Epidemiology of Chronic Liver Diseases and Risk Factors

Chronic liver diseases encompass a heterogeneous group of disorders marked by progressive hepatic injury, impaired metabolic and immunological function, and long-term morbidity. Globally, the burden of these conditions has risen in parallel with population growth, ageing and shifting lifestyle patterns. Viral hepatitis B and C remain major drivers of cirrhosis and hepatocellular carcinoma in many low- and middle-income regions, despite vaccines and antiviral therapies. Alcohol-related liver disease continues to exert substantial health and economic tolls, particularly in eastern Europe and parts of Asia. Meanwhile, non-alcoholic steatohepatitis (NASH) has emerged as the fastest-growing cause of chronic liver injury in high-income settings, reflecting the global obesity epidemic and insulin resistance. Rates of fatty liver and fibrosis vary markedly by age, sex and socioeconomic status, with higher prevalence in older adults and men. Diagnostic advances—non-invasive elastography, improved imaging and circulating biomarkers—have enhanced early detection, enabling more timely intervention. Nonetheless, gaps in civil registration, variable access to care and under-resourced screening programmes limit progress in many regions. Integrated public-health strategies that combine vaccination, alcohol policy, lifestyle modification and targeted surveillance are essential to curb future disease burden and reduce disparities.

Research from Nature Portfolio

Analyses of global burden data have revealed that the incidence of NASH-related cirrhosis more than doubled between 1990 and 2017, with age-standardised rates increasing annually by over 1 percent. Middle-high socio-demographic index regions experienced the steepest rises, while high-income Asia–Pacific saw slight declines. These findings underscore NASH as a principal emerging driver of cirrhosis in parallel with obesity and metabolic syndrome, signalling an urgent need for early-stage detection and preventive interventions targeting diet and physical activity.

Epidemiology of Chronic Liver Diseases and Risk Factors publication trend

The graph below shows the total number of articles in epidemiology of chronic liver diseases and risk factors across all publications each year (not limited to Nature Index journals).

Technical terms

Cirrhosis: Advanced fibrosis of the liver accompanied by architectural distortion and impaired function.

Non-alcoholic steatohepatitis (NASH): A progressive form of fatty liver disease characterised by inflammation and hepatocyte injury in the absence of significant alcohol intake.

Age-standardised rate: A summary measure of a rate that accounts for differences in age distribution across populations.

Disability-adjusted life year (DALY): A metric combining years of life lost due to premature death and years lived with disability.

Socio-demographic index (SDI): A composite measure of income, education and fertility used to stratify populations by development status.

References

1. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology (2020).
2. The incidence trends of liver cirrhosis caused by nonalcoholic steatohepatitis via the GBD study 2017. Scientific Reports (2021).
3. Global burden of liver cirrhosis and other chronic liver diseases caused by specific etiologies from 1990 to 2019. BMC Public Health (2024).