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
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
| Original language | English |
|---|---|
| Pages (from-to) | 796-829 |
| Number of pages | 34 |
| Journal | The Lancet Gastroenterology & Hepatology |
| Volume | 7 |
| Issue number | 9 |
| Early online date | 3 Aug 2022 |
| DOIs | |
| Publication status | Published - Sept 2022 |
Bibliographical note
Funding Bill & Melinda Gates FoundationAcknowledgments
S Afzal acknowledges institutional support from King Edward
Medical University. D Atlaw acknowledges support from Madda
Walabu University Goba Referral Hospital. M Ausloos, A Pana, and
C Herteliu are partially supported by a grant from the Romanian
National Authority for Scientific Research and Innovation (CNDS-
UEFISCDI), project number PN-III-P4-ID-PCCF-2016-0084. C
Herteliu is partially supported by a grant from the Romanian Ministry
of Research Innovation and Digitalization (project number ID-585-
CTR-42-PFE-2021). T M Drake acknowledges receiving research
funding from Aligos Therapeutics for unrelated work. A Boloor
acknowledges support from the PSG Institute of Medical Sciences
and Research, Coimbatore. V K Gupta and V B Gupta acknowledge
funding support from the National Health and Medical Research
Council (NHMRC), Australia. S Haque acknowledges the Jazan
University, Saudi Arabia, for providing the access to the Saudi Digital
Library for this research. H Kandel acknowledges support of the
Kornhauser Research Fellowship at the University of Sydney. Y J Kim
acknowledges support from the Research Management Centre,
Xiamen University, Malaysia (no. XMUMRF/2020-C6/ITCM/0004).
I Landires is a member of the Sistema Nacional de Investigación
(SNI), which is supported by Panama’s Secretaría Nacional de Ciencia,
Tecnología e Innovación (SENACYT). J V Lazarus acknowledges
support to ISGlobal from the Spanish Ministry of Science, Innovation
and Universities through the “Centro de Excelencia Severo Ochoa
2019–2023” Programme (CEX2018-000806-S), and from the
Government of Catalonia, Spain, through the CERCA Programme.
J A Loureiro was supported by Fundação para a Ciência e Técnologia
(FCT) under the Scientific Employment Stimulus
(CEECINST/00049/2018). O O Odukoya acknowledges support from
the Fogarty International Center of the National Institutes of Health
under the award number K43TW010704. The content is solely the
responsibility of the authors and does not necessarily represent the
official views of the National Institutes of Health. A M Samy
acknowledges the support from the Egyptian Fulbright Mission
Program and membership of the Egyptian Young Academy of
Sciences and Technology. P H Shetty acknowledges support from
Kasturba Medical College, Mangalore, Manipal Academy Of Higher
Education, Manipal, India
Data Availability Statement
To download the data used in these analyses, please visit the Global Health Data Exchange GBD 2019 website.For the Global Health Data Exchange GBD 2019 website see http://ghdx.healthdata.org/
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Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license