Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep;8(9):e701-e716.
doi: 10.1016/S2468-2667(23)00149-4.

Hepatitis B and C in Europe: an update from the Global Burden of Disease Study 2019

GBD 2019 Europe Hepatitis B & C Collaborators
Collaborators

Hepatitis B and C in Europe: an update from the Global Burden of Disease Study 2019

GBD 2019 Europe Hepatitis B & C Collaborators. Lancet Public Health. 2023 Sep.

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.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests J V Lazarus reports grants or contracts from AbbVie, Gilead Sciences, MSD, and Roche Diagnostics; royalties and licenses from Novavax; payment or honoraria for lectures from AbbVie, Gilead Sciences, Intercept, Janssen, and Novo Nordisk; participation on a data safety monitoring board or advisory board for the study “Same-visit hepatitis C testing and treatment to accelerate cure among people who inject drugs (The QuickStart Study): a cluster randomised control trial” (Australia); and leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with the European Association for the Study of the Liver Public Health and Policy Committee as a member, HIV Outcomes as a co-chair, and SHARE Global Health Foundation; all outside the submitted work. P C Matthews reports support for the present manuscript from The Francis Crick Institute, London, UK; grants and contracts from The Wellcome Trust and University College London Hospital National Institute for Health and Care Research Biomedical Research Centre; and funding from GSK for a PhD student fellowship. A-F A Mentis reports grants and contracts from MilkSafe (A novel pipeline to enrich formula milk using omics technologies), which is co-financed by the European Regional Development Fund of the EU and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH–CREATE–INNOVATE (project code T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment for expert testimony from serving as external peer-reviewer for Fondazione Cariplo, Italy; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid, as an editorial board member for Systemic Reviews and Annals of Epidemiology, and as Associate Editor for Translational Psychiatry; other financial or non-financial support from the BGI group as a scientific officer; outside the submitted work. M J Postma reports stock or stock options in PAG BV (Groningen, Netherlands) and HealthEcore (Zeist, Netherlands). All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Temporal trends in age-standardised HBV disease burden measures in eastern, central, and western Europe, 2010–19 Graphs show the linear interpolation of point estimates (lines) and 95% uncertainly intervals (shaded regions) of the annual estimations. DALY=disability-adjusted life-year. HBV=hepatitis B virus.
Figure 2
Figure 2
Age-standardised DALY rates for HBV-related diseases in Europe in 2019, and related 2010–19 percentage change DALY=disability-adjusted life-year. HBV=hepatitis B virus.
Figure 3
Figure 3
Temporal trends in age-standardised HCV disease burden measures in eastern, central, and western Europe, 2010–19 Graphs show the linear interpolation of point estimates (lines) and 95% uncertainly intervals (shaded regions) of the annual estimations. DALY=disability-adjusted life-year. HCV=hepatitis C virus.
Figure 4
Figure 4
Age-standardised DALY rates for HCV-related diseases in Europe in 2019, and related 2010–19 percentage change DALY=disability-adjusted life-year. HCV=hepatitis C virus.
See this image and copyright information in PMC

Comment in

References

    1. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388:1081–1088. - PMC - PubMed
    1. WHO Global hepatitis report, 2017. April 19, 2017. https://www.who.int/publications/i/item/9789241565455
    1. Younossi Z, Park H, Henry L, Adeyemi A, Stepanova M. Extrahepatic manifestations of hepatitis C: a meta-analysis of prevalence, quality of life, and economic burden. Gastroenterology. 2016;150:1599–1608. - PubMed
    1. Razavi-Shearer D, Gamkrelidze I, Nguyen MH, et al. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018;3:383–403. - PubMed
    1. Cox AL, El-Sayed MH, Kao JH, et al. Progress towards elimination goals for viral hepatitis. Nat Rev Gastroenterol Hepatol. 2020;17:533–542. - PMC - PubMed

Publication types

LinkOut - more resources