Mortality from fatty liver disease has increased, especially among older adults, white and Latino people and those in rural communities.
Deaths linked to metabolic dysfunction-associated fatty liver disease (MASLD) have surged over the past two decades and are projected to continue climbing through 2040, according to a new study published in JAMA Network Open. Mortality rates rose fastest in certain demographic groups, highlighting the need for targeted screening and interventions, including new medications.
“These findings could inform medical practice and public health to address increased MASLD-related mortality trends and timely identification of high-risk populations for interventions to reduce MASLD-related mortality in the United States,” wrote the researchers.
MASLD and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), are responsible for a growing proportion of advanced liver disease worldwide. Over time, the buildup of fat in the liver can lead to fibrosis, cirrhosis and liver cancer. Fatty liver disease is associated with obesity, type 2 disabetes and other metabolic conditions. With only one approved medication, management largely depends on lifestyle changes such as weight loss and exercise.
Xinrong Zhang, MD, PhD, of Stanford University Medical Center, and colleagues analyzed trends in MASLD-related mortality from 2006 through 2023 as well as predicted future rates through 2040. The team accessed data from the National Vital Statistics System, which included 27,961 ages 25 and older with deaths attributed to MASLD. More than half (55%) were at least 65 years old, 55% were women, 79% were white, 12% were Latino and 5.3% were Black.
To assess trends in MASLD mortality, the researchers looked at the average annual percentage change (AAPC) in age-standardized mortality rates (ASMRs) per 100,000 people. Between 2006 and 2023, the ASMR rose from 0.25 to 1.27 deaths per 100,000 people. Annual percentage changes generally increased over time, from +9.27% between 2006 and 2018 to +22.66 between 2018 and 2021, though there was a small decline (-1.23%) from 2021 to 2023. Based on these trends, the ASMR is expected to hit 2.24 deaths per 100,000 people by 2040.
People ages 65 and older had the highest ASMR (3.69 deaths per 100,000 in 2024) and the steepest rise, with an average annual percentage change of +15.34%. The mortality rate for this age group is expected to reach 7.12 in 2040. But even younger adults ages 25 to 44 saw a +2.65% rise. There were no significant differences between men and women in ASMRs or annual percentage change.
White people saw the largest ASMR rise (with an AAPC of +11.12%), followed by Latino (AAPC +10.67%), Black (AAPC +9.20%) and Asian people (AAPC +7.97%). Trends are expected to rise across all ethnicities by 2040. All these groups had similar projected increasing trends through 2040. What’s more, the MASLD mortality rose faster in rural areas compared with metropolitan regions, with an average annual percentage change of +13.5%.
The 2040 projections rely on a mostly unchanged set of circumstances driving MASLD mortality. But the approval and use of new therapies is likely to greatly alter the current trajectory of these trends.
“These shifts have profound implications for public health policy and resource allocation. The emergence of new therapies necessitates a recalibration of MASLD intervention strategies, where cost-effectiveness becomes a critical factor,” Pere Ginès, MD, PhD, of the Hospital Clínic of Barcelona, in Spain, and colleagues wrote in an invited commentary on the study. “As novel treatments enter the market, they must be compared not only against the status quo but also against each other in terms of both clinical benefit and economic viability.”
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