Global Hepatitis B Rates Decline, But Mortality Rates Fall Short of WHO Target

Hepatitis B
Hepatitis B
Researchers estimated the global, regional, and national prevalence of hepatitis B virus in addition to mortality and disability-adjusted life-years from 1990 to 2019.

The global, all-age prevalence of chronic hepatitis B virus (HBV) infection decreased by an estimated 31.3% from 1990 to 2019, with the rate decreasing by 76.8% in children aged younger than 5 years, according to a study in the Lancet Gastroenterology & Hepatology.

The findings are based on analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD).

Researchers estimated the global, regional, and national prevalence of HBV and the mortality and disability-adjusted life-years (DALYs). Researchers also calculated estimates for the burden of HBV from cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B.

In 2019, an estimated 316 million persons (95% uncertainty intervals [UI], 284-351) globally had chronic HBV infection, according to the investigators. The prevalence among all ages was 4.1% (3.7%-4.5%) in 2019, which was a 31.3% (29.0%-33.9%) decrease from 1990 and a 6.8% (5.5%-8.3%) reduction from 2015. In 2019, the global hepatitis B surface antigen (HBsAg) prevalence for infants and children aged younger than 5 years was 1.0% (95% UI, 0.8%-1.2%), a decrease of 76.8% (76.2% to 77.5%) from 1990 and 5.2% (13.6% to 16.7%) from 2015.

HBV-related diseases led to an estimated 555,000 deaths (95% UI, 487,000-63,000) globally in 2019, representing 48.8% (44.6%-52.7%) of all deaths associated with hepatitis. The absolute number of HBV-related deaths increased by 5.9% (-5.6% to 19.2%) from 1990 to 2019 and by 2.9% (-5.9% to 11.3%) from 2015 to 2019.

In 2019, HBV-related diseases were associated with 7.2 (95% UI, 6.3-8.1) deaths per 100,000 persons globally, a decrease of 26.8% (17.6%-34.7%) since 1990 and 1.4% (-9.9% to 6.6%) since 2015.

The absolute death counts due to HBV increased since 1990 in all geographic regions except for the Western Pacific region. The European and South-East Asia regions were the only regions that had a decrease in deaths since 2015, although neither achieved the World Health Organization-Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) goal of a 10% decrease in the time period.

Age-specific HBsAg prevalence and HBV-related death and DALY rates generally decreased over time, with the most marked improvements occurring in those aged 35 to 69 years.

A total of 4 countries from the 194 WHO locations for which GBD generates estimates met or exceeded the WHO-GHSS 2020 interim impact target of a 10% decrease in deaths from 2015 to 2019 with high certainty. Also, 147 countries met or exceeded the interim proxy target of less than 1% prevalence among infants and children aged younger than 5 years by 2020.

In 2019, 59 WHO locations had met or exceeded the 2030 proxy target of less than or equal to 0.1% HBsAg seroprevalence for infants and children aged younger than 5 years, and 68 locations had achieved an all-age mortality rate of less than or equal to 4 deaths per 100,000 persons per year.

Study limitations included limited data in some estimate models. In addition, the modeling strategy was based on a post hoc adjustment to incorporate vaccination trends more effectively.

“The prevalence of chronic HBV infection has declined in much of the world over the past several decades, as have mortality rates due to HBV-related diseases, but targeted reductions in death counts have yet to be achieved, due to population growth and aging,” the study authors commented. “There is an unequal distribution of the burden of HBV-related diseases due to differences in transmission modes and access to vaccination, screening, and treatment. Interventions along the hepatitis service continuum must be implemented to decrease hepatitis burden. With less than 10 years to go until the deadline for the elimination goals, efforts must be intensified to ensure the elimination goals for hepatitis B are achieved.”

Disclosure: Some of the contributors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

GBD 2019 Hepatitis B Collaborators. Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol. Published online June 20, 2022. doi:10.1016/S2468-1253(22)00124-8