Global burden of liver disease: 2026 update

Chronic liver disease (CLD) remains a major global health challenge, affecting more than 1.5 billion people worldwide and contributing to morbidity, mortality, and healthcare costs. Cirrhosis is the 12th leading cause of death globally and together with primary liver cancer accounts for nearly 2.4 million deaths annually, disproportionately affecting low- and middle-income countries. The principal etiologies driving the burden of liver disease include alcohol-associated liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD), and chronic viral hepatitis (HBV and HCV). Demographic changes, rising obesity, and increasing alcohol consumption are expected to escalate the burden of ALD and MASLD, while improved access to vaccination and antiviral therapy continues to reshape the epidemiology of viral hepatitis. Acute liver failure, though rare, results in significant clinical and economic consequences and highlights striking regional disparities in etiology and outcomes. Cirrhosis carries elevated risk of progression to hepatic decompensation, acute-on-chronic liver failure, and hepatocellular carcinoma. These complications are associated with limited access to advanced therapies in resource-restricted regions. Importantly, Africa now bears the highest age-standardized mortality rates from cirrhosis and liver cancer, driven largely by viral hepatitis, aflatoxin exposure, and constrained access to care. Liver transplantation remains lifesaving but is accessible to a minority of patients globally. The escalating burden of MASLD, the growing interplay of metabolic disease and alcohol use, and persistent gaps in viral hepatitis diagnosis and treatment underscore the urgent need for integrated prevention, early detection, and equitable access to evidence-based liver care. This review provides an updated global assessment of the burden of liver disease, highlighting widening regional disparities, and outlining priorities and strategies for reducing its worldwide impact.