Steatotic Liver Disease has Surpassed Viral Hepatitis as the Leading Cause of Cirrhosis in the US Veterans Health System

INTRODUCTION: Contemporary population-level estimates of the burden of cirrhosis using the revised steatotic liver disease (SLD) nomenclature are lacking. METHODS: Retrospective cohort study of patients with incident cirrhosis from 2008 to 2023 within the Veterans Health Administration. RESULTS: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the leading contributor to cirrhosis incidence and prevalence. Although hepatitis C virus cirrhosis has declined, it remains highly prevalent. Incident MASLD cases are balanced by deaths, whereas incident metabolic and alcohol-associated liver disease and alcohol-associated liver disease cases exceeded deaths. DISCUSSION: Substantial epidemiologic shifts in cirrhosis in the United States over the past decade, driven by the rising burden of SLD, underscore the need for multidisciplinary strategies targeting metabolic risk factors and alcohol use.