Global landscape of liver disease burden in 1990–2021

Liver diseases remain a major global contributor to disability-adjusted life years (DALYs). Using Global Burden of Disease 2021 data, we applied a three-tier framework linking total liver diseases to acute hepatitis, cirrhosis, liver cancer, and their main etiologies. In 2021, liver diseases caused 309.72 million new cases, 1.98 million deaths, and 63.53 million DALYs worldwide. Although global age-standardized rates declined, death and DALY rates increased in High-income North America and Australasia, with steatosis- and alcohol-related liver diseases accounting for a growing share of the burden. Independent datasets, including the World Health Organization and Global Cancer Observatory sources, supported these regional patterns. Disease burden showed marked age, sex, and etiological disparities, with metabolic factors rising rapidly. Although overall mortality is projected to decline, liver cancer due to steatohepatitis and hepatoblastoma is projected to rise. These findings highlight persistent regional, demographic, and etiological disparities and the need for targeted public health action.