Global burden of metabolic dysfunction-associated steatotic liver disease attributable to tobacco, 1990-2023, and...

Tobacco exposure is a well-established risk factor for metabolic dysfunction-associated steatotic liver disease (MASLD); however, its global burden remains poorly quantified. This study estimated the global, regional, and national burden of MASLD attributable to tobacco from 1990 to 2023 and projected trends to 2038.

Using Global Burden of Disease Study 2023 data, deaths, disability-adjusted life-years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) were estimated across 204 countries and territories. We assessed temporal trends using average annual percentage change, performed decomposition analysis, evaluated cross-national health inequalities with slope and concentration indices, and projected rates to 2038 using Bayesian age-period-cohort models.

Globally, deaths increased 2.3-fold (from 1,479 to 3,473) and DALYs 2.2-fold (from 41,636 to 90,682) from 1990 to 2023, whereas the ASMR (0.04 per 100,000) and ASDR (1.00 per 100,000) remained stable. The burden was 6- to 7-fold higher in males than in females, with substantial geographic heterogeneity: declines were observed in the high-income Asia Pacific region, whereas sharp increases occurred in Australasia, Southern Latin America, and North Africa and the Middle East. Population growth and ageing drove the absolute burden increase. Health inequalities widened. Projections indicate declining ASMRs and ASDRs through 2038, with more rapid declines in females.

Although age-standardized rates remained stable, the absolute burden more than doubled over three decades, with significant disparities by sex, region, and socioeconomic status. Targeted tobacco control and MASLD prevention strategies are urgently needed, particularly in high-burden regions and among males.

Abbreviations: MASLD, metabolic dysfunction-associated steatotic liver disease; DALYs, disability-adjusted life-years; ASDR, age-standardized DALYs rate; ASMR, age-standardized mortality rate; SDI, socio-demographic index.

The online version contains supplementary material available at 10.1007/s40200-026-01997-2.