MASH Drives Increasing Global Incidence of Cirrhosis, Chronic Liver Diseases

Daniel Huang, MBBS

Credit: National University Health System

Although death rates from cirrhosis are declining, the overall incidence has increased, driven by growth in metabolic dysfunction-associated steatohepatitis (MASH), according to findings from a recent study.¹

Leveraging data from the Global Burden of Disease (GBD) Study 2021, investigators found an 18% increase in incident cases, a 7% increase in deaths, and a 1% increase in DALYs attributable to cirrhosis and other chronic liver diseases between 2010 and 2021. Of note, MASH had the greatest number of incident cases and age-standardized incidence rate (ASIR) of the etiologies examined in the study.¹

Cirrhosis and chronic liver disease represent major global health concerns due to their rank among the top leading causes of death in many regions of the world. They are primarily caused by hepatitis B, hepatitis C, alcohol-related liver disease, and MASH, but the epidemiology of the causes of liver diseases has undergone drastic changes in recent years.²

“Changes in the underlying causes of liver disease have led to a corresponding shift in the landscape of cirrhosis and other chronic liver diseases,” Daniel Huang, MBBS, an assistant professor at the National University of Singapore and a transplant hepatologist at the National University Hospital, and colleagues wrote.¹

To provide updated estimates on the incidence, deaths, and disability-adjusted life years (DALYs) related to cirrhosis and other chronic liver diseases from 2010 to 2021, investigators assessed data from the GBD Study 2021 for disease due to alcohol use; chronic hepatitis B; chronic hepatitis C; non-alcoholic fatty liver disease; and cirrhosis related to other causes.¹

In 2021, there were an estimated 58,417,006 incident cases, 1,425,142 deaths, and 46,417,777 DALYs related to cirrhosis and other chronic liver diseases. Between 2010 and 2021, investigators called attention to an 18% increase in incident cases, a 7% increase in deaths, and a 1% increase in DALYs.¹

During the study period, there was an increase in ASIRS (annual percent change [APC], +0.35%; 95% CI, 0.30 to 0.40; P <.001), but investigators noted age-standardized death rates (ASDRs) (APC, −1.74%; 95% CI, −1.81 to −1.67; P <.001) and age-standardized DALYs (ASDALYs) (APC, −1.85%; 95% CI, −1.92 to −1.77; P <.001) declined.¹

Further analysis revealed MASH had the greatest number of incident cases (48,310,981; 95% UI, 4,419,137 to 52,313,165) and ASIRs (592.78; 95% UI, 542.23 to 643.24) per 100,000. For deaths and DALYs, investigators identified cirrhosis due to hepatitis B as the most significant contributor, with 431,964 (95% UI, 365,199 to 502,419) deaths and 13,882,280 (95% UI, 11,749,493—15,998,380) DALYs.¹

Of note, between 2010 and 2021, cirrhosis due to MASH had the highest percentage increase in incidence (+24%), deaths (+27%), and DALYs (+23%).¹

Additionally, investigators pointed out cirrhosis and other chronic liver diseases related to MASH were the only etiology with a rise in ASIR (APC, +0.86%; 95% CI, 0.82 to 0.90; P <.001), whereas cirrhosis due to hepatitis B displayed the greatest decrease (APC, −2.72%; 95% CI, −3 to −2.44; P <.001).¹

All etiologies also experienced a decrease in ASDR and ASDALY, with cirrhosis due to hepatitis B exhibiting the greatest decrease in ASDRs (APC, −2.14%; 95% CI, −2.23 to −2.04; P <.001). In contrast, ASDALYs were most significantly decreased in cirrhosis due to other causes (APC, −2.19%; 95% CI, −2.36 to −2.01; P <.001).¹

Further analysis stratified by World Health Organization region revealed Africa had a significantly increased ASIR for cirrhosis related to hepatitis B (130.77; 95% UI, 109.58 to 150.31) and cirrhosis related to hepatitis C (104.82; 95% UI, 87.05 to 123.93; P <.001). Investigators noted ASIRs of alcohol-associated cirrhosis in the Americas increased (APC, +0.52%; 95% CI, 0.35 to 0.68; P <.001), whereas ASIRs remained stable or declined in all other regions.¹

Additionally, in the Americas, the ASDR (APC, +1.05; 95% CI, 0.86 to 1.25; P <.001) and ASDALY (APC, +1.19; 95% CI, 0.97 to 1.41; P <.001) of MASH-related cirrhosis increased, in contrast to other regions where ASDR and ASDALY remained stable or declined.¹

“Concerted efforts targeted at the metabolic risk factors to curb the rising incidence of MASH, increasing linkage to care for viral hepatitis and reducing heavy alcohol consumption are required to sustain the decline in the global burden of cirrhosis,” investigators concluded.¹

References

1. Tham EKJ, Tan DJH, Danpanichkul P, et al. The Global Burden of Cirrhosis and Other Chronic Liver Diseases in 2021. Liver International. https://doi.org/10.1111/liv.70001

2. Devarbhavi H, Asrani SK, Arab JP, et al. Global burden of liver disease: 2023 update. J Hepatol. doi:10.1016/j.jhep.2023.03.017