The coexistence of nonalcoholic steatohepatitis-related liver cancer (LCN) and high fasting plasma glucose (HFPG) represents a growing clinical and public health challenge. This study was conducted to evaluate the deaths and disability-adjusted life years (DALYs) burden of populations with LCN combined with HFPG (LCN-HFPG).

We obtained age-standardized death rates (ASDRs) and DALYs rates (ASDALYRs) from 2005–2021, and forecasted to 2035 and calculated the average annual percent changes (AAPCs) for 2005–2021 and 2022–2035. In addition, we conducted health inequality, frontier, and decomposition analysis.

The ASDR and ASDALYR of LCN-HFPG has increased significantly from 2005 to 2021 with variations across regions. Middle-SDI countries experienced the highest burden in 2021. Males generally had higher deaths and DALY rates than females, except in low-middle and low-SDI areas. Among the five most populous countries, the United States has consistently had the highest ASDR and ASDALYR from 2005 to 2035, while Brazil has consistently had the lowest. In 2005, China ranked second in ASDR and ASDALYR, with India ranked third; however, by 2021 and 2035, India moved up to second place. Brazil is projected to have the lowest ASDR and ASDALYR for LCN-HFPG, while USA has much room to improve. The Western Pacific and South-East Asia regions showed the highest deaths and DALYs burden, while the African region had the lowest. Epidemiological transitions and population aging were major factors contributing to the increase. The disparity in disease burden is gradually decreasing, though significant inequality persists, especially between high- and low-SDI countries. The mortality rate of LCN-HFPG increases with age, with a more pronounced rise observed in older age groups. Similarly, DALY rates also increase with age, peaking in the 75–79 age group. Globally, mortality and DALY rates are higher in males than in females across all age groups. However, significant regional differences exist: in Africa and the Eastern Mediterranean, females exhibit higher DALY and mortality rates than their male counterparts, while in the Americas, Western Pacific, and European regions, males have higher mortality and DALY rates than females.

The ASDR and ASDALYR of LCN-HFPG are rising globally. Health inequalities in LCN-HFPG burden exist across regions, with middle- and low-SDI countries facing a disproportionate burden. Middle-aged and elderly populations are primarily affected. Our findings highlight pronounced health inequalities and potential drivers of LCN-HFPG burden, supporting the need for tailored interventions and data-driven policy planning.