Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

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Abstract

BACKGROUND: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. METHODS: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. FINDINGS: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [-5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [-5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. INTERPRETATION: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

˜The œLancet. Gastroenterology & hepatology

Topic

Hepatitis B Virus Studies

Field

Medicine

Canadian institutions

—

Funders

National Heart, Lung, and Blood InstituteResearch Management Centre, International Islamic University MalaysiaSistema Nacional de InvestigadoresCentre for Heart Rhythm Disorders, University of AdelaideNational Health and Medical Research CouncilMedical Research CouncilSchool of Public Health and Family Medicine, University of Cape TownUniversity of Texas Health Science Center at San AntonioSamsungDilla UniversityPirogov Russian National Research Medical UniversityUniversitas Ahmad DahlanMoscow Institute of Physics and TechnologyUniversitas PadjadjaranImam Abdulrahman Bin Faisal UniversityKurdistan University Of Medical SciencesUniversity of ColomboInternational Centre for Diarrhoeal Disease Research, BangladeshXiamen UniversityDivision of Mathematical SciencesUniversitas AirlanggaGolestan University of Medical SciencesNational Institute for Research in TuberculosisSoutheast UniversityAlfaisal UniversityUniversity of GondarUniversity of Health and Allied SciencesUniversitatea de Medicină şi Farmacie "Carol Davila" BucureştiUniversitas Muhammadiyah SurakartaRajshahi UniversityUniversity of SulaimaniInstituto Politécnico do PortoSemnan UniversitySecretaría Nacional de Ciencia, Tecnología e InnovaciónTechnische Universität BerlinUniversidade do PortoStudent Research Committee, Tabriz University of Medical SciencesPeking Union Medical CollegeBahir Dar UniversityDebre Tabor UniversityUniversità di BolognaShahid Beheshti University of Medical SciencesDirectorate for Biological SciencesGöteborgs UniversitetUniversidade de São PauloQazvin University of Medical SciencesUniversitair Medisch Centrum GroningenGuilan University of Medical SciencesKermanshah University of Medical SciencesUniversitas Syiah KualaImperial College LondonShiraz UniversityHarvard UniversityJimma UniversityMinisterio de Ciencia, Innovación y UniversidadesFlinders UniversityUniversiteit UtrechtNankai UniversityNational Institutes of HealthUniversity of Veterinary and Animal SciencesChinese University of Hong KongHaramaya UniversityAin Shams UniversityShiraz University of Medical SciencesKing Abdulaziz UniversityUnitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si InovariiUniversity of OxfordAmirkabir University of TechnologyKing Abdullah University of Science and TechnologyEastern Virginia Medical SchoolIsfahan University of Medical SciencesIslamic Azad UniversityOxford University Hospitals NHS Foundation TrustGachon UniversityEwha Womans UniversityKyung Hee UniversityYonsei UniversitySharif University of TechnologyKuwait UniversityJames Cook UniversityCurtin University of TechnologyUniversity of South AustraliaTabriz University of Medical SciencesUniversity of Cape TownNational Authority for Scientific Research and InnovationKhalifa University of Science, Technology and ResearchAjman UniversityUniversitas IndonesiaUniversity of Technology SydneyBirjand University of Medical SciencesGastrointestinal and Liver Diseases Research CenterCase Western Reserve UniversityUniversity of SydneyCharles Sturt UniversityWuhan UniversityRijksuniversiteit GroningenTaipei Medical UniversityCleveland ClinicUniversity College CorkAmity UniversityUniversitatea din BucureștiLa Trobe UniversityFogarty International CenterCOMSATS Institute of Information TechnologyNational University of SingaporeGeneralitat de CatalunyaStanford Cardiovascular Institute, School of Medicine, Stanford UniversityFrankfurt University of Applied SciencesMacquarie UniversityJordan University of Science and TechnologyHamad Bin Khalifa UniversityDivision of Human Resource DevelopmentSanjay Gandhi Postgraduate Institute of Medical SciencesNeyshabur University of Medical SciencesNational Center of Neurology and PsychiatryMashhad University of Medical SciencesTribhuvan UniversitySouth African Medical Research CouncilKasturba Medical College, ManipalPublic Health EnglandTehran University of Medical Sciences and Health ServicesFundação para a Ciência e a TecnologiaAksum UniversityAllos TherapeuticsDebre Markos UniversitySouth Eastern Sydney Local Health DistrictUniversity of DhakaWollega UniversitySocial Science Research CouncilCollege of Science and Engineering, University of MinnesotaJohns Hopkins UniversityWellcome TrustInstitute of Infection and ImmunityTrường Đại học Duy TânAddis Ababa UniversityUniversità degli Studi di FirenzeBill and Melinda Gates FoundationArak University of Medical SciencesUniversità degli Studi di MilanoIran University of Medical SciencesUniversity College LondonSüleyman Demirel ÜniversitesiDeakin UniversityHelsingin YliopistoMadda Walabu UniversityCentres de Recerca de CatalunyaU.S. Department of Veterans AffairsJazan UniversityUniversity of TabrizAhmadu Bello UniversityUnited Arab Emirates UniversityAutoritatea Natională pentru Cercetare StiintificăEmory UniversityNational Research University Higher School of EconomicsIstituto Superiore di SanitàMcMaster UniversitySecretaria Nacional de Ciencia y TecnologíaUniversity of South CarolinaHamad Medical CorporationUniversidad de AntioquiaMazandaran University of Medical SciencesUniversità degli Studi di Napoli Federico IINew Mexico State UniversityMoffitt Cancer CenterBournemouth UniversityUniversity of Science and Technology of ChinaGeorgetown UniversityBanaras Hindu UniversityUnited Nations Population FundUniversity of PeshawarQueensland University of TechnologyJahrom University of Medical SciencesLondon South Bank UniversityFlorida International UniversityUniversity of Rochester

Keywords

MedicineViral hepatitisHepatitis BPopulationHepatitis CGlobal healthLiver diseaseHepatitis B virusCirrhosisLiver cancerDisease burdenInternal medicineEnvironmental healthCancerPublic healthImmunologyPathologyVirus

Has abstract in OpenAlex

yes

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