Spatiotemporal evolution of HCV burden among women of reproductive age: a multinational age-period-cohort analysis

Abstract

Objective: To study the epidemiology and trends of HCV infection among women aged 15-49, this research aims to inform public health strategies and reduce its global impact by addressing maternal and child transmission risks.

Design: This research analyzed GBD data (1990-2021) on HCV in women aged 15-49, examining ASIR, ASPR, ASMR, and ASDR trends by region and age. APC and Bayesian models predicted future trajectories to guide public health policies.

Results: From 1990 to 2021, the global burden of hepatitis C virus (HCV) among women aged 15 - 49 witnessed a downward trend. The incidence rate (5.46 per 100,000) and mortality rate (0.068 per 100,000) of acute HCV were notably lower than those of chronic HCV, which stood at an incidence rate of 29.92 per 100,000 and a mortality rate of 1.42 per 100,000. In 2021, regions with a low Sociodemographic Index (SDI) endured the heaviest burden. Oceania, Central Asia, Eastern Europe, and several other regions experienced an upward trend in acute HCV cases; meanwhile, the number of chronic HCV cases increased in most regions, with the exception of Australasia. Pakistan had the highest HCV burden globally. Projections indicate that over the next decade, both the incidence and mortality rates of HCV will continue to decline, yet the total number of cases is expected to rise.

Conclusion: This study reveals the complex epidemiological landscape of acute and chronic hepatitis C in women of reproductive age globally. Despite the anticipated decline in standardized incidence and mortality rates of acute and chronic hepatitis C among women of reproductive age worldwide in the coming decade, the actual number of cases continues to increase annually. This underscores the substantial challenges faced by the World Health Organization's goal of eliminating HCV infection by 2030.

Keywords: Age-Period-Cohort Analysis; Bayesian Projections; GBD; Hepatitis C; Women of Childbearing Age.

Fig. 1

Estimated Annual Percentage Change (EAPC) of Mortality and DALY rates for Acute and Chronic HCV Among Women Aged 15-49 Years A:Mortality of Acute. HCV;B:DALY rates of Acute HCV;C:Mortality of Chronic HCV;D:DALY rates of Chronic HCV

Fig. 2

Global heat maps illustrating the disease burden of acute and chronic hepatitis C virus(HCV) infection among women aged 15-49 years in 2021A: Age-Standardized Mortality Rate(ASMR) for Chronic Hepatitis C in 2021;B: Estimated Annual Percentage Change (EAPC) inChronic Hepatitis C Mortality Rates, 1990–2021;C: Age-Standardized Mortality Rate(ASMR) for Acute Hepatitis C in 2021;D: Estimated Annual Percentage Change (EAPC) inAcute Hepatitis C Mortality Rates, 1990–2021

Fig. 3

The solid line illustrates the nonlinear relationship between the Sociodemographic Index (SDI) and the burden of hepatitis C disease(chronic and acute)across 21 GBD-defined regions, in 2021.A:ASIR for chronic hepatitis C(R=−0.4711,P<0.001) B:ASPR for chronic hepatitis C (R=−0.6774,P<0.001)C:ASMR for chronic hepatitis C (R=−0.5177,P<0.001)D:ASDR for chronic hepatitis C(R=−0.5122,P<0.001) E:ASIR for acute hepatitis C(R=−0.4634,P<0.001) F:ASPR for acute hepatitis C(R=−0.4634,P<0.001) G:ASMR for acute hepatitis C(R=−0.8274,P<0.001) H:ASDR for acute hepatitis C(R=−0.8262,P<0.001)

Fig. 4

A Trends in Mortality and Incidence (1990-2021)Line plots illustrating the Average Annual Percentage Change(AAPC) for mortality (left panel) and incidence (right panel) of chronic hepatitis C among women of reproductive age(15-49 years) from 1990 to 2021. These plots provide a visual representation of the overall temporal trends in diseaseburden over the three-decade period. B & C Age-Period-Cohort (APC) Analysis of Chronic Hepatitis C Temporal Drifts:The top left panel displays net and local drifts, with values greater than zero indicating an increasing trend in the burden ofchronic hepatitis C. Age Effects: The top right panel examines how different age groups within the reproductive age range contribute to the burden of chronic hepatitis C. Period and Cohort Rate Ratios: The bottom panel presents rate ratios for period and cohort effects; values greater than one suggest an increased burden of chronic hepatitis C associated with specific periods or birth cohorts

Fig. 5

Predictions of Age-Standardized Rates (ASR) and Absolute Numbers for Mortality, Incidence of Acute and Chronic Hepatitis C.This figure presents projected trends for acute and chronic hepatitis C in terms of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and absolute numbers of new cases: A:ASIR Trends for Chronic Hepatitis C: Projected changes in age-standardized incidence rates.B:ASMR Trends for Chronic Hepatitis C: Projected changes in age-standardized mortality rates.C:ASIR Trends for Acute Hepatitis C: Projected changes in age-standardized incidence rates.D:ASMR Trends for Acute Hepatitis C: Projected changes in age-standardized mortality rates.E:Number of New Cases of Chronic Hepatitis C: Projected trends in the absolute number of new chronic cases.F:Number of New Cases of Acute Hepatitis C: Projected trends in the absolute number of new acute cases

Fig. 6

Decomposition of Changes in New Cases of Acute and Chronic Hepatitis C (1990-2021)A: Acute Hepatitis C;B: Chronic Hepatitis C This figure decomposes the changes in the number of new cases of acute and chronic hepatitis C into contributions from:Population Growth (Green): Increase due to overall population expansion.Population Ageing (Red): Changes attributable to shifts in age structure.Epidemiological Changes (Blue): Variations due to disease transmission rates, healthcare improvements, and public health interventions.Black dots represent the total change contributed by all three components. Positive values indicate an increase in incidence, while negative values indicate a decrease. The analysis is conducted globally and across various Sociodemographic Index (SDI) regions