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Objective To investigate the effect of age on the incidence of cirrhosis and liver cancer in patients with chronic hepatitis B. Methods 279 patients with chronic hepatitis B were divided into the senior group and the younger group according to the age of the patients. The cumulative incidence of cirrhosis and liver cancer during 25 years of follow-up was calculated by using SPSS and R language through the long-term follow-up of HIS system, and the risk factors were analyzed by multivariate logistic regression. Results During follow-up, 24 cases developed cirrhosis and 12 cases developed liver cancer. The cumulative incidence of liver cirrhosis was 1.5%, 2.1%, 5.4%, 11.6% and 15.5% in the 5-year, 10-year, 15-year, 20-year and 25-year group, and 5.5%, 9.8%, 22.9%, 29.0% and 52.1% in the elderly, respectively. The difference between the younger age group and senior age group was statistically significant （P < 0.001）. A total of 2 risk factors （age and follow-up time） were included in the regression model. Two cases in the younger group developed into liver cancer after 17 and 21 years of followup, respectively. The cumulative incidence rates at 5, 10, 15, 20 and 25 years were 1.8%, 3.8%, 18.5%, 21.8% and 26.7%. A total of five factors （initial age, HBV-DNA load, HBV-DNA turned negative before the end-point, follow-up time, and sex） were included in the regression model. Conclusions The incidence of cirrhosis and liver cancer in CHB patients aged ≥ 40 years, especially in male patients, is significantly higher than younger CHB patients. Timely initiation of antiviral therapy can delay disease progression and reduce the incidence of terminal liver disease. Whether antiviral therapy should be initiated for people aged 30 to 40 years remains to be studied. [ABSTRACT FROM AUTHOR]