Around 1.1 million deaths were caused by viral hepatitis worldwide
in 2019 and deaths due to hepatitis C are still rising despite the availability
of direct-acting antiviral treatment, according to analyses of the Global
Burden of Disease study presented this month at the online AASLD Liver Meeting.
The studies found that few countries are on course to meet interim targets for the reduction of deaths due to viral hepatitis, designed to encourage progress towards the goal of hepatitis elimination by 2030.
Targets set by the World Health Organization for hepatitis
elimination by 2030 include targets for 65% reductions in deaths from hepatitis
B and C by 2030.
Assessing progress towards these targets is essential for
monitoring elimination efforts but few countries collect comprehensive data on deaths
caused by viral hepatitis.
To calculate how many deaths are attributable to hepatitis B
and C, researchers in Boston and Atlanta used data compiled by the Global Burden of Disease study.
The Global Burden of Disease research group gathers data on deaths and illness with
a wide range of causes for all countries and its data can be used to extrapolate
trends in mortality.
Abigail Adams of the Task Force for Global Health, Atlanta,
presented an analysis of global hepatitis C-related deaths.
The research group estimated hepatitis C-related deaths and
changes in death counts between 1990 and 2019 using national hepatitis C virus prevalence
data and data on deaths caused by cirrhosis, chronic liver disease and primary
liver cancer. They also looked at the impact of direct-acting antiviral treatment
on deaths, focusing on changes in the death rate between 2015 and 2019.
Worldwide, 542,326 people were estimated to have died from
hepatitis C in 2019, a 59% increase since 1990, a 28% increase since 2000 and a
9% increase since 2015.
As well as setting a target for a reduction in deaths by
2030, the World Health Organization set an interim target of reducing deaths
caused by hepatitis C by 10% between 2015 and 2020. Only four countries, all in eastern Europe, are on course to meet that target. Moldova reports a 17.5%
reduction in deaths between 2015 and 2019 while Ukraine reports an 11.3%
reduction and Lithuania a 13.5% reduction. The Russian Federation reports a
10.7% reduction in mortality rate.
Deaths due to hepatitis C are highly concentrated; 20 countries
account for 76% of global deaths from hepatitis C and within this group of 20, more
than half of all global deaths from hepatitis C occurred in five countries – China,
India, the United States, Japan and Egypt.
Looking at deaths by region, 45% of deaths due to hepatitis
C in 2019 occurred in south-east Asia or the Western Pacific region, 20% in the
European region, 15% in the Americas, 10% in Africa and 10% in the eastern
Mediterranean region.
Deaths from hepatitis C increased most sharply after 1990 in
the Russian Federation (+204%), Thailand (+148%), the United States (+131%),
India (+103%) and Egypt (+102%).
Between 2015 and 2019, deaths from hepatitis C continued to
increase in all high burden countries except for the Russian Federation.
Rochele Obiekwe of the Coalition for Global Hepatitis
Elimination reported on a similar analysis of hepatitis B mortality.
The researchers estimated that 555,487 people died from hepatitis
B-related causes in 2019 and there has been little change in the number of
deaths caused by hepatitis B since 1990.
Nevertheless, 25 countries are on track to meet the 2020
interim target of a 10% reduction in deaths, chiefly in central and west
Africa. Bangladesh, India and Russia will also meet the target.
As with hepatitis C, deaths from hepatitis B are highly
concentrated. Twenty countries accounted for 81% of deaths in 2019 and two
countries – China and India – accounted for more than half of all deaths due to
hepatitis B worldwide. Fifty-five per cent of deaths due to hepatitis B in 2019 occurred
in south-east Asia or the Western Pacific region, 15% in Africa, 10% in the eastern Mediterranean region, 10% in the European region and 10% in the
Americas.
Few countries with a high burden of hepatitis B-related
deaths are on track to meet the 2020 interim target and most have seen
increases in deaths of between 5 and 11% since 2015. Only two high burden
countries – Democratic Republic of Congo and Russia – are on track to meet the
2020 targets.