Stevan Gonzalez, MD, MS, is the Director of Liver Transplantation at Baylor Scott and White All Saints Medical Center in Fort Worth, Texas. 

Stevan Gonzalez, MD, MS

Closing Chronic Liver Disease Gaps Requires Earlier Detection, Community Outreach

Awareness, access, and community-driven screening may answer the unmet need of the underestimated rates of chronic liver disease in the US. Earlier detection is imperative to treat liver disease, so that clinicians can recommend lifestyle modifications, medications, and monitoring to halt damage and even reverse early-stage scarring.

Why Do Clinicians Need To Screen or Recognize Liver Disease Earlier?

“The liver is a vital organ capable of repairing itself,” Steven Gonzalez, MD, MS, Director of Liver Transplantation at Baylor Scott & White Health, said in an interview with 

Approaching Liver Health Through a Community Health Lens and Early Identification

 from the 2026 Liver Health Symposium, hosted by the Global Liver Institute. “ In many of these conditions [fatty liver disease, metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease, and even viral hepatitis], even if a person does have evidence of advancing or progressive liver disease, you can actually avoid cirrhosis, and the liver can actually return to improved function and move further away from cirrhosis.”

What’s the Reality of Liver Disease in The US?

estimated 1.5% of the US’s adult population have chronic liver disease or cirrhosis, with mortality rates having nearly doubled since 1999. The most prominent underlying drivers of chronic liver disease include metabolic syndrome, chronic alcohol use, and viral hepatitis, particularly Hepatitis C.

More than 5 million people are living with chronic Hepatitis B or Hepatitis C.

About 42,340 new cases of liver cancer are diagnosed each year, with approximately 31,000 associated deaths.

Patient Populations Disproportionately Impacted by Liver Disease

Gonzalez emphasized that many chronic liver diseases disproportionately affect populations that may face barriers to accessing healthcare.

He pointed to hepatitis C as one example, noting that the disease disproportionately affects individuals who may not regularly seek medical care, including people experiencing homelessness, those who are incarcerated, and individuals with a history of injection drug use.

He added that MASLD can also be associated with social determinants of health, including food insecurity and limited access to resources that support healthy lifestyles and preventive care.

Gonzalez also highlighted the importance of targeted screening efforts. He noted that individuals from countries where hepatitis B is endemic should be screened for infection.

Other groups who may benefit from evaluation include people with diabetes, obesity, high cholesterol, high blood pressure, a family history of liver disease, or a history of excessive alcohol use.

“You need to really outreach to those communities in an effort to reduce the burden of liver disease in the US,” Gonzalez said.

Editor’s Note: Gonzalez reports relevant disclosures with Mallinckrodt Pharmaceuticals, Salix, AbbVie, Gilead, and others.

Alqahtani, S. A., Paik, J. M., Biswas, R., Arshad, T., Henry, L., & Younossi, Z. M. (2021). Poor Awareness of Liver Disease Among Adults With NAFLD in the United States. 

(11), 1833–1847. https://doi.org/10.1002/hep4.1765

More than 40% of U.S. adults have liver disease, with higher risk among Hispanics, new study finds

https://www.vcuhealth.org/news/more-than-40-percent-of-us-adults-have-liver-disease-with-higher-risk-among-hispanics-new-study/

Videos

Stevan Gonzalez, MD, MS, explains patient characteristics and social determinants of health associated with chronic liver disease. 

Chronic Liver Disease: How PCPs Can Improve Early Detection

Since chronic liver disease often presents with "silent" symptoms, improving early detection requires support beyond hepatologists; primary care clinicians and community-based health organizations can develop their role in increasing awareness and expanding screening efforts.

“We're recognizing that chronic liver disease in the US is vastly underestimated, and it's beyond what a liver specialist can do in terms of the general population,” Steven Gonzalez, MD, MS, Director of Liver Transplantation at Baylor Scott & White Health, said in an interview with 

his talk from the 2026 Liver Health Symposium, hosted by the Global Liver Institute. “That's where our primary care providers and our community-based health organizations are going to play a very important role in increasing awareness, education, and screening.”

How Much of the US is Impacted by Chronic Liver Disease?

According to the Centers for Disease Control and Prevention (CDC), chronic liver disease is the 9th leading cause of death in the United States. In total, 1.8% of adults ≥ 18 years of age have been diagnosed with liver disease, standing at 4.5 million individuals. Furthermore, an estimated 33% of US adults have metabolic dysfunction-associated steatotic liver disease (MASLD), while cirrhosis impacts around 2.6% of the population.

Why Don’t More Patients Know They Have Liver Disease?

As Gonzalez explains, the liver is a “resilient” organ.

As such, one of the greatest challenges is that chronic liver disease often progresses without noticeable symptoms. Since the liver can continue functioning despite ongoing injury, patients may live with inflammation and fibrosis for years or even decades before receiving a diagnosis.

By the time cirrhosis develops, the liver has often sustained irreversible scarring. At that stage, patients may begin experiencing fatigue, nausea, unintentional weight loss, or mild cognitive impairment.

The American Liver Foundation emphasizes that early intervention, whether through alcohol cessation, treatment of viral hepatitis, or management of obesity and metabolic disease, can halt disease progression and, in some patients, reverse early-stage liver damage before irreversible scarring develops.

One reason many cases go undetected is that routine laboratory testing does not specifically screen for liver fibrosis. Liver enzyme testing, fibrosis assessments, and imaging are often performed only after clinicians suspect underlying liver disease or identify patients at increased risk

What Characteristics Should Clinicians Look Out For in Chronic Liver Disease?

In recent years, rates of chronic liver disease, particularly alcohol-associated liver disease (ALD) and MASLD, have increased.

“There are groups of populations in the U.S. who are disproportionately affected by alcohol-associated liver disease, and that includes women, younger people, and Native Americans.”

Gonzalez said addressing the growing burden of chronic liver disease will require a broader public health approach, with primary care clinicians, community organizations, and hepatologists working together to identify at-risk patients before irreversible liver damage occurs. Earlier screening, patient education, and timely referral, he noted, may represent the greatest opportunity to reduce the long-term impact of chronic liver disease.

Editor’s Note: Gonzalez reports relevant disclosures with Mallinckrodt Pharmaceuticals, Salix, AbbVie, Gilead, and others. 

Centers for Disease Control and Prevention. FastStats. CDC. Published October 11, 2019. Accessed July 10, 2026. 

https://www.cdc.gov/nchs/fastats/liver-disease.htm

Hazeldine S, Hydes T, Sheron N. Alcoholic liver disease – the extent of the problem and what you can do about it. Clinical Medicine. 2015;15(2):179-185. doi:10.7861/clinmedicine.15-2-179

Paik JM, Shah D, Eberly K, Golabi P, Henry L, Younossi ZM. Changes in mortality due to Chronic Liver Diseases (CLD) during the COVID-19 pandemic: Data from the United States” National Vital Statistics System. PloS one. 2024;19(9):e0289202. doi:10.1371/journal.pone.0289202

Earlier diagnosis is imperative for chronic liver disease; Stevan Gonzalez, MD, MS, explains how PCPs and community-based screening programs can help. 

Stevan Gonzalez, MD, MS

Articles