Projected Trends in Metabolic Dysfunction-Associated Steatotic Liver Disease Mortality Through 2040

Importance: Population-based data for metabolic dysfunction-associated steatotic liver disease (MASLD)-related mortality trends and forecasts in the United States are limited. Objective: To examine MASLD-related mortality trends in the United States from 2006 to 2023 and forecast mortality rates up to 2040 overall and in subgroups by age, sex, race and ethnicity, and urbanization. Design, Setting, and Participants: This cross-sectional study used data from the National Vital Statistics System dataset. Data on deaths attributed to MASLD were obtained for adults aged 25 years and older from January 1, 2006, to December 31, 2023. Main Outcomes and Measures: Trends were evaluated by average annual percentage change (AAPC) in age-standardized mortality rates (ASMRs) per 100000 persons, and mortality rates were forecasted to 2040 using projection models. Results: A total of 27961 decedents aged 25 years and older with MASLD (15251 [54.5%] aged ≥65 years; 15450 [55.3%] female; 3373 [12.1%] Hispanic, 1480 [5.3%] non-Hispanic Black, and 21936 [78.5%] non-Hispanic White) were documented from 2006 to 2023. ASMRs rose from 0.25 to 1.27 per 100000 persons, with AAPCs increasing from 9.27% in 2006 to 2018 to 22.66% in 2018 to 2021, then decreasing to -1.23% from 2021 to 2023, leading to projected ASMRs of 2.24 per 100000 persons in 2040. There were significant differences in the increases of ASMRs by age, with those aged 65 years or older having the steepest rise (AAPC, 15.34%; 95% CI, 14.40%-16.32%; P <.001; 45-64 years: 8.76%; 95% CI, 7.29%-10.22%; P <.001; 25-44 years: 2.65%; 95% CI, 0.49%-4.86%; P =.02) and a projected increase from 3.69 per 100000 persons in 2024 to 7.12 per 100000 persons in 2040. However, there was no significant difference in ASMRs by sex (AAPC among women: 11.24%; 95% CI, 10.09%-12.40%; P <.001; AAPC among men: 11.04%; 95% CI, 9.56%-12.63%; P <.001). ASMRs rose for all major racial ethnic groups, with the highest ASMR increase observed for non-Hispanic White individuals (AAPC, 11.12%; 95% CI, 9.48%-12.83%; P <.001), followed by Hispanic (AAPC, 10.67%; 95% CI, 9.11%-12.26%; P <.001), non-Hispanic Black (AAPC, 9.20%; 95% CI, 7.32%-11.11%; P <.001), and non-Hispanic Asian (AAPC, 7.97%; 95% CI, 4.66%-11.75%; P <.001) individuals, while the projected values for these 4 groups showed similar increasing trends to 2040. There were also significant differences in ASMRs by metropolitan categories overall, with the highest rise in nonmetropolitan areas (AAPC, 13.50%; 95% CI, 10.70%-16.32%; P <.001). Conclusions and Relevance: In this cross-sectional study, MASLD-related mortality increased rapidly between 2006 and 2023 and was projected to rise over the next 20 years, with the largest disparities among those aged 65 years and older, among non-Hispanic White and Hispanic individuals, and among nonmetropolitan populations.