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. 2025 Mar;45(3):e70001.
doi: 10.1111/liv.70001.

The Global Burden of Cirrhosis and Other Chronic Liver Diseases in 2021

Ethan Kai Jun Tham  1 , Darren Jun Hao Tan  1 , Pojsakorn Danpanichkul  2 , Cheng Han Ng  3   4 , Nicholas Syn  1 , Benjamin Koh  1 , Ryan Yan Zhe Lim  1 , Karn Wijarnpreecha  5 , Magaret Li Peng Teng  6 , Benjamin Kai Yi Nah  3 , Benedix Kuan Loo Sim  3 , Xianda Cheng  1 , Zixuan Zhang  1 , Kartik Mitra  1 , Toru Nakamura  4   7 , Hirokazu Takahashi  8 , Rohit Loomba  9   10 , Ming-Hua Zheng  11   12 , Mark Muthiah  1   3   13 , Daniel Q Huang  1   3   13
Affiliations

The Global Burden of Cirrhosis and Other Chronic Liver Diseases in 2021

Ethan Kai Jun Tham et al. Liver Int. 2025 Mar.

Abstract

Background and aim: The burden of cirrhosis and other chronic liver diseases has changed in recent years due to shifts in the contributing aetiologies. We estimated the burden of cirrhosis and other chronic liver diseases, including etiological and regional differences, across 204 countries and territories from 2010 to 2021.

Approach and results: We analysed temporal trends in the burden of cirrhosis and other chronic liver diseases utilising data from the Global Burden of Disease Study 2021. We estimated annual frequencies and age-standardised rates (ASRs) of incident cases, deaths and disability-adjusted life-years (DALYs) by sex, country, World Health Organisation region and its contributing aetiologies. 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. From 2010 to 2021, there was a rise in age-standardised incidence rates (ASIRs) (APC: +0.35%) but age-standardised death rates (ASDRs) (APC: -1.74%) and age-standardised disability-adjusted life-years (ASDALYs) (APC: -1.85%) declined. Cirrhosis related to metabolic dysfunction-associated steatohepatitis (MASH) contributed to 48 310 981 incident cases in 2021 and was largely responsible for the overall increase in ASIRs from 2010 to 2021. Cirrhosis and other chronic liver diseases related to MASH were the only aetiology with a rise in ASIR (APC: +0.86%). Age-standardised deaths related to all aetiologies of cirrhosis and other chronic liver diseases declined during the study period. Age-standardised deaths and DALYs related to MASH increased in the Americas, unlike all other world regions where they declined or remained stable.

Conclusions: Age-adjusted deaths related to cirrhosis and other chronic liver diseases are declining. However, the age-adjusted incidence of cirrhosis and other chronic liver diseases is increasing, driven by increases in the incidence of MASH.

Keywords: chronic liver disease; cirrhosis; global burden.

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Conflict of interest statement

C.H.N. has served as a consultant for Boxer Capital. R.L. serves as a consultant to Aardvark Therapeutics, Altimmune, Anylam/Regeneron, Amgen, Arrowhead Pharmaceuticals, AstraZeneca, Bristol‐Myer Squibb, CohBar, Eli Lilly, Galmed, Gilead, Glympse Bio, Hightide, Inipharma, Intercept, Inventiva, Ionis, Janssen Inc., Madrigal, Metacrine Inc., NGM Biopharmaceuticals, Novartis, Novo Nordisk, Merck, Pfizer, Sagimet, Theratechnologies, 89 bio, Terns Pharmaceuticals and Viking Therapeutics. In addition, his institutions received research grants from Arrowhead Pharmaceuticals, Astrazeneca, Boehringer‐Ingelheim, Bristol‐Myers Squibb, Eli Lilly, Galectin Therapeutics, Galmed Pharmaceuticals, Gilead, Intercept, Hanmi, Intercept, Inventiva, Ionis, Janssen, Madrigal Pharmaceuticals, Merck, NGM Biopharmaceuticals, Novo Nordisk, Merck, Pfizer, Sonic Incytes and Terns Pharmaceuticals. D.H., co‐founder of LipoNexus Inc., has served as an advisory board member for Gilead. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

