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. 2025 Nov 1;82(5):1229-1240.
doi: 10.1097/HEP.0000000000001243. Epub 2025 Jan 29.

Prevalence and predictors of cirrhosis and portal hypertension in the United States

Zobair M Younossi  1 , Leyla de Avila  2 , Andrei Racila  1   2 , Fatema Nader  3 , James Paik  2 , Linda Henry  3 , Maria Stepanova  2   3
Affiliations

Prevalence and predictors of cirrhosis and portal hypertension in the United States

Zobair M Younossi et al. Hepatology. .

Abstract

Background and aims: There is a paucity of data about the prevalence of cirrhosis and portal hypertension in the US general population.

Approach and results: We used National Health and Nutrition Examination Surveys (NHANES 2017-2020) to estimate the prevalence of cirrhosis and clinically significant (CS)-portal hypertension in alcohol-associated liver disease (ALD), MetALD, viral hepatitis to include chronic hepatitis B (CHB) and chronic hepatitis C (CHC), and metabolic dysfunction-associated steatotic liver disease (MASLD). Cirrhosis was evaluated using liver stiffness measurement by transient elastography or FIB-4 score; CS-portal hypertension was defined through liver stiffness measurement and platelet count or the use of nonselective beta-blockers in the presence of cirrhosis.The prevalence of chronic liver disease etiologies was ALD 0.85%, MetALD 3.38%, CHB 0.23%, CHC 0.73%, ALD + viral hepatitis 0.16%, and MASLD 33.05%. In the general population, the prevalence of ALD-cirrhosis was 0.08%, MetALD-cirrhosis 0.19%, CHB-cirrhosis 0.01%, CHC-cirrhosis 0.10%, MASLD-cirrhosis 1.27%, ALD + viral hepatitis-cirrhosis 0.08%, and other cirrhosis 0.87%. The prevalence of CS-portal hypertension in chronic liver disease was 1.31% in MetALD, 1.60% in CHB, 4.73% in CHC, 2.00% in MASLD, and 0.35% in controls, to yield a population prevalence of 0.98%. In multivariate analysis, excessive alcohol use, CHC, male sex, obesity, type 2 diabetes, and hypertension were independently associated with an increased risk of cirrhosis (all p <0.05). Predictors of having CS-portal hypertension in chronic liver disease included CHC, obesity, and type 2 diabetes (all p <0.05).

Conclusions: The prevalence of cirrhosis in the United States is 2.6% while the prevalence of CS-portal hypertension is 0.98%. Individuals with MASLD comprise the majority of US residents with cirrhosis.

Keywords: MASH; NAFLD; NASH; chronic liver disease chronic; compensated liver disease; decompensated liver disease; epidemiology; viral hepatitis.

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