Background <p>Understanding the temporal trends of metabolic dysfunction-associated steatohepatitis-related liver cancer (MASH-LC) in older adults is crucial for raising public awareness and informing future policy decisions.</p> Methods <p>This is the first study to use Global Burden of Disease (GBD) data to analyze the burden of MASH-LC specifically in adults aged 65 years and older. Utilizing data from GBD 2021, we analyzed the incidence, mortality, and disability-adjusted life years (DALYs) of MASH-LC among individuals aged 65 and older from 1990 to 2021. We also examined corresponding age-standardized rates and conducted stratified analyses based on region, sex, age, and temporal changes. To assess cross-national health inequality, we further applied the slope index of inequality (SII) and concentration index (CI), which have not been previously employed in studies of MASH-LC among older adults.</p> Results <p>Globally, age-standardized incidence, mortality, and DALYs rates (ASIR, ASMR, and ASDR) of MASH-LC in older adults exhibited a significant upward trend, with a higher burden observed in males. The absolute numbers of incidence, deaths, and DALYs increased by 251.59%, 231.08%, and 211.00%, respectively. While ASIR declined notably in high-sociodemographic index (SDI) regions, ASMR and ASDR were highest in low-SDI regions by 2021. China bore the heaviest burden globally, whereas Australia and the United Kingdom experienced the most substantial growth. Cross-national inequality analyses indicate that indicated that the burden of MASH-LC in older adults was more concentrated in low-SDI countries. Additionally, the disease burden escalated with age, with peak burden ages differing slightly between sexes.</p> Conclusion <p>The global burden of MASH-LC in older adults has risen markedly. Targeted preventive strategies are urgently needed to mitigate disease progression and reduce disparities across populations.</p>