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

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 MASLD-related 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 time frame. CONCLUSIONS: The burden of MASLD-related cirrhosis and HCC is growing. While the burden of liver complications is similar between MASLD and ALD, the substantially larger size of the MASLD population means that the modest increases in incidence of cirrhosis and HCC could translate into a large absolute burden.