Article Text

Download PDFPDF
Original research
Epidemiology of chronic liver diseases in the USA in the past three decades
  1. Zobair M Younossi1,2,
  2. Maria Stepanova3,
  3. Youssef Younossi3,
  4. Pegah Golabi1,2,
  5. Alita Mishra1,2,
  6. Nila Rafiq1,2,
  7. Linda Henry3
  1. 1 Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia, USA
  2. 2 Department of Medicine, Center For Liver Disease, Inova Fairfax Hospital, Falls Church, Virginia, USA
  3. 3 Department of Statistical Services, Center for Outcomes Research in Liver Diseases, Washington, DC, USA
  1. Correspondence to Dr Zobair M Younossi, Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA 22042, USA; zobair.younossi{at}


Objective Given significant advances in treatment of viral hepatitis and the growing epidemic of obesity, the burden of the different types of liver diseases in the USA may be changing. Our aim was to assess the shift in the prevalence of different liver disease aetiologies in the USA over the past three decades.

Design National Health and Nutrition Examination Surveys (NHANES; cross-sectional 1988–1994 and 1999–2016) were used.

Results A total of 58 731 adults from NHANES (1988–2016) were included. Over the study period, the prevalence of chronic hepatitis B and alcoholic liver disease remained stable: 0.3%–0.4% and 0.8%–1.0%, respectively (p>0.05). The prevalence of chronic hepatitis C decreased nearly twofold: 1.6% in 1988–1994 to 0.9% in 2013–2016 (p=0.03). In contrast, the prevalence of non-alcoholic fatty liver disease (NAFLD; by US-Fatty Liver Index) increased from 20.0% (1988–1994) to 28.3% (1999–2004) to 33.2% (2009–2012) and 31.9% (2013–2016) (p<0.0001). Furthermore, steady increases were observed in the rates of obesity (22.2% in 1988–1994 to 31.0% in 1999–2004 to 38.9% in 2013–2016), type 2 diabetes mellitus (T2DM) (from 7.2% to 8.2% to 13.5% same years), insulin resistance and hypertension (all p<0.0001). Yearly trend analyses showed that the only LD with consistently increasing prevalence was NAFLD (trend p=0.01). Multivariable regression analysis showed that obesity (OR 10.4; 95% CI 9.5 to 11.3) and T2DM (OR 3.7; 95% CI 3.2 to 4.2) were the major independent predictors of NAFLD.

Conclusions Over the past 30 years in the USA, NAFLD is the only liver disease with growing prevalence, synchronous with the increasing rates of obesity and T2DM.

  • non-alcoholic fatty liver disease
  • epidemiology
  • trends
  • obesity
  • diabetes

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors ZMY is the guarantor of the article and contributed to the study concept and design; obtained funding and supervised the study. MS contributed to the acquisition of data, analysis and interpretation of data and statistical analysis. YY and PG gave technical or material support. AM and NR contributed to the study concept and design and interpretation of data. All authors contributed to the critical revision of the manuscript for important intellectual content.

  • Funding Internal funds only.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by Inova Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.