Global Incidence and Mortality of Hepatitis B and Hepatitis C Acute Infections, Cirrhosis and Hepatocellular Carcinoma From 2010 to 2019

Nicolette Veracruz; Robert G. Gish; Ramsey Cheung; Amit S. Chitnis; Robert J. Wong


J Viral Hepat. 2022;29(5):352-365. 

In This Article

Abstract and Introduction


Hepatitis B virus (HBV) and hepatitis C virus (HCV) contribute to significant healthcare burden globally. We aim to provide an updated and comprehensive analysis of global trends in the incidence and mortality of HBV and HCV related acute infections, cirrhosis and hepatocellular carcinoma (HCC). Estimates of annual cause-specific disease incidence and mortality for HBV and HCV were analysed using the 2010–2019 Global Burden of Diseases, Injuries and Risk Factors Study database. Three distinct disease states were evaluated: acute infections, cirrhosis and HCC. Age-standardized disease incidence and mortality were presented per 100,000 population and stratified by age, sex, year and 21 world regions. From 2010 to 2019, overall incidence of acute HBV declined by 19.3% (95% CI 4.1–32.0, p < .05) and HBV cirrhosis declined by 15.0% (95% CI 9.8–20.7, p < .05). Incidence of HCV cirrhosis increased by 5.6% (95% CI 0.3–10.2, p < .05) and HCV HCC remained stable. Incidence of acute HCV declined until 2015, after which it began increasing. From 2010 to 2019, overall mortality for HBV cirrhosis and HCV cirrhosis declined, whereas mortality for acute infections and HCC remained stable. Major differences in HBV and HCV incidence and mortality trends were observed when stratified by world regions. In conclusion, while our analyses of global trends in HBV and HCV incidence and mortality demonstrate encouraging trends, disparities in disease epidemiology were observed across world regions. These observations will identify regions and populations where greater focus and resources are needed to continue progressing towards viral hepatitis elimination.


Hepatitis B virus (HBV) and hepatitis C virus (HCV) contribute to significant healthcare burden globally.[1] The WHO estimates that globally, 296 million people have chronic HBV (CHB) and 58 million have chronic HCV (CHC), and disparities in timely access to diagnostic testing, disease monitoring and antiviral therapy persist in many world regions.[2–4] Untreated CHB and CHC lead to continued disease progression, resulting in development of cirrhosis and hepatocellular carcinoma (HCC). Cirrhosis is a leading cause of mortality and morbidity across the world, and in 2016, cirrhosis ranked as the 11th leading cause of death (accounting for 2.2% of deaths) and 15th leading cause of morbidity (accounting for 1.5% of disability-adjusted life years (DALY) worldwide.[5] In 2017, there were over 2 million liver-related deaths, representing an 11.4% increase since 2012.[6]

In recent years, there have been many advances in the overall management of CHB and CHC infection. Improved awareness and implementation of routine viral hepatitis screening have led to earlier identification of CHB and CHC, and targeted interventions such as education and vaccination programmes have reduced the incidence of acute and chronic viral hepatitis. Major advances in antiviral therapies for CHB and most recently, highly effective direct acting antivirals (DAAs) for CHC with a cure rate in excess of 98% have led to significant reductions in cirrhosis, HCC and overall viral hepatitis related mortality.[7,8]

However, implementation and access to these improvements in CHB and CHC care are not uniform across world regions, which have likely resulted in significant disparities in CHB and CHC disease progression to cirrhosis and HCC. Accurate estimates of the contemporary burden of CHB and CHC are vital for setting clinical, research and policy priorities, as well as to highlight regions where more resources and targeted advocacy are needed if we are to continue progressing towards the WHO's target of 2030 for viral hepatitis elimination.[9] We aim to provide an updated and comprehensive global analysis of disease epidemiology trends of CHB and CHC incidence and mortality, focusing on acute viral infections, cirrhosis and HCC.