- Design
- Narrative review of global burden estimates
- Population
- Global population with chronic liver disease
- Primary outcome
- Prevalence, mortality and drivers of liver disease
- Effect
- More than 1.5 billion affected; nearly 2.4 million deaths a year from cirrhosis and liver cancer
This Gastroenterology review updates the global picture of liver disease. Chronic liver disease affects more than 1.5 billion people. Cirrhosis is the 12th leading cause of death worldwide, and together with primary liver cancer accounts for nearly 2.4 million deaths a year, falling disproportionately on low- and middle-income countries.
The main drivers are alcohol-related liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic hepatitis B and C. Ageing populations, obesity and rising alcohol use are expected to push the first two upward, and the authors highlight the growing overlap of metabolic disease and alcohol in the same patients. Vaccination and antivirals are reshaping viral hepatitis, but gaps in diagnosis and treatment persist. Africa now has the highest age-standardised death rates from cirrhosis and liver cancer.
For Indian practice, all three drivers are present at scale. The practical response is earlier detection: fibrosis assessment in people with metabolic risk or harmful drinking, and hepatitis B and C testing where risk exists.
- Assess fibrosis risk with FIB-4 in adults with type 2 diabetes, obesity or harmful drinking.
- Ask about alcohol in every patient with MASLD; the two often coexist.
- Test for hepatitis B and C in people at risk, and link positives to treatment.
- Check hepatitis B vaccination status in adults at ongoing risk.
- Refer patients with indeterminate or high FIB-4 for elastography.
Why it matters
Most liver deaths follow years of detectable, silent fibrosis that nobody looked for.
Don't overread it
This is a narrative review of burden estimates, not new primary data.
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