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. 2025 Sep;45(9):e70283.
doi: 10.1111/liv.70283.

Global Burden of Alcohol-Associated Liver Disease Across 204 Countries, 1990-2021: GBD 2021 Findings

Yubo Wang  1   2 , Xue Han  3 , Xiaoqing Zhang  3 , Xiaoyan Yuan  4 , Qingyu Wei  5 , Lixuan Sang  6 , Bing Chang  1 , Quansheng Li  5
Affiliations

Global Burden of Alcohol-Associated Liver Disease Across 204 Countries, 1990-2021: GBD 2021 Findings

Yubo Wang et al. Liver Int. 2025 Sep.

Abstract

Background and aims: Alcohol-associated liver disease (ALD) is a general term for liver diseases caused by long-term and excessive alcohol consumption, which poses a serious threat to human health.

Methods: The data were collected from the estimates of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) in 2021. We focused on the impacts of age, gender, risk factors and the socio-demographic index (SDI). Additionally, the trends in the prevalence, deaths, and Disability-Adjusted Life Years (DALYs) of ALD from 1990 to 2021 were calculated through the Estimated Annual Percentage Change (EAPC). The Norepred model was employed to predict the prevalence and deaths of ALD by gender until 2046.

Results: From 1990 to 2021, the prevalence and deaths of ALD increased. In 2021, the prevalence, deaths, and DALYs of ALD were higher among men aged over 55. The age-standardised prevalence rate (ASPR) of liver cancer due to alcohol use was positively correlated with the SDI, while the age-standardised mortality (ASMR) and age-standardised DALYs rate (ASDR) of cirrhosis due to alcohol were negatively correlated with the SDI. The highest disease burden of ALD was observed in Eastern Europe and Central Asia. The prevalence and deaths increased significantly from 1990 to 2021 and are projected to continue increasing until 2046. A high body mass index (BMI) and smoking are major risk factors for ALD.

Conclusion: ALD poses a significant global health burden, which is particularly pronounced among the elderly over 55 years old. A high BMI and smoking are key risk factors for ALD-related deaths.

Keywords: alcohol‐associated liver disease; cirrhosis; global burden; liver cancer; risk factors.

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