Global burden of chronic liver disease due to NAFLD from 2012 to 2021: A trend, decomposition, and health inequality analysis

Non-alcoholic fatty liver disease (NAFLD) is considered to be an important driver of the increasing burden of chronic liver disease (CLD) worldwide. It is necessary to analyze the burden of CLD due to NAFLD (CLD-NAFLD) systematically. Data related to CLD-NAFLD burden from 2012 to 2021 were obtained from the Global Burden of Disease Study (GBD) 2021. The temporal trend of the incidence and disability-adjusted life years (DALYs) was quantified by average annual percentage change (AAPC). The driving factors of the incidence/DALYs change were explored through decomposition analysis. Slope index and concentration index were employed to investigate cross-country health inequalities. During 2012-2021, the global age-standardized incidence rate (ASIR) of CLD-NAFLD increased from 551.52 to 592.78 (per 100,000 population), while the age-standardized DALY rate (ASDR) decreased from 31.92 to 30.90 (per 100,000 population). North Africa and Middle East had the highest age-standardized prevalence rate (ASPR), East Asia experienced the most rapid increase in ASIR, and Caribbean exhibited the most substantial increase in ASDR. Decomposition analysis showed that the main factors driving the increase in incident cases were population growth and epidemiologic changes, whereas population aging and population growth were the main driving factors for the increase of DALYs. There was cross-country health inequality in the DALYs, which showed a decreasing trend from 2012 to 2021. However, the health inequality in incidence was not significant. The burden of CLD-NAFLD continues to increase. Health policy makers must develop corresponding strategies for the primary health care of metabolic diseases.