Global, Regional and National Burden of Chronic Hepatitis C, 1990-2021: A Systematic Analysis for the GBD Study 2021

Chronic hepatitis C (CHC) remains a major global health burden, disproportionately affecting low-resource regions. Despite direct-acting antiviral (DAA) advancements, persistent liver complications and socioeconomic disparities hinder progress. This study aims to analyse CHC burden trends (1990-2021) across sociodemographic index (SDI), age, gender and geography using Global Burden of Disease (GBD) 2021 data. Data on incidence, death, prevalence and disability-adjusted life years (DALYs) were extracted from the Global Health Data Exchange (GHDx) platform, and countries were stratified by SDI. To analyse the trend in the disease burden of CHC, we utilised R software to compute the estimated annual percentage change (EAPC). Based on our investigation, we discovered that global incident cases rose 20.4% (3.7-4.5 M), yet age-standardised incidence rate (ASIR) declined annually by 0.55%. Globally, there has been a decreasing trend in the age-standardised mortality rate, prevalence and DALYs associated with CHC. Furthermore, women have shown a more significant decrease in incidence and mortality compared to men. New cases in those over 70 increased significantly, driven by population growth, particularly in low-SDI countries. These findings indicate that CHC burden remains concentrated in low-SDI regions and ageing populations. Persistent gender and socioeconomic inequities demand equitable DAA access, ageing-focused care and gender-sensitive interventions to achieve elimination targets.