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. 2021 Oct;15(5):1068-1082.
doi: 10.1007/s12072-021-10232-4. Epub 2021 Aug 3.

The global trends and regional differences in incidence and mortality of hepatitis A from 1990 to 2019 and implications for its prevention

Guiying Cao #  1 , Wenzhan Jing #  2 , Jue Liu  2 , Min Liu  3
Affiliations

The global trends and regional differences in incidence and mortality of hepatitis A from 1990 to 2019 and implications for its prevention

Guiying Cao et al. Hepatol Int. 2021 Oct.

Abstract

Background and purpose: Despite decades of improved sanitation and hygiene measures and vaccine introduction, hepatitis A has been spread through numerous outbreaks globally. We used data from the Global Burden of Disease (GBD) study to quantify hepatitis A burden at the global, regional and national levels.

Methods: Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of hepatitis A between 1990 and 2019 were derived from the GBD study 2019. Percentage changes of cases and deaths, and estimated annual percentage changes (EAPCs) of ASIRs and ASMRs were calculated to quantify their temporal trends.

Results: Global hepatitis A incident cases increased by 13.90% from 139.54 million in 1990 to 158.94 million in 2019. ASIR of hepatitis A remained stable (EAPC = 0.00, 95% CI -0.01 to 0.01), whereas ASMR decreased (EAPC = -4.63, 95% CI -4.94 to -4.32) between 1990 and 2019. ASIR increased in low (EAPC = 0.09, 95% CI 0.04 to 0.14) and low-middle (EAPC = 0.04, 95% CI 0.03 to 0.06) socio-demographic index (SDI) regions. For GBD regions, the most significant increases of ASIR were detected in high-income Asia Pacific (EAPC = 0.53, 95% CI 0.41 to 0.66), Oceania (EAPC = 0.31, 95% CI 0.25 to 0.36), and Australasia (EAPC = 0.28, 95% CI 0.13 to 0.44). EAPC of ASIR was positively associated with SDI value in countries and territories with SDI value ≥ 0.7 (ρ = -0.310, p < 0.001).

Conclusion: There is an unfavorable trend that hepatitis A is still pending in hyperendemic regions and is emerging in low endemic regions. These highlight the need of targeted and specific strategies to eliminate hepatitis A, such as sanitation measures and a comprehensive plan for surveillance and vaccination against hepatitis A.

Keywords: Age-standardized incidence rate; Age-standardized mortality rate; Global burden of disease; Hepatitis A; Prevention; Trend.

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Conflict of interest statement

Guiying Cao, Wenzhan Jing, Jue Liu, Min Liu declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The global trends in incidence of hepatitis A in 204 countries and territories. A The ASIRs of hepatitis A in 2019; B the relative change in incident cases of hepatitis A between 1990 and 2019; C the EAPCs of hepatitis A ASIRs from 1990 to 2019. ASIR age-standardized incidence rate, EAPC estimated annual percentage change
Fig. 2
Fig. 2
The EAPCs of hepatitis A ASIRs from 1990 to 2017 at regional level. ASIR age-standardized incidence rate, EAPC estimated annual percentage change, SDI socio-demographic index
Fig. 3
Fig. 3
The number of incident cases of hepatitis A by age group, by SDI regions, from 1990 to 2019. The data of five SDI regions are presented in the top-right panel. SDI socio-demographic index
Fig. 4
Fig. 4
The age distribution of incident cases of hepatitis A by GBD region in 1990 and 2019. GBD Global Burden of Disease
Fig. 5
Fig. 5
The EAPCs of hepatitis A ASIRs at countries and territorial level. A The correlation between EAPC and ASIR of hepatitis A in 1990. B The correlation between EAPC and SDI in 2019. The incident cases of hepatitis A from 204 countries and territories were represented by the circles. The size of circles increased with the incident cases of hepatitis A. The ρ indices and p values were derived from Pearson correlation analysis. ASIR age-standardized incidence rate, EAPC estimated annual percentage change, SDI socio-demographic index
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