and national liver cancer attributable to smoking and alcohol use burden, 1990–2021: analysis for the global burden of disease 2021 study. BMC Public Health, 2025, 25:2037.