Analysis of the burden of liver cirrhosis related to non-alcoholic fatty liver disease in China from 1990 to 2021

Objective The incidence of chronic liver disease due to non-alcoholic fatty liver disease (NAFLD) is gradually increasing worldwide. This study assessed the disease burden of liver cirrhosis related to NAFLD in China from 1990 to 2021 and predicted future trends.Methods Data were obtained from the Global Burden of Disease (GBD) 2021 study. Joinpoint model was used to calculate the trend changes of liver cirrhosis related to NAFLD in China, and age-period-cohort analyse was used to estimate the independent effects of age, period, and cohort. ARIMA model was used to predict the prevalence in the next 15 years.Results In 2021, the incidence of cirrhosis related to NAFLD in China was 672.02/100,000, the prevalence was 20,470.78/100,000, and the mortality rate was 0.45/100,000.The 1990-2021 age-standardized incidence rate (ASIR) mean annual percentage change (AAPC) was 0.74 % (95% CI = 0.69 %- 0.78%). There was a decreasing trend in the age standardized death rate (ASDR) with an AAPC of -1.73% (95%CI = −2.06% - −1.40%). The age effect showed an overall fluctuating downward trend in incidence with age. Mortality showed an overall increasing trend. The period effect showed an overall decreasing and then increasing trend in period rate ratios (RR), with the highest risk of morbidity in 2017-2021, the period RR of morbidity = 1.16 (95% CI = 1.11,1.21); and a decreasing trend in mortality, with the highest risk of death in 1992-1996, the risk RR of mortality = 1.50 (95% CI = 1.43,1.58). The cohort effect showed a significant increase in the risk of incidence and a decreasing trend in the risk of mortality from 1977-2002. The ASIR is projected to increase from 621.18/100,000 to 662.27/100,000 over the next 15 years. Of these, ASIR is predicted to decrease in males and increase substantially in females. ASDR for the whole population will decrease from 0.31/100,000 to 0.29/100,000 people. Of these, the ASDR is projected to decrease slightly for males and increase slightly for females.Conclusions The future incidence of liver cirrhosis related to NAFLD in China from 1990 to 2021 still shows an increasing trend. More attention needs to be paid to young men and postmenopausal women, and targeted public health interventions focusing on NAFLD management are urgently needed.