Burden of primary liver cancer and underlying etiologies among young adults from 1990 to 2021 and modelled Projection to 2050.
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This study analyzes the global burden of primary liver cancer among young adults (15-49 years) from 1990 to 2021, revealing a 46.0% rise in incidence and 59.0% increase in prevalence, yet declining age-standardized mortality (Estimated Annual Percentage Change-EAPC = -1.27). Middle-SDI regions faced the highest burden, with East Asia accounting for 66,472 prevalent cases and stark national disparities (e.g., Mongolia ASR = 1846.83/100,000 vs. Morocco ASR = 16.73). Population growth drove 42.8-47.8% of case increases, while metabolic risks and alcohol use (surpassing smoking in 2021) emerged as dominant factors. Males showed a 3.5-fold higher smoking-related risk than females. Deaths rose notably among those ≥30 years, with a 20.6% increase in 30-34-year-olds, signaling earlier onset. A shift from hepatitis B to metabolic/behavioral risks underscores evolving etiology. Projections suggest 133,561 cases by 2050, urging prioritized early screening and equitable resource allocation beyond traditional viral hepatitis frameworks.