Abstract
<title>Abstract</title> <p>Background Metabolic dysfunction-associated steatohepatitis (MASH) is increasingly recognized as a major cause of cirrhosis and hepatocellular carcinoma (HCC), particularly among young and middle-aged adults (15–49 years). This study analyzes data from the Global Burden of Disease Study 2021 (GBD 2021) to examine trends from 1990 to 2021 and suggest future interventions. Methods We evaluated global trends in incidence, prevalence, disability-adjusted life years (DALYs), and mortality for MASH-associated cirrhosis and HCC using the average annual percentage change (AAPC). Joinpoint models identified significant trend inflection points. The burden was assessed using incidence, DALYs, deaths, and age-standardized rates (ASRs), stratified by age, gender, socio-demographic index (SDI), region, and country. Results In 2021, globally, there were 35.6 million incident cases of MASH-associated cirrhosis among young and middle-aged adults (95% UI: 31.7–40.0), resulting in 0.75 million DALYs (95% UI: 0.48–1.12) and 15,108 deaths (95% UI: 9520–22,599). MASH-associated HCC led to 4296 new cases (95% UI: 3311–5510), 0.18 million DALYs (95% UI: 0.14–0.23), and 3545 deaths (95% UI: 2729–4558). The highest incidence of MASH-associated cirrhosis was in the 15–24 age group, while MASH-associated HCC peaked in the 45–49 age group. Significant variations were observed based on gender, SDI quintiles, and geographical regions. Conclusion MASH-associated cirrhosis and HCC pose a significant public health challenge among young and middle-aged adults, with notable regional and national differences. The increasing incidence of MASH-associated cirrhosis, especially in the 15–24 age group, is altering the etiology of chronic cirrhosis. Urgent measures are needed to enhance prevention, promote healthy lifestyles, strengthen healthcare responsiveness, and maintain vigilant epidemiological monitoring to address this alarming trend.</p>