Hepatitis B and C in Europe: an update from the Global Burden of Disease Study 2019
Paolo Angelo Cortesi, Carla Fornari, Sara Conti, Ippazio Cosimo Antonazzo, Pietro Ferrara, Ayman Ahmed, Cătălina Liliana Andrei, Tudorel Andrei, Anton A Artamonov, Maciej Banach, Carl Michael Baravelli, Till Bärnighausen, Akshaya Srikanth Bhagavathula, Н. И. Брико, Daniela Călina, Giulia Carreras, Sheng‐Chia Chung, Mostafa Dianatinasab, Eleonora Dubljanin, Oyewole Christopher Durojaiye, Ifeanyi Jude Ezeonwumelu, Adeniyi Francis Fagbamigbe, Florian Fischer, Silvano Gallus, Е. В. Глушкова, Davide Golinelli, Giuseppe Gorini, Shoaib Hassan, Simon I Hay, Mihaela Hostiuc, Irena Ilić, Milena Ilić, Mihajlo Jakovljević, Elham Jamshidi, Jacek Jerzy Jozwiak, Zubair Kabir, Joonas H. Kauppila, Rovshan Khalilov, Moien AB Khan, Khaled Khatab, Ai Koyanagi, Carlo La Vecchia, Jeffrey V. Lazarus, Caterina Ledda, Miriam Levi, Platon D Lopukhov, Joana A. Loureiro, Philippa C. Matthews, Alexios‐Fotios A. Mentis, Tomislav Meštrović, Babak Moazen, Shafiu Mohammed, Lorenzo Monasta, Francesk Mulita, Christopher J L Murray, Ionuţ Negoi, Bogdan Oancea, Claudia Palladino, Jay Patel, Ionela-Roxana Petcu, Maarten J. Postma, David Laith Rawaf, Salman Rawaf, Esperanza Romero‐Rodríguez, Milena M Santric-Milicevic, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Rafael Tabarés‐Seisdedos, Mircea Tampa, Nuno Taveira, Arulmani Thiyagarajan, Marcos Roberto Tovani‐Palone, Ronny Westerman, Михаил Сергеевич Застрожин, Giampiero Mazzaglia, LG Mantovani
Abstract
BACKGROUND: In 2016, the World Health Assembly adopted the resolution to eliminate viral hepatitis by 2030. This study aims to provide an overview of the burdens of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Europe and their changes from 2010 to 2019 using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: We used GBD 2019 estimates of the burden associated with HBV-related and HCV-related diseases: acute hepatitis, cirrhosis and other chronic liver diseases, and liver cancer. We report total numbers and age-standardised rates per 100 000 for mortality, prevalence, incidence, and disability-adjusted life-years (DALYs) from 2010 to 2019. For each HBV-related and HCV-related disease and each measure, we analysed temporal changes and percentage changes for the 2010-19 period. FINDINGS: In 2019, across all age groups, there were an estimated 2·08 million (95% uncertainty interval [UI] 1·66 to 2·54) incident cases of acute hepatitis B and 0·49 million (0·42 to 0·57) of hepatitis C in Europe. There were an estimated 8·24 million (7·56 to 8·88) prevalent cases of HBV-related cirrhosis and 11·87 million (9·77 to 14·41) of HCV-related cirrhosis, with 24·92 thousand (19·86 to 31·03) deaths due to HBV-related cirrhosis and 36·89 thousand (29·94 to 45·56) deaths due to HCV-related cirrhosis. Deaths were estimated at 9·00 thousand (6·88 to 11·62) due to HBV-related liver cancer and 23·07 thousand (18·95 to 27·31) due to HCV-related liver cancer. Between 2010 and 2019, the age-standardised incidence rate of acute hepatitis B decreased (-22·14% [95% UI -35·44 to -5·98]) as did its age-standardised mortality rate (-33·27% [-43·03 to -25·49]); the age-standardised prevalence rate (-20·60% [-22·09 to -19·10]) and mortality rate (-33·19% [-37·82 to -28·13]) of HBV-related cirrhosis also decreased in this time period. The age-standardised incidence rate of acute hepatitis C decreased by 3·24% (1·17 to 5·02) and its age-standardised mortality rate decreased by 35·73% (23·48 to 47·75) between 2010 and 2019; the age-standardised prevalence rate (-6·37% [-8·11 to -4·32]), incidence rate (-5·87% [-11·24 to -1·01]), and mortality rate (-11·11% [-16·54 to -5·53]) of HCV-related cirrhosis also decreased. No significant changes were observed in age-standardised rates of HBV-related and HCV-related liver cancer, although we observed a significant increase in numbers of cases of HCV-related liver cancer across all ages between 2010 and 2019 (16·41% [2·81 to 30·91] increase in prevalent cases). Substantial reductions in DALYs since 2010 were estimated for acute hepatitis B (-27·82% [-36·92 to -20·24]), acute hepatitis C (-27·07% [-15·97 to -39·34]), and HBV-related cirrhosis (-30·70% [-35·75 to -25·03]). A moderate reduction in DALYs was estimated for HCV-related cirrhosis (-6·19% [-0·19 to -12·57]). Only HCV-related liver cancer showed a significant increase in DALYs (10·37% [4·81-16·63]). Changes in age-standardised DALY rates closely resembled those observed for overall DALY counts, except for HCV-liver related cancer (-2·84% [-7·75 to 2·63]). INTERPRETATION: Although decreases in some HBV-related and HCV-related diseases were estimated between 2010 and 2019, HBV-related and HCV-related diseases are still associated with a high burden, highlighting the need for more intensive and coordinated interventions within European countries to reach the goal of elimination by 2030. FUNDING: Bill & Melinda Gates Foundation.