FIGURE 1
FIGURE 1
Global incident cases/age‐standardised incident rates, deaths/age‐standardised death rates and DALYs/age‐standardised DALYs rates of cirrhosis and other chronic liver diseases from 2010 to 2021, stratified by WHO region. (A) Age‐standardised incident rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by the WHO region. (B) Contribution by WHO region of incident cases due to cirrhosis and other chronic liver diseases in 2010 and 2021. (C) Trends in age‐standardised incident rates due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by the WHO region. (D) Age‐standardised death rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by the WHO region. (E) Contribution by the WHO region of deaths due to cirrhosis and other chronic liver diseases in 2010 and 2021. (F) Trends in age‐standardised death rates due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by the WHO region. (G) Age‐standardised DALYs due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by the WHO region. (H) Contribution by the WHO region of DALYs due to cirrhosis and other chronic liver diseases in 2010 and 2021. (I) Trends in age‐standardised DALYs due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by the WHO region.
FIGURE 2
FIGURE 2
Global/age‐standardised incident rates, deaths/age‐standardised death rates and DALYs/age‐standardised DALYs rates of cirrhosis and other chronic liver diseases from 2010 to 2021, stratified by SDI. (A) Age‐standardised incident rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by SDI. (B) Contribution by SDI of incident cases due to cirrhosis and other chronic liver diseases in 2010 and 2021. (C) Trends in age‐standardised incident rates due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by SDI. (D) Age‐standardised death rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by SDI. (E) Contribution by SDI of deaths due to cirrhosis and other chronic liver diseases in 2010 and 2021. (F) Trends in age‐standardised death rates due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by SDI. (G) Age‐standardised DALYs due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by SDI. (H) Contribution by SDI of DALYs due to cirrhosis and other chronic liver diseases in 2010 and 2021. (I) Trends in age‐standardised DALYs due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by SDI.
FIGURE 3
FIGURE 3
Global age‐standardised incident rates, age‐standardised death rates and age‐standardised DALYs rates of cirrhosis and other chronic liver diseases from 2010 to 2021, stratified by gender. (A) Age‐standardised incident rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by SDI. (B) Age‐standardised death rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by SDI. (C) Age‐standardised DALY due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by SDI.
FIGURE 4
FIGURE 4
Map depicting the ASIR, ASDR and ASDALY across the countries.
FIGURE 5
FIGURE 5
Global incident/age‐standardised incident rates, deaths/age‐standardised death rates and DALYs/age‐standardised DALYs rates of cirrhosis and other chronic liver diseases from 2010 to 2021, stratified by aetiology. (A) Age‐standardised incident rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by aetiology. (B) Contribution by aetiology of incident cases due to cirrhosis and other chronic liver diseases in 2010 and 2021. (C) Trends in age‐standardised incident rates due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by aetiology. (D) Age‐standardised death rates due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by aetiology. (E) Contribution by aetiology of deaths due to cirrhosis and other chronic liver diseases in 2010 and 2021. (F) Trends in age‐standardised death rates due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by aetiology. (G) Age‐standardized DALYs due to cirrhosis and other chronic liver diseases in 2010 and 2021, split by aetiology. (H) Contribution by aetiology of DALYs due to cirrhosis and other chronic liver diseases in 2010 and 2021. (I) Trends in age‐standardised DALYs due to cirrhosis and other chronic liver diseases from 2010 to 2021, split by aetiology.
FIGURE 6
FIGURE 6
Contribution of aetiologies stratified by the WHO region. (A) Contributions of aetiologies to the incident cases for cirrhosis and chronic liver diseases, stratified by the WHO region. (B) Contributions of aetiologies to the deaths for cirrhosis and chronic liver diseases, stratified by the WHO region. (C) Contributions of aetiologies to the DALYs for cirrhosis and chronic liver diseases, stratified by the WHO region. (D) Contributions of aetiologies to the ASIR for cirrhosis and chronic liver diseases, stratified by the WHO region. (E) Contributions of aetiologies to the ASDR for cirrhosis and chronic liver diseases, stratified by the WHO region. (F) Contributions of aetiologies to the ASDALY for cirrhosis and chronic liver diseases, stratified by the WHO region.
FIGURE 7
FIGURE 7
Contribution of aetiologies stratified by SDI. (A) Contributions of aetiologies to the incident cases for cirrhosis and chronic liver diseases, stratified by SDI. (B) Contributions of aetiologies to the deaths for cirrhosis and chronic liver diseases, stratified by SDI. (C) Contributions of aetiologies to the DALYs for cirrhosis and chronic liver diseases, stratified by SDI. (D) Contributions of aetiologies to the ASIR for cirrhosis and chronic liver diseases, stratified by SDI. (E) Contributions of aetiologies to the ASDR for cirrhosis and chronic liver diseases, stratified by SDI. (F) Contributions of aetiologies to the ASDALY for cirrhosis and chronic liver diseases, stratified by SDI.
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