A 2026 update summarises the worldwide burden of chronic liver disease, now affecting more than 1.5 billion people. Cirrhosis is the twelfth leading cause of death, and with primary liver cancer accounts for about 2.4 million deaths a year, falling hardest on lower- and middle-income countries.
The drivers are shifting: alcohol-associated and metabolic dysfunction-associated steatotic liver disease (MASLD) are rising with obesity and alcohol use, while vaccination and antivirals reshape viral hepatitis. Africa now carries the highest age-standardised cirrhosis and liver-cancer mortality, driven by viral hepatitis, aflatoxin and limited access to care; transplantation reaches only a minority.
For practice the message is about where effort pays off: case-finding and treating viral hepatitis, addressing MASLD and alcohol, and recognising that much of the burden, and the access gap, sits in resource-limited settings including much of South Asia. It is an epidemiological synthesis, framing priorities rather than reporting a trial.
- Chronic liver disease affects over 1.5 billion people; cirrhosis and liver cancer cause about 2.4 million deaths a year.
- MASLD and alcohol-associated disease are rising with obesity and alcohol use.
- Africa has the highest age-standardised cirrhosis and liver-cancer mortality.
- The burden and access gap concentrate in lower- and middle-income regions.
- Prioritise viral hepatitis case-finding and MASLD and alcohol prevention.
Why it matters
It locates the fastest-growing and least-served liver-disease burden, which shapes where screening and treatment matter most.
Don't overread it
This is an epidemiological review framing priorities, not a study of any single intervention's effect.
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