Global Burden of Chronic Liver Disease and Temporal Trends: A Population‐Based Analysis From 1990 to 2021 With Projections to 2050

ABSTRACT Background and Aims Globally, the aetiology and epidemiology of chronic liver disease (CLD) are undergoing significant changes. We aimed to investigate the updated global burden of CLD, evaluate the cross‐country inequalities, and provide 2050 predictions. Methods Using the Global Burden of Disease Study (GBD) 2021 data resources, we analysed and forecasted CLD prevalence, incidence, and related death from 1990–2021 to 2050, respectively. We calculated average annual percent change (AAPC) by joinpoint regression model and quantified inequalities according to World Health Organisation‐recommended health equity standards. Results In 2021, the number of prevalent, incident CLD and related deaths globally were 1.7 billion (95% uncertainty interval (UI): 1.6–1.8), 58.4 million (95% UI: 54.2–62.8) and 1.4 million (95% UI: 1.3–1.5), respectively. During 1990–2021, the age‐standardised incidence rate (ASIR) increased, especially in those aged 15–49 (AAPC: 0.49%; 95% confidence interval [CI]: 0.45%–0.53%), in Europe (AAPC: 0.41%; 95% CI: 0.41%–0.42%) and the Americas (AAPC: 0.41%; 95% CI: 0.39%–0.42%), whereas the age‐standardised death rate (ASDR) decreased globally (AAPC: −1.26%; 95% CI: −1.35% [−1.17%]) and across subgroups. During 1990–2021, the ASIR of metabolic dysfunction‐associated steatotic liver disease (MASLD) increased the most in those aged 15–49 (AAPC: 0.72%; 95% CI: 0.67%–0.77%) and in the Western Pacific region (AAPC: 0.73%; 95% CI: 0.59%–0.86%). Socio‐demographic index (SDI)‐related inequalities decreased for the age‐standardised prevalence rate (ASPR) and ASIR of CLD but increased for ASDR, placing a disproportionately heavier burden on low‐SDI countries. From 2022 to 2050, the ASIR of CLD is projected to increase (AAPC: 0.20%; 95% CI: 0.19%–0.20%), but the ASDR is projected to decline (AAPC: −1.91%; 95% CI: −1.96% [−1.85%]). Conclusions This study's findings highlight targeted interventions for CLD disparities, focusing on MASLD management, the younger population (15–49 years), and socio‐demographic inequalities.