Evolving burden of metabolic dysfunction–associated steatotic liver disease and its complications in a US nationwide healthcare system

Sep 29, 2026

Metabolic dysfunction–associated steatotic liver disease (MASLD) is a rapidly expanding public health concern, making it essential to measure evolving cirrhosis and related complications to guide care delivery. In a U.S. nationwide Veterans Health Administration cohort, temporal trends from 2010–2021 were analyzed for MASLD-related cirrhosis and hepatocellular carcinoma (HCC), compared with hepatitis C virus (HCV) and alcohol-associated liver disease (ALD). MASLD incidence and prevalence increased, with higher growth among older adults, Whites, Hispanics, and people with diabetes.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

MASLD definition and clinical progression

Public health impact and projected trends

Evolving burden of metabolic dysfunction–associated steatotic liver disease and its complications in a US nationwide healthcare system VISUAL ABSTRACT DOI: 10.1097/HC9.0000000000000878 O R IG INAL ART ICL E Evolving burden of metabolic dysfunction–associated steatotic liver disease and its complications in a US nationwide healthcare system Basim Ali 1 | Ronald Samuel 1,2 | Jennifer R. Kramer2,3,4 | Liang Li5 | Xian Yu2,3 | Yumei Cao2,3 | Roxanne Desiderio 1,3 | George Cholankeril 1 | Steven M. Asch5 | Hashem B. El-Serag 1,3 | Fasiha Kanwal 1,2,3 1Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA 2VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA 3Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA 4Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA 5Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA Correspondence Fasiha Kanwal, Baylor College of Medicine, McNair Building, Suite A10-198, 7200 Cambridge Street, BCM 901, Houston, Texas 77030, USA. Email: [kanwal@bcm.edu](kanwal@bcm.edu) | | Abstract | | | --- | --- | --- | | | Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a growing public health problem. Measuring the burden of cirrhosis and its complications in people with MASLD is important to inform health care delivery.
Methods: We aimed to quantify the changes in the burden of MASLDrelated cirrhosis and hepatocellular carcinoma (HCC) in a nationwide U.S. healthcare system. We used data from the Veterans Health Administration to examine temporal trends between 2010 and 2021 in the annual incidence and prevalence of cirrhosis and HCC in a large cohort of patients with MASLD, and to compare them to those in patients with hepatitis C virus infection (HCV) and alcohol-associated liver disease (ALD) .
Results: The MASLD cohort grew from 78,082 in 2010 to 621,400 patients in 2021 . The annual age-standardized incidence rates of MASLD-related cirrhosis rose from 1.39 (95% CI, 1.13, 1.65) to 1.91 (95% CI, 1.80, 2.02) per 1000 patients (37 .4% increase) . HCC incidence increased from 0 .08 (95% CI, 0 .02, 0 . 14) to 0 .22 (0 . 18, 0 .26) per 1000 patients (175% increase) . Cirrhosis and HCC prevalence also increased, particularly among adults older than age 65, Whites, Hispanics, and individuals with diabetes. Temporal trends in the incidence and prevalence of cirrhosis and HCC among patients with ALD were similar to those in MASLD. In contrast, patients with HCV experienced a sharp decline in the incidence of cirrhosis and HCC in this | | | | | | Abbreviations: ALD, alcohol-associated liver disease; ALT, alanine aminotransferase; AUDIT-C, Alcohol Use Disorders Identification Test-Consumption; BMI, body mass index; CCR, Central Cancer Registry; CDW, Corporate Data Warehouse; CPT, Current Procedural Terminology; FIB-4, Fibrosis-4 Index; GEE, Generalized Estimating Equation; HbA1c, glycated hemoglobin; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HDL, high-density Lipoprotein; ICD- 9/10, International Classification of Diseases, 9th/10th Revision; IU, International Units; MASH, metabolic dysfunction–associated steatohepatitis; MASLD, metabolic dysfunction–associated steatotic liver disease; SAS, Statistical Analysis System; T2DM, type 2 diabetes mellitus; VA, Veterans Affairs; VHA, Veterans Health Administration. Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website, www.hepcommjournal.com. -- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- ----- - This is an open access article distributed under the terms of the Cre

FAQs

What problem does the study address about MASLD?

It quantifies how the burden of MASLD-related cirrhosis and hepatocellular carcinoma (HCC) has changed over time to support health care delivery planning.

How was the burden of MASLD complications measured?

The study used Veterans Health Administration data to evaluate temporal trends from 2010 to 2021 in annual incidence and prevalence of cirrhosis and HCC in a large MASLD cohort.

How did MASLD trends compare with ALD and HCV trends?

Incidence and prevalence trends for cirrhosis and HCC among ALD patients were similar to those in MASLD, while HCV patients experienced a sharp decline in incidence of cirrhosis and HCC during the period.

Sep 29, 2026

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