Chronic liver diseases (CLDs) are a global health concern of significant magnitude, yet their true impact is often underestimated [1]. These diseases contribute to approximately two million deaths each year, accounting for around 4% of all global fatalities [2]. Despite their prevalence, CLDs frequently receive less attention compared to other major health issues. A timely study by Lee et al. which included 59,204 adult participants, examines CLD trends in the United States and highlights the disparity in disease burden across socioeconomic groups. Notably, lower-income communities face a higher burden of liver disease, with increased risks of overall CLDs (33%), hepatitis C virus (HCV) (75%), hepatitis B virus (HBV) (50%), advanced fibrosis (33%) and non-alcoholic fatty liver disease (NAFLD) (8%) compared to higher-income groups [3]. This disparity may be attributed to limited access to healthier lifestyle resources and healthcare facilities among lower-income populations [4].

Ethnicity also plays a crucial role in the prevalence and distribution of CLDs (Figure 1). In the United States, different ethnic groups exhibit varying rates of liver diseases [5]. For example, Asian and African–American populations have a higher prevalence of HBV, while American–Indian and Alaskan Native populations experience higher rates of HCV infection [6]. In Malaysia, the prevalence of liver diseases shows distinct ethnic patterns: HBV is more common among the Chinese, while NAFLD is more prevalent among Malays and Indians [7]. Despite these variations, the increased burden of liver diseases observed in lower-income groups persists across different ethnicities [3], indicating that socioeconomic factors are a major determinant of health outcomes in addition to genetic and lifestyle factors.

NAFLD, in particular, is a condition that warrants significant attention. According to the study by Lee et al. NAFLD is the most common CLD, affecting approximately 32.8% of the population. Its prevalence has been steadily rising over the past two decades affecting individuals across all socioeconomic status, reflecting broader trends in obesity and metabolic syndrome [3]. In Malaysia, while HBV remains the most common CLD encountered in secondary care settings, NAFLD has emerged as the leading cause of liver cirrhosis and hepatocellular carcinoma [7]. Moreover, NAFLD not only leads to more liver-related complications but is also associated with a higher risk of cardiovascular events [8, 9].

Understanding the epidemiology of CLDs is essential for shaping effective healthcare policies. Tailoring policies to address the specific needs of different socioeconomic and ethnic groups can help reduce the impact of these diseases. Implementing targeted healthcare programs that consider the unique challenges faced by lower-income populations and different ethnic groups is crucial. Given that NAFLD is now the most common cause of CLD and a leading cause of liver-related morbidity and mortality, a coordinated effort from all stakeholders is necessary. Addressing the public health threat of obesity and its related conditions, including NAFLD, requires a multifaceted approach that includes prevention, early detection and comprehensive management to improve health outcomes on a broader scale [10].

慢性肝病 （CLD） 是一个重大的全球健康问题，但其真正的影响往往被低估 [1]。这些疾病每年导致约 200 万人死亡，约占全球死亡人数的 4% [2]。尽管 CLD 很普遍，但与其他主要健康问题相比，CLD 通常受到较少的关注。Lee 等人的一项及时研究包括 59,204 名成年参与者，研究了美国的 CLD 趋势，并强调了不同社会经济群体之间疾病负担的差异。值得注意的是，低收入社区面临更高的肝病负担，与高收入群体相比，总体 CLD （33%）、丙型肝炎病毒 （HCV） （75%）、乙型肝炎病毒 （HBV） （50%）、晚期纤维化 （33%） 和非酒精性脂肪性肝病 （NAFLD） （8%） 的风险增加 [3]。这种差异可能归因于低收入人群获得更健康的生活方式资源和医疗保健设施的机会有限 [4]。

种族在 CLD 的患病率和分布中也起着至关重要的作用（图 1）。在美国，不同种族的肝病发病率不同 [5]。例如，亚洲和非裔美国人的 HBV 患病率较高，而美洲-印第安人和阿拉斯加原住民的 HCV 感染率较高 [6]。在马来西亚，肝病的患病率显示出不同的种族模式：HBV 在华人中更常见，而 NAFLD 在马来人和印度人中更常见 [7]。尽管存在这些差异，但在低收入群体中观察到的肝病负担增加在不同种族中仍然存在 [3]，这表明除了遗传和生活方式因素外，社会经济因素是健康结果的主要决定因素。

尤其是 NAFLD，是一种值得高度关注的疾病。根据 Lee 等人的研究，NAFLD 是最常见的 CLD，影响了大约 32.8% 的人口。在过去的二十年里，其患病率一直在稳步上升，影响到所有社会经济地位的个体，反映了肥胖和代谢综合征的广泛趋势 [3]。在马来西亚，虽然 HBV 仍然是二级保健机构中最常见的 CLD，但 NAFLD 已成为肝硬化和肝细胞癌的主要原因 [7]。此外，NAFLD 不仅导致更多与肝脏相关的并发症，而且还与更高的心血管事件风险有关[8,9]。

了解 CLD 的流行病学对于制定有效的医疗保健政策至关重要。调整政策以满足不同社会经济和种族群体的特定需求有助于减少这些疾病的影响。实施有针对性的医疗保健计划，考虑到低收入人群和不同种族群体面临的独特挑战，这一点至关重要。鉴于 NAFLD 现在是 CLD 的最常见原因，也是肝脏相关发病率和死亡率的主要原因，因此所有利益相关者必须做出协调努力。应对肥胖及其相关疾病（包括 NAFLD）的公共卫生威胁需要采取多方面的方法，包括预防、早期发现和综合管理，以在更广泛的范围内改善健康结果[10]。