Trends of global burden related to HBV and HCV from 1990 to 2019: An age-period-cohort analysis

The spread of disease related to Hepatitis B and C poses a significant public health problem. There have been a few studies that examine the effects of cohort and period on the trend of mortality caused by Hepatitis B and C. This analysis aims to use an age-period-cohort (APC) framework to explore trends in mortality attributed to Hepatitis B and C worldwide and in different socio-demographic index (SDI) regions between 1990 and 2019. The data for this analysis were taken from the Global Burden of Disease study, which was used to perform an APC analysis. The age effects reflect differences in exposure to risk factors at different stages of life. The period effects reflect population-wide exposures at a circumscribed year. The cohort effects indicate different risks across birth cohorts. The results of the analysis include both the net drift and local drift, which are reported as the annual percentage change and that by age group. The age-standardized mortality rate for Hepatitis B declined from 12.36 to 6.74 per 100 000, and for Hepatitis C from 8.45 to 6.67 per 100 000 between 1990 and 2019. The net drifts in mortality were -2.41% (95% confidence interval (CI) -2.47 to -2.34) for Hepatitis B and -1.16% (95% CI, -1.23 to -1.09) for Hepatitis C, with negative local drifts in most age groups. Mortality from Hepatitis B increased with age until 50+ years, while mortality from Hepatitis C rose steadily with age. The period effect for Hepatitis B was profound, suggesting effective national efforts in controlling the disease and the need for similar programs for Hepatitis B and C. Mortality varied across the world and had moderate to weak negative correlations with the SDI, which substantially decreases in the high-middle and middle SDI regions, but has persistently high rates in the low SDI region. Global efforts to manage Hepatitis B and C have shown positive trends, but variations in trends were observed across regions with divergent age, cohort, and period effects. The national efforts of a comprehensive strategy are crucial to further strengthen the elimination of Hepatitis B and C.