# Global Epidemiology of Smoking and Liver Cancer from 1990 to 2021

## TL;DR

This study examines how smoking contributes to liver cancer worldwide from 1990 to 2021, showing rising deaths and disability despite declining rates.

## Contribution

The study provides a comprehensive global analysis of smoking-attributable liver cancer burden and trends over three decades.

## Key findings

- Global smoking-attributable liver cancer deaths increased by 67.10% from 1990 to 2021.
- Significant disparities in liver cancer burden were observed by gender, age, and region, with higher impacts in East Asia.
- Projections suggest a decline in smoking-related liver cancer mortality and disability rates by 2040, especially among males.

## Abstract

Liver cancer is a prevalent and highly malignant tumor worldwide, and smoking has been suggested as a potentially significant risk factor, but this association remains understudied and not widely recognized. This study utilized global epidemiological data (1990–2021) from open access databases, analyzing smoking-related liver cancer burden and trends by age, sex, region, and country using mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs), with projections for disease burden in 2040. The results show that from 1990 to 2021, the global number of smoking-attributable liver cancer deaths increased (cumulative growth: 67.10%; annual growth rate: 1.63%), while the age-standardized mortality rate (ASMR) declined. Similarly, global DALYs rose (cumulative growth: 49.5%; annual growth rate: 1.32%), yet age-standardized DALY rates (ASDRs) decreased. Significant disparities were observed across gender, age groups, regions, and countries, with higher burdens in males and in regions such as East Asia. Projections indicate that by 2040, both the ASMR and ASDR for smoking-associated liver cancer will decline significantly, particularly among the male population. In conclusion, although the burden of liver cancer related to smoking is on a downward trend, there are still significant demographic and regional differences. Future efforts should prioritize strengthened public health policies, targeted interventions, and further research into the smoking–liver cancer relationship to enhance prevention and control strategies.