Changing profile and burden of hepatocellular carcinoma in Arab Countries in 1990–2021

Introduction and Objectives: Hepatocellular carcinoma (HCC) remains a major health burden in Arab countries, with notable shifts in etiology and epidemiology over recent decades. This study evaluates the changing burden and profile of HCC across 22 Arab nations from 1990 to 2021. Materials and Methods: We analyzed the Global Burden of Disease (GBD) 2021 data for 22 Arab countries, extracting age-standardized rates (ASR) and estimated annual percentage changes (EAPC) for HCC incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by etiology and gender. Results: In 2021, Mauritania (age-standardized prevalence rate (ASPR): 20.9) and Egypt (19.3) had the highest HCC prevalence, both surpassing the global average (8.7). The region exhibited a rising trend in MAFLD-associated HCC (estimated annual percentage change (EAPC): 2.24 %), notably in Oman (2.24 %), Egypt (2.15 %), and Qatar (2.05 %), exceeding global growth. Meanwhile, viral hepatitis-related HCC declined, with Kuwait showing a 5.07 % reduction in mortality. HCC mortality was highest in Mauritania (age-standardized mortality rate (ASMR): 20.6) and Egypt (19.7). Gender disparities persisted: males had higher incidence (age-standardized incidence rate (ASIR): 16.5) than females (8.2), but notably, the gender gap narrowed over time, especially for MAFLD-linked HCC. The EAPC in female HCC incidence is increasing faster than in males, such as in the UAE. Conclusions: The Arab region faces a substantial, evolving HCC burden, shifting from viral hepatitis to MAFLD. Urgent public health strategies targeting metabolic risk factors and viral hepatitis elimination are vital to mitigate future increases.