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Disease burden of metabolic dysfunction-associated steatotic liver disease in the elderly population globally and in China from 1990 to 2021

Published on Apr. 30, 2026Total Views: 15 timesTotal Downloads: 5 timesDownloadMobile

Author: ZHANG Qiang 1# ZHAO Xiaoxiao 2# WANG Haibo 3 XU Peng 4 WANG Yaxing 5 ZHAO Xinke 6 LIU Fan 6 LI Jiali 6 HE Tao 7 CHEN Zhengtao 8 Ding Yunhan 9 KE Lixin 10 LI Jieyun 11 XUN Yangqin 12 LU Cuncun 6

Affiliation: 1. Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Henan University of CM, Zhengzhou 450000, China 2. Department of Geriatric Medicine Center, Affiliated Hospital of Shandong University of TCM, Jinan 250014, China 3. Department of Critical Care Medicine, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou 730000, China 4. China Institute for History of Chinese Medicine and Medical Literature, China Academy of Chinese Medical Sciences, Beijing 100700, China 5. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China 6. Institute of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou 730101, China 7. Department of Rehabilitation and Spinal Cord Injury, Gansu Rehabilitation Center Hospital, Lanzhou 730000, China 8. Department of Traditional Chinese Medicine, People's Liberation Army 93811 Unit, Lanzhou Military Region Air Force Hospital, Lanzhou 730020, China 9. Clinical Laboratory of South Hospital District, Affiliated Hospital of Chengde Medical Uni-versity,Chengde 067000, Hebei province, China 10. Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen 9713GZ, Netherlands 11. School of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China 12. School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China #Co-first authors: ZHANG Qiang and ZHAO Xiaoxiao

Keywords: Metabolic dysfunction-associated steatotic liver disease Non-alcoholic fatty liver disease Older adult Disease burden Prediction model

DOI: 10.12173/j.issn.1004-5511.202506178

Reference: Zhang Q, Zhao XX, Wang HB, et al. Disease burden of metabolic dysfunction-associated steatotic liver disease in the elderly population globally and in China from 1990 to 2021[J]. Yixue Xinzhi Zazhi, 2026, 36(4): 428-437. DOI: 10.12173/j.issn.1004-5511.202506178. [Article in Chinese]

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Abstract

Objective  To analyze the changing trend and influencing factors of the disease burden of older adults with metabolic dysfunction-associated steatotic liver disease (MASLD) globally and in China from 1990 to 2021, and to predict its future trend.

Methods  Data on the prevalence and disability-adjusted life years (DALYs) of MASLD among individuals aged 60 years and older from the Global Burden of Disease (GBD) 2021 database were extracted for a global context, China, and five socio-demographic index (SDI) regions. Joinpoint regression analysis was employed to calculate the average annual percent change (AAPC) in the age-standardized prevalence (ASPR) and DALY rates (ASDR) from 1990 to 2021, and the subgroup analyses were conducted by age and gender. A three-factor decomposition model was used to quantify the relative impacts of aging, population growth, and epidemiological change on the changes in disease burden, while a Bayesian age-period-cohort model was applied to predict the trend in disease burden of older adults with MASLD from 2022 to 2035.

Results  The number of MASLD patients in the global and Chinese elderly populations was 366,398,400 cases and 98,916,800 cases in 2021, respectively, representing an increase of 176.40% and 230.71% compared to 1990. The number of DALYs was 1,834,700 person-years and 234,100 person-years, showing increases of 139.52% and 127.06%, respectively. During the period from 1990 to 2021, ASPR [AAPC=0.67%, 95%CI (0.62%, 0.72%)] and ASDR [AAPC=0.20%, 95%CI (0.06%, 0.34%)] of MASLD in the global elderly population exhibited a significant upward trend. ASPR [AAPC=0.65%, 95%CI (0.55%, 0.75%)] of MASLD in the elderly population in China showed a significantly upward trend, while ASDR [AAPC=-0.49%, 95%CI (-0.92%, -0.06%)] showed a significantly downward trend. Subgroup analyses by gender indicated that in both 1990 and 2021, the number of prevalence and DALYs in the elderly female populations were higher than those in the corresponding male populations globally and in China. Additionally, while the ASDR of MASLD among the elderly in high-middle and low SDI regions regions showed significant downward trends from 1990 to 2021, the number of patients and DALYs across the five SDI regions increased in 2021 compared to 1990. The 60~64 age group accounted for the highest proportion of case numbers and DALYs among the global elderly population with MASLD in 2021, whereas the 65~69 age group ranked the first in China. Decomposition analysis revealed that population growth was the primary influencing factor for the increase in disease burden of MASLD across all areas, contributing the most (122.09%) to the increase in DALYs in China. The prediction model indicated that by 2035, the number of cases and DALYs in the global elderly population would increase by 65.80% and 43.11%, respectively, compared to 2021, while in China, the increases would be 104.95% and 24.78%, respectively.

Conclusion  The disease burden of MASLD in the elderly populations globally and in China remains substantial and is expected to continue increasing in the future. It is recommended to promote healthy lifestyle practices while actively adopting a multidisciplinary management approach for elderly MASLD patients and enhancing the research and development of effective drugs to alleviate the burden associated with this disease.

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