BACKGROUND: Liver cancer is one of the leading causes of cancer-related deaths worldwide. In Europe, viral hepatitis, alcohol consumption, and metabolic diseases contribute to this burden. Using data from the Global Burden of Disease Study 2021, we report here the liver cancer epidemiology in Europe between 1990 and 2021, describing recent trends, geographical disparities, and the major risk factors influencing disease outcomes.

METHODS: The Global Burden of Disease Study 2021 provided standardized data on liver cancer incidence, mortality, and disability-adjusted life years (DALYs) across Europe from 1990 to 2021, utilizing advanced statistical modeling tools like DisMod-MR 2.1 to ensure accuracy and comparability. Age-standardized rates (age-standardized incidence rate, ASIR; age-standardized mortality rate (ASMR); and age-standardized DALYs rate, ASDR) were analyzed alongside the socio-demographic Index (SDI) to evaluate trends, regional disparities, and associations using joinpoint regression and LOESS modeling. Data visualization involved Python tools, including choropleth maps and regression plots.

RESULTS: Liver cancer burden in Europe has increased significantly, with the ASIR rising from 3.04 [2.93-3.14] in 1990 to 4.20 [3.93-4.40] in 2021, the ASMR increasing from 3.08 [2.96-3.18] to 3.86 [3.59-4.05], and the ASDR rising from 78.48 [76.09-80.74] to 91.43 [86.48-95.79]. Males consistently showed higher rates than females, and older populations bore the highest burden, with deaths and DALYs peaking in the 95+ age group in 2021. Nationally, Andorra reported the highest ASIR, ASMR, and ASDR in 2021, while Ukraine had the lowest rates. Hepatitis C and alcohol-related liver cancer were the leading contributors, with NASH showing the fastest growth. Regions with higher SDI demonstrated greater burden, highlighting healthcare access and detection disparities.

CONCLUSION: Liver cancer burden in Europe is driven by rising obesity, aging populations, lifestyle changes, and healthcare disparities, with incidence and mortality growing faster in the Europe, especially the Western region. Comprehensive strategies focusing on prevention, early detection, and equitable access to care are essential.