The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013

Abstract

Background: With recent improvements in vaccines and treatments against viral hepatitis, an improved understanding of the burden of viral hepatitis is needed to inform global intervention strategies. We used data from the Global Burden of Disease (GBD) Study to estimate morbidity and mortality for acute viral hepatitis, and for cirrhosis and liver cancer caused by viral hepatitis, by age, sex, and country from 1990 to 2013.

Methods: We estimated mortality using natural history models for acute hepatitis infections and GBD's cause-of-death ensemble model for cirrhosis and liver cancer. We used meta-regression to estimate total cirrhosis and total liver cancer prevalence, as well as the proportion of cirrhosis and liver cancer attributable to each cause. We then estimated cause-specific prevalence as the product of the total prevalence and the proportion attributable to a specific cause. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs).

Findings: Between 1990 and 2013, global viral hepatitis deaths increased from 0·89 million (95% uncertainty interval [UI] 0·86-0·94) to 1·45 million (1·38-1·54); YLLs from 31·0 million (29·6-32·6) to 41·6 million (39·1-44·7); YLDs from 0·65 million (0·45-0·89) to 0·87 million (0·61-1·18); and DALYs from 31·7 million (30·2-33·3) to 42·5 million (39·9-45·6). In 2013, viral hepatitis was the seventh (95% UI seventh to eighth) leading cause of death worldwide, compared with tenth (tenth to 12th) in 1990.

Interpretation: Viral hepatitis is a leading cause of death and disability worldwide. Unlike most communicable diseases, the absolute burden and relative rank of viral hepatitis increased between 1990 and 2013. The enormous health loss attributable to viral hepatitis, and the availability of effective vaccines and treatments, suggests an important opportunity to improve public health.

Funding: Bill & Melinda Gates Foundation.

Copyright © 2016 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Decomposed drivers of global changes in DALYs attributable to viral hepatitis between 1990 and 2013, by virus and for all hepatitis viruses combined

Error bars represent 95% uncertainty intervals. DALYs=disability-adjusted life-years.

Figure 2. Leading causes of mortality and trends, 1990–2013

COPD=chronic obstructive pulmonary disease.

Figure 3. Map of viral hepatitis-related, age-standardised mortality rate, by GBD region

Overlaid pie charts indicate each virus type’s contribution to the total hepatitis-related mortality; the size of the pie charts are proportional to the region’s hepatitis-attributable mortality rate. GBD=Global Burden of Disease.

Figure 4

Age-standardised disability-adjusted life-year rates (per 100 000 per year) attributable to hepatitis A, B, C, and E viruses in 2013, by country

Figure 5. Burden of viral hepatitis, stratified by economic status

(A) Annual deaths and (B) DALYs of viral hepatitis. Error bars indicate 95% uncertainty intervals. DALYs=disability-adjusted life-years.