This review updates the global burden of liver disease. Chronic liver disease affects more than 1.5 billion people. Cirrhosis is the 12th leading cause of death worldwide, and with primary liver cancer accounts for nearly 2.4 million deaths a year, disproportionately in low- and middle-income countries.
Alcohol-associated liver disease and MASLD are rising with obesity and alcohol use, and increasingly coexist in the same patients. Vaccination and antivirals are reshaping viral hepatitis, but diagnosis and treatment gaps persist. Africa now has the highest age-standardised mortality from cirrhosis and liver cancer. Liver transplantation reaches only a minority.
It is a narrative review, not new data, but it sets the context for any hepatology service: the burden is shifting toward metabolic and alcohol-related disease, which begins in primary care, long before a hepatologist sees the patient.
- Screen for liver fibrosis in people with type 2 diabetes or obesity using FIB-4, followed by elastography if raised.
- Ask about alcohol in every patient with MASLD — the two commonly coexist and compound risk.
- Test for hepatitis B and C at least once in adults, and vaccinate against hepatitis B where not immune.
- Refer patients with cirrhosis for HCC and varices surveillance.
Why it matters
It frames liver disease as a growing, largely preventable cause of death that most services still detect late.
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