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

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<middle dot>08 million (95% uncertainty interval [UI] 1<middle dot>66 to 2<middle dot>54) incident cases of acute hepatitis B and 0<middle dot>49 million (0<middle dot>42 to 0<middle dot>57) of hepatitis C in Europe. There were an estimated 8<middle dot>24 million (7<middle dot>56 to 8<middle dot>88) prevalent cases of HBV-related cirrhosis and 11<middle dot>87 million (9<middle dot>77 to 14<middle dot>41) of HCV-related cirrhosis, with 24<middle dot>92 thousand (19<middle dot>86 to 31<middle dot>03) deaths due to HBV-related cirrhosis and 36<middle dot>89 thousand (29<middle dot>94 to 45<middle dot>56) deaths due to HCV-related cirrhosis. Deaths were estimated at 9<middle dot>00 thousand (6<middle dot>88 to 11<middle dot>62) due to HBV-related liver cancer and 23<middle dot>07 thousand (18<middle dot>95 to 27<middle dot>31) due to HCV-related liver cancer. Between 2010 and 2019, the age-standardised incidence rate of acute hepatitis B decreased (-22<middle dot>14% [95% UI -35<middle dot>44 to -5<middle dot>98]) as did its age-standardised mortality rate (-33<middle dot>27% [-43<middle dot>03 to -25<middle dot>49]); the age-standardised prevalence rate (-20<middle dot>60% [-22<middle dot>09 to -19<middle dot>10]) and mortality rate (-33<middle dot>19% [-37<middle dot>82 to -28<middle dot>13]) of HBV-related cirrhosis also decreased in this time period. The age-standardised incidence rate of acute hepatitis C decreased by 3<middle dot>24% (1<middle dot>17 to 5<middle dot>02) and its age-standardised mortality rate decreased by 35<middle dot>73% (23<middle dot>48 to 47<middle dot>75) between 2010 and 2019; the age-standardised prevalence rate (-6<middle dot>37% [-8<middle dot>11 to -4<middle dot>32]), incidence rate (-5<middle dot>87% [-11<middle dot>24 to -1<middle dot>01]), and mortality rate (-11<middle dot>11% [-16<middle dot>54 to -5<middle dot>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<middle dot>41% [2<middle dot>81 to 30<middle dot>91] increase in prevalent cases). Substantial reductions in DALYs since 2010 were estimated for acute hepatitis B (-27<middle dot>82% [-36<middle dot>92 to -20<middle dot>24]), acute hepatitis C (-27<middle dot>07% [-15<middle dot>97 to -39<middle dot>34]), and HBV-related cirrhosis (-30<middle dot>70% [-35<middle dot>75 to -25<middle dot>03]). A moderate reduction in DALYs was estimated for HCV-related cirrhosis (-6<middle dot>19% [-0<middle dot>19 to -12<middle dot>57]). Only HCV-related liver cancer showed a significant increase in DALYs (10<middle dot>37% [4<middle dot>81-16<middle dot>63]). Changes in age-standardised DALY rates closely resembled those observed for overall DALY counts, except for HCV-liver related cancer (-2<middle dot>84% [-7<middle dot>75 to 2<middle dot>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.