Regional inequities in metabolic dysfunction–associated steatotic liver disease burden and care quality in high-burden settings: implications for health systems
image: MASLD burden and care quality vary widely across regions. Low-QCI regions show higher mortality and disability, unfavorable metabolic risk profiles, and delayed detection patterns. Strengthening prevention, early case finding, fibrosis assessment, and treatment access may slow MASLD progression.
Credit: Xiaodong Sun, Ying Xue
Background and Aims
Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasing rapidly, yet regional differences in burden and care quality remain unclear. This study aimed to compare regional incidence, mortality, and disability; evaluate care quality; identify key determinants; and project future incidence.
Methods
We analyzed the Global Burden of Disease 2023 estimates of MASLD incidence, deaths, and disability-adjusted life years from 1990 to 2023 by age, sex, country, and region. Age-standardized rates were assessed using joinpoint regression. A composite Quality of Care Index (QCI) was derived through principal component analysis. Gradient boosting models with SHapley Additive exPlanations interpretation identified key predictors, and Bayesian age–period–cohort models generated incidence projections.
Results
In 2023, South and East Asia had the largest numbers of new cases, while North Africa and the Middle East and Andean Latin America recorded the highest age-standardized incidence, mortality, and disability rates. Eastern Europe and Andean Latin America showed sustained increases in mortality and disability despite moderate incidence growth. QCI values were lowest in South Asia, Western Sub-Saharan Africa, and Eastern Europe. High body mass index and fasting plasma glucose were prominent contributors in comparative risk attribution analyses, and machine learning models identified age and calendar year as the strongest predictors of modeled burden patterns. Incidence is projected to continue increasing through 2050, particularly in India and China.
Conclusions
MASLD is a growing health challenge marked by wide regional inequalities in burden and care quality. South Asia and East Asia carry the largest numbers of new cases, whereas North Africa and the Middle East and Andean Latin America show disproportionately high age-standardized rates. Eastern Europe and Andean Latin America face high mortality and disability burdens, and Mexico shows particularly high ASDR within the broader Latin American context. Low-QCI regions, including South Asia, Western Sub-Saharan Africa, and Eastern Europe, require stronger diagnostic infrastructure, early case finding, and accessible fibrosis assessment. Regions with large incident case numbers need stronger metabolic prevention and better integration of MASLD screening into diabetes and metabolic disease care. Latin American settings with high disability burden require improved fibrosis risk stratification and referral pathways for advanced liver disease. Higher-QCI and high-income settings should focus on equitable access to fibrosis assessment, long-term monitoring, and emerging therapies. Tailoring these strategies to regional burden profiles, QCI performance, and health system capacity may help reduce severe MASLD outcomes and slow the rising burden through 2050.
Full text
https://www.xiahepublishing.com/2310-8819/JCTH-2026-00127
The study was recently published in the Journal of Clinical and Translational Hepatology.
The Journal of Clinical and Translational Hepatology (JCTH) is owned by the Second Affiliated Hospital of Chongqing Medical University and published by XIA & HE Publishing Inc. JCTH publishes high quality, peer reviewed studies in the translational and clinical human health sciences of liver diseases. JCTH has established high standards for publication of original research, which are characterized by a study’s novelty, quality, and ethical conduct in the scientific process as well as in the communication of the research findings. Each issue includes articles by leading authorities on topics in hepatology that are germane to the most current challenges in the field. Special features include reports on the latest advances in drug development and technology that are relevant to liver diseases. Regular features of JCTH also include editorials, correspondences and invited commentaries on rapidly progressing areas in hepatology. All articles published by JCTH, both solicited and unsolicited, must pass our rigorous peer review process.
Follow us on X: @xiahepublishing
Follow us on LinkedIn: Xia & He Publishing Inc.