Background <p>Both chronic hepatitis B (CHB) and fatty liver disease (FLD) are major contributors to the burden of severe liver diseases. China bears the heaviest burden of CHB worldwide, while the prevalence of FLD has been substantially increased in the last decades. However, the prevalence and clinical impact of concurrent CHB and FLD in China remain unclear, impeding effective prevention and management of severe liver diseases.</p> Methods <p>We conducted a systematic review and meta-analysis on prevalence and clinical characteristics of concurrent CHB and FLD in China. Eligible literatures were retrieved from Medline, EmBase, Web of Science, WanFang and China National Knowledge Infrastructure (CNKI), up to 31 December 2023. The pooled prevalence was estimated using a random-effects model. The weighted mean difference was calculated to compare the clinical characteristics across different groups.</p> Results <p>A total of 114 studies with 318,770 participants were included for the analysis. The pooled prevalence of CHB with concurrent FLD in the general population was 1.48% (95% CI: 1.02%-2.14%). The pooled prevalence of FLD in CHB patients was 26.75%, while the pooled prevalence of CHB in FLD patients was 16.94%. The co-morbidity group exhibited higher levels of body mass index (BMI), triglycerides, fasting insulin and albumin than the CHB group. The total cholesterol level in the co-morbidity group was 0.48mmol/L lower than the FLD group. Additionally, it demonstrated a significantly lower hepatitis B virus DNA load and higher prevalence of diabetes, hypertension, and hyperuricemia than the CHB group.</p> Conclusions <p>The co-occurrence of CHB and FLD is an emerging public health concern in China, showing distinct clinical characteristics compared to those with CHB or FLD alone. Our study highlights an urgent need of tailored prevention and treatment strategies for this population.</p>